Hair loss treatments that actually work

For male pattern hair loss, androgenetic alopecia, the evidence base narrows quickly. The American Academy of Dermatology’s 2024 guideline names oral finasteride and topical minoxidil as first-line pharmacological therapy, and recognises low-dose oral minoxidil as a reasonable option for suitable candidates.

Almost everything else sold for this condition sits outside that evidence.

Finasteride

An oral tablet that reduces conversion of testosterone to DHT, the hormone driving follicle miniaturisation.

A systematic review of twelve studies found moderate-quality evidence that daily oral finasteride increases hair count and improves both patient and investigator assessment of appearance. Use for up to five years reduces the likelihood of further visible loss.

The important framing: its primary achievement is stopping the decline. Regrowth happens for many men, but preservation is the reliable outcome and it is the one worth deciding on.

Side effects are the reason it is discussed as much as it is. A minority of users report sexual side effects including reduced libido and erectile difficulty. These generally resolve on stopping. Reports of persistent symptoms after discontinuation exist, are contested in the literature, and are not well quantified, which is an honest answer rather than a reassuring one. Discuss it properly with a prescriber rather than with a forum.

Minoxidil

Applied topically as a solution or foam, or taken as a low-dose oral tablet. The mechanism is not fully established; it appears to extend the growth phase and improve follicular blood supply.

Topical minoxidil is available without prescription in most countries and works independently of hormones, which makes it usable by men who do not want finasteride.

Low-dose oral minoxidil has moved from off-label curiosity to guideline-acknowledged option, and is now widely prescribed. It requires medical supervision: it is a blood pressure medicine at higher doses, and side effects include unwanted hair growth elsewhere on the body and, less often, fluid retention.

Using both

The evidence favours combination. A meta-analysis of seven randomised controlled trials found topical minoxidil-finasteride combination superior to either alone, with meaningful improvements in hair density, hair diameter and global photographic assessment.

A twelve-month service evaluation of combined oral minoxidil and finasteride reported 92.4% of patients stable or improved, and 57.4% showing overt regrowth.

That second figure is the useful way to read all of this: most men hold their ground, and rather more than half see visible regrowth.

What to expect, and when

Nothing for three months. Both treatments have a lag. Assessing at six weeks tells you nothing.

Early shedding is normal with minoxidil, as follicles synchronise into a new cycle.

Six to twelve months before a fair assessment.

It is indefinite. Stop either treatment and the benefit reverses over the following months. This is maintenance, not a course.

Earlier is better. Both drugs preserve follicles far more effectively than they revive dormant ones. The single strongest predictor of a good outcome is starting while there is still something to keep.

Everything else

Hair transplant surgery relocates follicles from areas not affected by DHT. It is genuinely effective for the right candidate, and it is generally recommended alongside medical treatment rather than instead of it, otherwise the untransplanted hair keeps thinning around the graft.

Ketoconazole shampoo, microneedling and low-level laser therapy have some supporting evidence, weaker than the first-line options. Reasonable as additions; poor as substitutes.

Supplements, “DHT-blocking” shampoos and rosemary oil do not have evidence comparable to the guideline treatments. Where a specific deficiency exists, correcting it is worthwhile; taking biotin without a deficiency is not.