Ketoconazole likely works by offsetting reductions in the anagen phase and exacerbations of the telogen phase of hair growth, not by stimulating IGF-1 or activating growth directly.

“The reason we say this is that there's no reason to think that ketoconazole can actually stimulate IGF-1 or activate growth itself. It's probably offsetting some of the reductions in the antigen phase and some of the exacerbation of the telogen phase.”