You do not have to use Nizoral. Some people use it becausse it's part of the Big3 or they have dandruff or they believe it helpes with their hair loss situation. I would try Propecia and/or Minoxidil first. I've heard that Minoxidil can cause flakes on your scalp and Nizoral shampoo might make them go away or something...
Read this from this Hairlosstalk website.
http://www.hairlosstalk.com/hair-loss-news/News-sid-249-file-article-pageid-2.php
Some people wonder why the Propecia trial did not use Nizoral as the shampoo of
choice. The main problem with this was that Nizoral shampoo was not readily available
when the trial started. If the Propecia trial was taking place today when Nizoral
is readily available it probably still would not be used. Although Nizoral is
officially used for treating dermatitis and combating mild scalp fungal infections,
the active ingredient (ketoconazole) has known anti
androgen properties and this may have some positive effect on hair growth.
The objective of arranging a trial to test Propecia was to examine the effects
of the drug, not the effects of Nizoral.
In one small clinical study it was even suggested that the
actions of Nizoral on hair growth were equivalent to the effects of 2% minoxidil
(4).
Nizoral and Tgel are not made by Merck, the makers of Propecia, so they are
not likely to promote the merits of combining Nizoral or Tgel with using Propecia
even though there may be advantanges to the consumer in doing so. However,
many dermatologists will recommend to their patients the use of Propecia, Nizoral
and Tgel. You can use all three in a combined regimen. Nizoral should
not be used more than twice a week. Other days you can use Tgel and normal shampoo
in rotation. The only problem with Nizoral and Tgel is that they can be quite
drying to the hair. You can remedy this with a separate conditioner.
