L-tyrosine for Alopecia Areata: Still No Good Evidence Despite Frequent Use

L-tyrosine for Treating Alopecia Areata: Does it help?

L-tyrosine is often discussed as a treatment for alopecia areata. In fact, it’s often discussed as a treatment that non-physicians use. For some reason, there is a feeling amongst many that there is one set of treatments that non-physicians recommend for alopecia areata and a different set of treatments that physicians recommend.

This is non-sense. There is only one group of treatments for alopecia areata - and those are treatments that work!

I envision two big buckets of treatments. Bucket one is treatments that work. Bucket two is treatments that don’t work. Inside bucket one are shelves - on the top shelf are treatments that work really well. On the middle shelf are treatments that work moderately. On the bottom shelf are treatments that occasionally help some people and have evidence but they just don’t work all that well

If something works for my patients with alopecia areata….. I’m all in. Whether it’s Allopathic, Naturopathic, Ayurvedic…. Acupuncture, Homeopathic or TCM. It if works, I’m all for it!

These names (allopathic, naturopathic, etc) are all just names to confuse and separate. And they do a wonderful job achieving these goals.

But there is one human body and one bucket of treatments that work.

Treatments are treatments.

If something works for my patients with alopecia areata….. I’m all in. I’ve used and recommended countless alternative treatments through the years. If it works … it works.

Is L-tyrosine on my list of treatments with good evidence for helping? No, not yet.

To date, there has never been a good study conducted with l-tyrosine that shows it consistently helps alopecia areata.

I recently reviewed over 2000 published studies in the medical journals conducted with l-tyrosine - and I can’t find even one that addresses it’s use in alopecia areata. None of the 15 leading textbooks in the world in the last 15 years have any reference to L-tyrosine for alopecia areata. None of the leading reviews and papers on alopecia areata have L-tyrosine as a treatment. None of the leading alopecia areata clinicians and researchers across the world in alopecia areata support the use of L-tyrosine as a mainstay treatment.

So why is L-tyrosine still discussed?

Well that’s not something we’ll be able to get to the bottom of in this short article.

Are there going to be people in the world with alopecia areata that report that their hair benefits from l-tyrosine? Of course. Especially in alopecia areata where the rate of “spontaneous” regrowth is so high. In addition, a large proportion of patients who take L-tyrosine also take other supplements and treatments and separating the effect of L-tyrosine becomes challenging sometimes - if not impossible.

Are there going to be practitioners who feel “what is this guy talking about - I use this treatment all the time!” Of course.

But there is still not evidence.

Spontaneous Regrowth and Placebo Response is High in Alopecia Areata

30 % to as high as 60 % of people who use placebos in alopecia areata will get tremendous regrowth. It just depends on what type of patient is recruited into the study.

Alopecia Areata is an autoimmune disease that affects about 2% of the world. About 1/3 of patients with limited alopecia will regrow hair in 6 months with NO TREATMENT and about 1/3 will regrow by the end of 1 year WITH NO TREATMENT.

Here’s what 100 patient with alopecia will find happens to their hair if they DO NOTHING AT ALL:

So do we need good studies in alopecia areata?

Well, there is no type of hair loss more important that having good studies that in alopecia areata. If you are really going to prove a treatment works, and is just not placebo, you need good studies,. The placebo rate and spontaneous regrowth rate is very high.

I can show you any treatment in the world works for alopecia areata …. if you allow me to select the right patient myself. That’s a fact. Usually of course that’s a patietn with limited disease and certain trichoscopic features on examination. But in certain situations, I know with near certainly that the hair is coming back on its own.

Don’t kid yourself. The world of practicing hair specialists take a lot of credit sometimes when treating alopecia areata. The credit themselves that it’s the magic of their treatments that are doing the job to get the hair to grow. Sometimes it is - but many times it’s not. Sometimes it’s what the hair was going to do whether that hair specialist was there or not. This is mainly the case in more limited forms of the disease. Granted in more extensive alopecia areata, spontaneous and complete growth is much less likely to occur. But that’s not what I am talking about here. I’m talking about the 85 % of the world with limited disease who search for help with various treatments.

So, how can one prove L-tyrosine really helps?

That’s the easiest answer to this entire article ….a really good study! There has never ever been one when it comes to L-tyrosine.

If someone truly thinks L-tyrosine works for patients with alopecia areata, come forth and conduct the proper study …. and let’s move on. A good study involves a randomized placebo controlled trial with one half of the group receiving L-tyrosine and one half receiving placebo pills. Provided the study is large enough (with enough patients) and statistically powered to show a difference…. we can answer the question.

For L-tyrosine this is not a case report of a 35 year old patient who got her hair back with L--tyrosine. This kind of study is useless. It’s a study that is powered to show the difference. Typically that would be a study of at least 60 patients of which 30 are randomized to receive L-tyrosine and 30 are randomized to receive placebo pills. The patients will need to have similar SALT score and have be matched in other relevant ways. With good study, we can gain a lot of information.

I’m all for inexpensive easy to treatments. (Yes, there are those who think that many physicians are just out to support expensive treatments and fuel drug companies but that too is a bit of nonsense). I support use of inexpensive treatments in my practice all the time. These include anthralin, minoxidil, antihistamines and even onion juice. Not every patient with alpecia areata needs to spend $ 15,000 yearly to get treatment with a JAK inhibitor. But I’m also 100 % against useless treatments that waste time and money, rob emotions and dilute the thinking that goes into good clear thinking.

We do not practice hair loss with the idea that “Joe in California likes this treatment” and “Betty in Paraguay likes this treatment.”

That’s what we did in the 5000 years before now.

Now we practice with evidence based medicine. We rigorously study things. We rigorously prove that certain treatments work. We rigorously work to prove that certain treatments don’t work. Evidence based medicine is available to the world! Every single person. The principles of science are available to all. Every single person.

There is no eastern and western. There is no northern and southern. There is a meticulous methodology to proving and disproving things in the land of hair loss.

To date, no such good study of L-tyrosine in alopecia areata exists.

Someday it might…