Hair loss treatments

Proven hair loss treatments — what works

For androgenetic alopecia (male and female pattern baldness), two medicines have the strongest evidence: minoxidil (topical) and finasteride (oral, men only). Neither cures baldness permanently — they slow progression and partially reverse miniaturisation while used.

See our full hair loss guide for other causes — alopecia areata, telogen effluvium, and thyroid disease need different approaches.

Minoxidil (Regaine)

Mechanism: Vasodilator — extends hair follicle growth phase. Exact mechanism incompletely understood.

Formulations:

• 2% solution — men and women
• 5% solution or foam — men; 5% also used for women under guidance

How to use:

• Apply 1ml to dry scalp once or twice daily — typically crown and thinning areas
• Wash hands after application
• Allow to dry before bed or styling — alcohol-based solutions flammable until dry
• 4 to 6 months minimum before assessing results

Expected results:

• Stops or slows further loss in many users
• Visible regrowth in roughly 40 to 60% — finer vellus hairs thicken over time
• Does not restore fully bald areas with no follicles remaining

Side effects:

• scalp irritation, itching, dryness
• initial shedding — temporary, distressing but often precedes improvement
• unwanted facial hair if drips on face — women especially
• tachycardia, dizziness — rare with excessive application

Contraindications: pregnancy, breastfeeding, scalp inflammation or open wounds.

Cost: OTC from pharmacies — ongoing expense if continued long term.

Finasteride (Propecia) — men only

Mechanism: 5-alpha reductase type II inhibitor — reduces DHT (dihydrotestosterone) by ~60%, the hormone shrinking susceptible follicles.

Dose: 1mg once daily — takes 3 to 6 months for visible effect, peak at 12 to 24 months.

Evidence (men with MPHL):

• ~90% stop further loss or improve on scalp hair counts
• ~65% show visible regrowth over 2 years in trials
• Hairline recession may stabilise; crown responds best

Side effects:

• reduced libido, erectile dysfunction, ejaculation disorders — reported in 1 to 5% in trials; many real-world reports higher — usually reversible on stopping
• depression — rare reports; discuss with GP if mood changes
• gynaecomastia — uncommon

Women: Contraindicated — teratogenic to male foetus — women who are or may become pregnant must not handle crushed tablets.

PSA testing: Lowers PSA by ~50% — tell GP before prostate screening.

Availability: Private prescription common; NHS GP may prescribe off-label.

Proscar 5mg: Prostate dose — do not split tablets for hair loss without pharmacist/GP instruction — inconsistent dosing risk.

Dutasteride

Blocks type 1 and 2 5-alpha reductase — stronger DHT suppression. Used off-label for hair loss — not routine NHS. Side effect profile similar to finasteride — includes potential persistent sexual side effects reported anecdotally (post-finasteride syndrome — debated in literature).

Combining treatments

Minoxidil + finasteride — complementary mechanisms — often better than either alone in men. Minoxidil stimulates growth; finasteride protects from further DHT damage.

Treatments with weaker or situational evidence

Treatment	Evidence summary
Low-level laser therapy	Some small trials show modest benefit — not NHS standard
PRP (platelet-rich plasma)	Mixed results — private, expensive
Microneedling	Adjunct to minoxidil in some studies
Ketoconazole shampoo	Anti-androgenic at scalp — weak vs finasteride
Spironolactone	Used off-label for female pattern loss with hyperandrogenism — specialist
Hair transplant	Moves permanent-zone follicles — does not stop ongoing loss elsewhere without medical therapy

Realistic expectations

• Younger men with recent thinning — best response
• Long-standing complete baldness — follicles may be gone — medicines cannot recreate
• Women — minoxidil main option; finasteride not used
• Maintenance forever — budget and commitment matter
• 12-month trial before judging failure

When these treatments are wrong

Do not self-treat with minoxidil/finasteride if:

• patchy bald spots (alopecia areata)
• scarring scalp changes
• rapid diffuse shedding after illness (telogen effluvium — wait)
• children — paediatric referral

Pattern baldness treatment is marathon not sprint — consistency beats switching products every month.

Common questions

How long does minoxidil take to work?

Minimum 4 to 6 months before visible regrowth — peak results at 12 months. Initial shedding in the first 2 to 8 weeks is normal as old hairs make way for new growth. Stop if no benefit after 12 months. Must continue indefinitely to maintain results.

Is finasteride available on the NHS for hair loss?

Finasteride 1mg is licensed for male pattern baldness but NHS prescribing varies — many men obtain private prescriptions. The 5mg prostate dose (Proscar) must not be split without medical guidance. Not prescribed for women.

Can women use minoxidil?

Yes — 2% or 5% minoxidil is licensed for female pattern hair loss. Apply to scalp once or twice daily. Stop if pregnant or breastfeeding. Unwanted facial hair can occur if product runs onto face — apply carefully.

Do hair loss shampoos work?

Ketoconazole shampoo (Nizoral) has weak anti-DHT evidence — may help scalp health but is not equivalent to finasteride or minoxidil. Caffeine and biotin shampoos lack strong evidence for regrowth. They do not harm but should not replace proven treatments.

What happens if I stop finasteride or minoxidil?

Hair loss resumes over months — you lose gains made during treatment. Finasteride's DHT suppression reverses within days. Minoxidil-dependent hairs shed when application stops. Plan for long-term use if treatment succeeds.

Can finasteride and minoxidil be used together?

Yes — many men use both for male pattern baldness. Finasteride blocks DHT systemically; minoxidil acts locally on the scalp. Evidence suggests combination is more effective than either alone. Women should use minoxidil only — not finasteride.

Are hair loss treatments available on the NHS?

Minoxidil is often bought over the counter. Finasteride 1mg may be prescribed on NHS in some areas but is commonly private. Wigs are available on NHS prescription for alopecia areata and some medical hair loss. Hair transplant is not funded for cosmetic pattern baldness.

Sources

• NHS — Hair loss treatment
• BAD — Male pattern hair loss patient leaflet