Hair loss treatments

Proven treatments for hair loss

For androgenetic alopecia, better known as male and female pattern baldness, two medicines have the strongest evidence behind them: minoxidil, which is applied to the scalp, and finasteride, an oral tablet used only in men. Neither medicine cures baldness permanently — instead, they slow its progression and partially reverse the miniaturisation of hair follicles for as long as they are used.

See our full hair loss guide for other causes of hair loss, such as alopecia areata, telogen effluvium and thyroid disease, which need different approaches to treatment.

How minoxidil (Regaine) works

Minoxidil is a vasodilator that extends the growth phase of the hair follicle, although its exact mechanism in hair loss is not fully understood. It is available as a 2% solution suitable for both men and women, and as a stronger 5% solution or foam used mainly by men, though 5% is sometimes used by women under guidance.

How to use minoxidil

Minoxidil is usually applied to a dry scalp once or twice daily, typically over the crown and other thinning areas, and hands should be washed thoroughly afterwards. It should be allowed to dry fully before bed or styling, since alcohol-based solutions remain flammable until dry. It takes a minimum of 4 to 6 months of consistent use before results can be fairly assessed.

What results to expect from minoxidil

Minoxidil stops or slows further hair loss in many users, and produces visible regrowth in roughly 40 to 60% of people, as finer vellus hairs gradually thicken over time. It cannot, however, restore hair in areas that are completely bald with no remaining follicles.

Side effects of minoxidil

Minoxidil can cause scalp irritation, itching and dryness, and many people notice an initial phase of increased shedding that is temporary and often distressing, but tends to precede improvement. Unwanted facial hair can develop if the product drips onto the face, which is a particular concern for women, and rare side effects with excessive application include a fast heartbeat and dizziness. It should not be used during pregnancy or breastfeeding, or on scalp inflammation or open wounds. Minoxidil is bought over the counter from pharmacies, and represents an ongoing expense if you continue using it long term.

How finasteride (Propecia) works for men

Finasteride is a type II 5-alpha reductase inhibitor, meaning it reduces levels of dihydrotestosterone (DHT), the hormone responsible for shrinking susceptible hair follicles, by around 60%. It is taken as a standard-strength tablet once daily, and typically takes 3 to 6 months to produce a visible effect, with peak results seen at 12 to 24 months.

Evidence for finasteride in men with pattern hair loss

In trials of men with male pattern hair loss, around 90% stop losing further hair or see improved scalp hair counts, and around 65% show visible regrowth over two years. Hairline recession may stabilise with treatment, while the crown area tends to respond best.

Side effects of finasteride

Reduced libido, erectile dysfunction and ejaculation disorders are reported in around 1 to 5% of men in trials, with higher rates reported in real-world use, though these effects are usually reversible once treatment stops. Depression is a rare but reported side effect, so it is worth discussing any mood changes with a GP, and gynaecomastia (breast tissue enlargement) is an uncommon effect. Finasteride is contraindicated in women, since it is teratogenic to a male foetus, meaning women who are or may become pregnant must not handle crushed tablets. It also lowers PSA levels by around 50%, so it is important to tell your GP you are taking it before any prostate screening test.

Finasteride is commonly obtained through a private prescription, though an NHS GP may prescribe it off-label in some cases. A separate, higher-strength version of the tablet, sold as Proscar for prostate conditions, should never be split for hair loss use without specific instruction from a pharmacist or GP, since this risks inconsistent dosing.

Dutasteride as an alternative

Dutasteride blocks both type 1 and type 2 5-alpha reductase, producing stronger DHT suppression than finasteride. It is used off-label for hair loss and is not routine on the NHS. Its side effect profile is similar to finasteride’s, and it has also been linked anecdotally to potentially persistent sexual side effects sometimes described as post-finasteride syndrome, though this remains debated in the medical literature.

Combining minoxidil and finasteride

Using minoxidil and finasteride together takes advantage of their complementary mechanisms, and is often more effective than using either alone in men. Minoxidil stimulates new growth at the scalp, while finasteride protects existing hair from further DHT-related damage.

Treatments with weaker or situational evidence

Treatment	Evidence summary
Low-level laser therapy	Some small trials show a modest benefit, but it is not a standard NHS treatment.
PRP (platelet-rich plasma)	Results are mixed, and it is only available privately at a significant cost.
Microneedling	Sometimes used as an adjunct alongside minoxidil in research studies.
Ketoconazole shampoo	Has a mild anti-androgenic effect on the scalp, but is weaker than finasteride.
Spironolactone	Used off-label for female pattern hair loss with hyperandrogenism, under specialist care.
Hair transplant	Moves follicles from a permanent zone but does not stop ongoing loss elsewhere without medical therapy.

Realistic expectations for hair loss treatment

Younger men with recently started thinning tend to see the best response to treatment, whereas long-standing, complete baldness may mean the follicles are gone entirely, and medicines cannot recreate them. For women, minoxidil is the main treatment option, since finasteride is not used. Anyone starting treatment should budget for ongoing, indefinite maintenance and allow a full 12-month trial before judging whether it has worked.

When these treatments are not appropriate

Minoxidil and finasteride should not be used without a proper assessment if you have patchy bald spots, which may suggest alopecia areata, scarring changes to the scalp, or rapid, diffuse shedding following an illness, which may be telogen effluvium and often improves without treatment. Children with hair loss should be referred for specialist paediatric assessment rather than started on these treatments.

Treating pattern baldness is a marathon rather than a sprint, and staying consistent with one treatment tends to work better than switching products every few months.

Common questions about hair loss treatments

How long does minoxidil take to work for hair loss?

Minoxidil usually needs a minimum of 4 to 6 months before visible regrowth appears, with peak results seen around 12 months. Some initial shedding in the first 2 to 8 weeks is normal, as old hairs make way for new growth, and treatment needs to continue indefinitely to maintain any results.

Is finasteride available on the NHS for hair loss?

The standard finasteride tablet is licensed for male pattern baldness, but NHS prescribing varies between areas, so many men obtain it through a private prescription instead. It is not prescribed for women, and the higher-strength prostate version must not be split without medical guidance.

Can women use minoxidil for hair loss?

Yes, 2% or 5% minoxidil is licensed for female pattern hair loss and is applied to the scalp once or twice daily. It should be stopped if you become pregnant or are breastfeeding, and care is needed to apply it accurately, since unwanted facial hair can occur if the product runs onto the face.

Do hair loss shampoos actually work?

Ketoconazole shampoo has only weak evidence for reducing DHT and may help general scalp health, but it is not equivalent to finasteride or minoxidil. Caffeine and biotin shampoos lack strong evidence for regrowth, and while they are unlikely to cause harm, they should not replace proven treatments.

What happens if I stop taking finasteride or using minoxidil?

Hair loss resumes over the following months, and any gains made during treatment are gradually lost. Finasteride's effect on DHT reverses within days of stopping, while hairs that depended on minoxidil begin shedding once application stops, so long-term use is needed if treatment is working.

Can finasteride and minoxidil be used together for hair loss?

Yes, many men use both treatments together for male pattern baldness, since finasteride blocks DHT throughout the body while minoxidil acts locally on the scalp. Evidence suggests the combination is more effective than either treatment alone, though women should use minoxidil only, not finasteride.

Are hair loss treatments available on the NHS?

Minoxidil is usually bought over the counter rather than prescribed. Standard-strength finasteride may be prescribed on the NHS in some areas but is more commonly obtained privately, while wigs are available on NHS prescription for alopecia areata and some other medical hair loss, though hair transplants are not funded for cosmetic pattern baldness.

Sources

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