Ketoconazole shampoo in conjunction with systemic antiandrogens treatment has been used off label to treat androgenic alopecia. Its anti-fungal properties reduce scalp microflora & consequently may reduce follicular inflammation that contributes to alopecia. Furthermore ketoconazole blocks the local synthesis of dihydrotestosterone in the scalp as well as acts as an antagonist of the androgen receptor. Hence it has been hypothesized that ketoconazole when used together with systemic antiandrogens may result in a more complete blockade of androgen receptor in the scalp & consequently may lead to a more effective treatment of androgenic alopecia. Clinical studies suggest that ketoconazole shampoo used either alone or in combination with other treatments may be useful in reducing hair loss Nizoral shampoo may be beneficial in men suffering from androgenic alopecia as there is evidence to suggest that using Nizoral shampoo increases hair thickness & decreases hair shedding, as well as increasing hair follicles in anagen-phase (growth phase).