Get essential information about ketoconazole for hair loss.

The Science

What Is Ketoconazole?

Ketoconazole cream is used to treat anti-fungal skin conditions such as ringworm and dandruff. In addition, it also has anti-androgenic properties which may help to reduce hair loss.

Nizoral shampoo contains 2% ketoconazole. It is readily available and is the most popular product for men who want to try using ketoconazole.

Because it is a topical medication, side effects are usually much less than with oral drugs such as finasteride.

How Does Ketoconazole Work?

The primary ways ketoconazole can help male pattern baldness is thought to be by reducing inflammation and androgen levels in the scalp.

When taken orally, ketoconazole tablets quickly lower testosterone and DHT hormones in the body. By using a topical cream instead, the aim is to achieve the same effect but in the localised scalp area only.

It’s anti-fungal abilities may also be useful in reducing scalp microflora, leading to less inflammation and fibrosis in hair follicles.

Ketoconazole Results

Alongside finasteride and minoxidil, ketoconazole is one of the most studied male hair loss treatments. The results are generally promising:

  • A study from 1998 compared the performance of 2% ketoconazole shampoo vs 2% minoxidil. Hair density in male patients was improved similarly by both products.(1)
  • A review of 5 human studies researching ketoconazole for hair loss found that hair shaft thickness increased following ketoconazole use.(2)
  • 2% topical solutions of minoxidil and ketoconazole were again compared, this time for females suffering hair loss. Hair stabilisation and growth were comparable for each medication. Positive results were only noted after 6 months of once daily ketoconazole use.(3)

For people looking for an alternative to minoxidil, ketoconazole may be a good option to try.

Weight Of Science

Sporadic research has been conducted over the past two decades. As ketoconazole is also used for skin conditions and prostate problems, its side effects are well known.

Side Effects

Oral ketoconazole has been shown to cause liver damage. However, the reported side effects with the use of topical ketoconazole are minor.

It seems to be a hair loss treatment with one of the most favourable side effect profiles.

It’s important to note that ketoconazole is not approved for hair loss, so most studies have focused on its brief use for skin conditions. It’s possible that using the cream/shampoo for years to treat hair loss MAY increase the chances of side effects.

Here are the most common issues with topical ketoconazole:

Skin Burning

Redness and skin burning can occur when applying ketoconazole cream on a regular basis.


Excessive use may cause scalp itching. If this happens, it’s advised to discontinue use for a few days until the irritation subsides.

What Does It Cost?

You can buy nizoral shampoo or ketoconazole cream from a number of retailers without a prescription.

Online and offline chemists and supermarkets are likely to sell these products.

Amazon also has a number of options.

A bottle of nizoral shampoo or ketoconazole cream only costs around £8 per tube/bottle making it a very cost effective treatment. One bottle of shampoo should last around two months with daily applications.

Are There Alternatives To Ketoconazole?

Minoxidil is the most popular topical hair loss treatment. It has more studies showing a positive impact, but also has more reported side effects.

Finasteride is probably the most powerful chemical treatment for male hair loss. This comes at a physical cost though, as the potentially serious side effects discourage many people from using it.

Low level laser therapy has a similar number of scientific studies as ketoconazole and is a non-chemical option.

Our full list of science based hair loss treatments can be found here.