Claims, Benefits: Restores hair in nearly all balding men and women.

Bottom Line: If it works at all, it’s because it contains minoxidil and possibly saw palmetto. But you’re paying a lot for that, and you don’t know what you’re getting.

Full Article, Wellness Letter, March 2003:

Hope (If Not Hair) Springs Eternal

It’s hard to avoid the ads on radio and TV for Avacor, the "revolutionary" hair restorer. The "all-natural system" (pills, lotion, and shampoo) costs $500 to $1,000 a year—a price many balding men and women are willing to pay, judging by the ever-increasing number of ads. And with a claimed success rate of more than 90% and a "money-back guarantee," it’s worth a try, right? Wrong. This is just the latest in a long line of baldness "remedies." The difference is, this one mixes a little science with a lot of useless ingredients to pull the wool over your eyes.

A hairy tale

Avacor is sold to treat androgenic alopecia, the very common inherited form of balding that affects both men and women. The ads talk about dihydrotestosterone (DHT), a hormone formed from testosterone, as the substance believed to be largely responsible for balding by causing hair follicles to shrink. (One approved drug for hair loss, finasteride—brand name Propecia—is known to act on DHT, see below.) The Avacor pills are supposed to block the effects of DHT on hair follicles. It’s hard to figure out exactly what’s in Avacor, since the label uses obscure names to hide common herbs, but the pills contain a hodgepodge that includes ginkgo, horsetail, bilberry, and saw palmetto. Of these, only saw palmetto might help against baldness, since it appears to have some of the same effects in the body as finasteride and may affect the production of DHT. However, even if saw palmetto did help, you have no idea how much is in Avacor.

The lotion for the scalp also contains a long list of questionable or indecipherable ingredients. The only one that counts is minoxidil, though it’s hidden behind its chemical name. Yes, that’s the FDA-approved hair-loss drug (brand name Rogaine, see below), now sold over the counter at about $10 to $20 for a month’s supply. Minoxidil may help some people grow a little hair, but its success rate is far less than the 90% claimed for Avacor. And minoxidil is hardly "natural."

You call that a study?

The makers of Avacor cite just one study—one they funded and performed—which supposedly showed Avacor’s wildly successful results. But this study is meaningless, since it was so poorly designed, lacks details, and is unpublished. And there are no other studies on Avacor. Other than that, the ads and website rely on testimonials. (All positive, of course, though there are negative testimonials about Avacor on the Internet, including some stating—no surprise here—that the users could not get their money back.) There are good studies on minoxidil, but who knows if there’s enough of it in Avacor to do any good?

Bottom line: If you want to try minoxidil and/or saw palmetto, you can buy them for a small fraction of what Avacor costs. Avacor’s other ingredients are all questionable, and some of the herbs may have adverse effects or drug interactions. The Better Business Bureau has alerted the Federal Trade Commission about the unsubstantiated claims made in Avacor’s ads. By the time the FTC, and possibly the FDA, cracks down on Avacor, consumers will have lost millions of dollars. The product will then disappear, probably showing up a year later with a different name. There are already copycat products on the market, also containing unknown quantities of minoxidil and herbs.

A growth industry

Two drugs have been approved by the FDA for hair growth:

Minoxidil (brand name Rogaine, now OTC) dilates blood vessels and was originally developed as an oral medication to treat high blood pressure. This lotion promotes hair growth in about 25% of men and women, though it may take several months to work. New hair is usually thinner and lighter, like baby hair, and grows mostly on the top of the head, not at the hairline. Its effects may fade with time. Skin irritation is the most commonly reported side effect. Dizziness and increased heart rate have also been reported, but rarely.

Finasteride (brand name Propecia) is the same oral prescription drug used in higher doses (and called Proscar) to treat an enlarged prostate. It inhibits the conversion of testosterone to DHT. Propecia is not effective in men who are completely bald, but it does promote hair growth and slow hair loss in men who are just beginning to lose hair. In one study 60% of men had new hair growth and more than 80% slowed their hair loss after 6 to 12 months of treatment.

Propecia does have some drawbacks. It costs about $50 a month and takes at least six months to work. If you stop taking it, new hair will fall out. It may lower PSA levels, making it harder to detect prostate cancer. So if you are using Propecia and are having a PSA test, be sure to tell your physician. (Saw palmetto may have the same effect.) Women should not take it: it causes severe birth defects in male fetuses, so pregnant or potentially pregnant women should not even touch the tablets. And when tested in postmenopausal women, it did not make hair grow.

We don’t recommend Propecia because its long-term safety is unknown. This is disquieting, since young men are the prime candidates, and the drug has to be taken for a lifetime. If you do decide to take it, you should know that although the standard dose is one milligram, there is some evidence that one-fifth that amount also works. If you cut the pill into quarters, you will save money.

UC Berkeley Wellness Letter, March 2003