Been seeing ketoconazole shampoo recommended everywhere in hair loss circles as a cheap addition to fin + min. Looking into whether it's actually worth adding to the protocol.
The theory: ketoconazole (KCZ) is an antifungal that also has anti-androgenic properties. Studies have shown that 2% KCZ shampoo used 2-3x per week can reduce scalp DHT and sebum, which in theory protects follicles. There's also a small but decent RCT showing it was comparable to 2% minoxidil in one study (though that study is old and has methodological limitations).
Nizoral is the branded version, 1% OTC. In some countries 2% is available by prescription. Generic KCZ shampoos are available at much lower prices.
My take after 3 months using it: scalp feels cleaner, less sebum buildup between washes, no noticeable side effects. Whether it's actually contributing to hair retention beyond my fin + min, I genuinely cannot tell — there's no way to isolate the variable. But it's low risk, reasonably cheap, and the evidence base, while not overwhelming, is better than most "hair growth" supplements.
The main downside: it can dry out your hair if used too often. 2-3 times per week maximum, leave it on for 2-5 minutes, then condition the lengths.
I've used it consistently for 2 years alongside fin + min. I think of it as a low-cost insurance add-on. The anti-inflammatory properties are probably the more meaningful mechanism in practice — scalp inflammation from seborrheic dermatitis or just general buildup does stress follicles. Reducing that is worth something.
Buy the generic on Amazon rather than branded Nizoral. Same active ingredient, fraction of the price. I pay about £4 for a 200ml bottle that lasts months at 2-3x weekly use.
Do you need to wash your hair every time you use it or can you just apply it to the scalp without washing the lengths?
You can apply it just to the scalp and avoid the lengths if your hair is long and you're worried about drying it out. The antifungal and anti-androgenic effects are at the scalp level. I usually put it on after wetting my hair, focus on massaging it into the scalp, leave it for a few minutes, then rinse. Then condition mid-lengths to ends if needed.