Hair Loss

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Male pattern hair loss is one of the few areas in men’s health where two treatments genuinely work, are widely available, and are still surrounded by enough noise that most men end up buying neither.

Finasteride and minoxidil both work. Both work modestly. And both have to be taken indefinitely, stop, and you lose what you gained, usually within months. That last point is the one that gets soft-pedalled in the marketing, and it is the one that should shape the decision, because you are not choosing a course of treatment. You are choosing a habit.

The other thing worth understanding early is that these drugs are much better at holding ground than taking it back. Hair follicles that have miniaturised over years can sometimes be coaxed back; follicles that are gone are gone. This makes the timing of the decision matter more than almost anything else about it. The best outcome belongs to the man who starts while he still has something to protect.

What the evidence supports

Finasteride works by blocking the conversion of testosterone to DHT, the androgen that drives follicle miniaturisation in genetically susceptible men. It has the larger effect of the two and the more complicated side-effect conversation.

Minoxidil works by a mechanism that is still not fully explained, which is unusual for a drug this well established. It is available without a prescription topically and increasingly used orally at low dose off-label.

The two are frequently combined, and the combination generally outperforms either alone.

Expect maintenance and modest regrowth, not restoration. Trial photographs are taken under standardised lighting at fixed angles for a reason. The realistic outcome for most men is that the loss stops and some density returns.

Almost everything else sold for hair loss has thin evidence. Shampoos, supplements, laser combs and derma-rollers occupy a spectrum from “plausible but under-studied” to “no mechanism and no data.” The two drugs above are where the evidence is concentrated.

Which article you need

If you have been offered the tablet instead of the foam, the oral minoxidil evidence covers the single randomised trial that compares the two directly. They came out roughly level over 24 weeks. The trade is unwanted hair elsewhere, which affected 49% of the men on the tablet against 25% on the solution, and there is a short contraindication list worth reading before you start.

This section is currently built around one thorough piece: what the trials actually show for finasteride and minoxidil. It covers the effect sizes, the side-effect data including what is and is not established about persistence after stopping, the timeline to expect, and what happens when treatment ends.

Finasteride side effects is the honest version of the most contested question in this category. Trials report sexual side effects in 8.7% against 5.1% on placebo, but when men were told to expect them, 43.6% reported them against 14.3% who were not told. Both facts are real and neither settles it.

The shedding phase explains the single most common way men waste this treatment: starting, shedding heavily around month two or three, concluding the drug is making it worse, and quitting right before it works.

And hair transplants covers the constraint nobody raises at consultation, your donor supply is finite, and the loss carries on in everything that was not transplanted.

And if you have hit the ceiling of what finasteride does, how dutasteride compares covers the one large head-to-head trial, the size of the difference, why the drug is approved for hair loss in South Korea and Japan but not the United States, and the PSA interaction that every man on either drug needs to tell his doctor about.

And if you are being offered something beyond the two approved drugs, what the evidence supports sorts PRP, microneedling, laser caps, topical finasteride, rosemary oil and biotin by the quality of the trials behind each. It also explains why a laser cap marked FDA cleared may never have been tested in a single patient.

What else is worth reading

Hair loss is one of the places where men’s health and mental health overlap more than is usually acknowledged. The distress is frequently disproportionate to the visible change, and it is worth taking seriously rather than dismissing. How depression actually presents in men is relevant if the preoccupation has started affecting other things.

If you are considering finasteride and worried about sexual side effects, the honest framing is that they occur in a minority, are usually reversible, and are also reported by men taking placebo at rates high enough to complicate the picture. Telling a physical erection problem from a psychological one is useful background if something changes after starting.

Sudden diffuse shedding, as opposed to the gradual recession at the temples and crown, is a different phenomenon with different causes, including illness, rapid weight loss and thyroid disease. If you have recently lost a lot of weight, the weight and metabolic section is worth a look. And the general screening list covers the bloodwork that is actually worth having.

If your hair loss started abruptly, is patchy rather than patterned, or comes with scalp pain, itching or scarring, that is not male pattern baldness and it warrants a dermatologist rather than a subscription service.

Related topics

Finasteride works by lowering DHT, which is made from testosterone; the hormone itself is covered in testosterone and male vitality. The broader baseline checks are in general men’s health.