One of the most pesky chronic health issues I see in my patients is hair thinning. The first step in the evaluation of this is to try to determine the cause. This includes starter testing for hypothyroid, iron deficiency anemia, iron deficiency, looking at the scalp to see if there is a skin condition like seborrheic dermatitis, assessing stress and diet (low protein or malnutrition in general) but other considerations will be hormonal changes (androgenic alopecia or female pattern hair loss), heredity, autoimmune disease (ex/alopecia areata), and inflammatory conditions of the scalp including lichen planopilaris.
Depending on which condition she has, the treatments are different. The current study addressed female pattern hair loss (FPHL), which is a general thinning of the hair over the central part of the scalp and is often associated with menopause.
Pycnogenol is a proprietary product of French maritime pine bark extract that contains about 70% 
procyanidins and phenolic compounds (catechin and epicatechin). It is often used as an antioxidant and anti-inflammatory but in this study, they investigated its effects on total hair density and scalp microcirculation in postmenopausal Chinese women. These women were aged 45-60 y.o. and were at least one year postmenopausal. Thirty women took a placebo and 33 took Pycnogenol at 50 mg three times daily for 6 months. Patients were assessed at baseline and after 2 and 6 months of treatment. Photographs, trans-epidermal water loss and hair density were evaluated.
Results:
Hair density increased in both the Pycnogenol and the placebo group at both the 2 month and 6 months follow up but if we break it down, the increases were statistically non-significant in the placebo group but significant increases of 30% at 2 months and 23% at 6 months in the Pycnogenol group.
Microcirculation was assessed using photoplethysmography. There was a slight decrease after two and six months in the placebo group and by 21% after two months and 44% decrease after six months in the Pycnogenol group. The decrease in photoplethysmography relates to improvement in microcirculation, meaning, the Pycnogenol group had significantly improved microcirculation of the scalp, especially at the 6-month mark.
Skin hydration did not change significantly in either group.
Commentary :
I’m definitely going to try this with my patients who have FPHL, given the minimal list of effective natural treatment options. Conventional treatments tend to start with 2% or 5% topical minoxidil and recent studies demonstrate efficacy with an oral minoxidil, which is more appealing to take than the topical although either can be fraught with troublesome or worrisome side effects. Let’s try the Pycnogenol!!
Reference:
Cai C, Zeng B, Lin L, et al. An oral French maritime pine bark extract improves hair density in menopausal women: A randomized, placebo-controlled, double blind intervention study. Health Sci Rep. January 6, 2023;6(1):e1045
