Available over the counter, buy it without a prescription

• Comes in a solution or foam

• In clinical studies, topical minoxidil regrew 20.0 hairs per centimeter over 16 weeks

• Increases blood flow to scalp and reactivates hair follicles

• Side effects of topical minoxidil may include scalp irritation and unwanted hair growth in nearby areas

Prescription-only medication

1. Blocks DHT and prevents follicle miniaturization

2. Great for slowing thinning and encouraging hair regrowth

3. In long-term trials, 80% of men maintained or improved hair density

4. Potential side effects of oral finasteride include reduced libido or erectile changes in a small percentage of users

The practice of prescribing drugs for unapproved (but evidence-informed) indications is known as off-label use. In the case of persistent or severe male pattern baldness, some clinicians turn to alternative medications originally developed for other conditions, but found to benefit patients with thinning hair or hair loss due to their effects on hair follicles and hormone regulation.

Spironolactone (CaroSpir, Aldactone)

Spironolactone is a potassium-sparing diuretic most commonly prescribed for hypertension, heart failure, and hormonal acne. However, it also has anti-androgenic properties, meaning it reduces the activity of male hormones such as testosterone and dihydrotestosterone (DHT), the very hormone implicated in male pattern baldness and female pattern hair loss.

In lower doses, spironolactone has been used off-label in both men and women to address hair loss in other areas of the body and diffuse thinning across the scalp. While it is more frequently prescribed in cases of female pattern baldness, its selective use in males is growing among endocrinologists and dermatologists, particularly when finasteride is contraindicated.

Dutasteride (Avodart)

Dutasteride, marketed under the brand name Avodart, is a 5-alpha-reductase inhibitor, similar in function to finasteride, but more potent. Whereas finasteride inhibits only one isoenzyme involved in DHT conversion, dutasteride suppresses two, offering a more comprehensive blockade of the hormone responsible for miniaturization of hair follicles.

Studies suggest that dutasteride may outperform finasteride in some cases, leading to greater hair density over time. However, because it has not been FDA-approved specifically to treat male pattern hair loss, it is prescribed off-label and with careful consideration of potential side effects.

As with finasteride, potential side effects of oral dutasteride include decreased libido and sexual dysfunction, though the incidence remains low in most clinical settings.

Hair loss may be genetic, but it’s not always that simple. While male pattern hair loss and male pattern baldness are the most common types, other health-related and environmental factors can also disrupt healthy hair follicles and lead to noticeable thinning or balding.

• Hormonal changes and sensitivity to DHT

• Thyroid problems

• Autoimmune disorders (e.g., alopecia areata)

• Nutritional deficiencies (iron, zinc, protein)

• Physical or emotional stress

• Illness or infection: hair loss is common post-COVID

• Hairstyles and hair care products that damage the scalp

• Hairstyles that pull hair, like tight braids or ponytails

• Hair styling products used in dyes and perms can cause hair to fall out

• Cancer treatments: hair shedding is a common side effect of radiation to the head (chemotherapy)

The result? You may experience patchy hair loss or even total loss of hair across the body, including eyelashes and eyebrows in severe cases.

Hair loss may be genetic, but it can also indicate an underlying health problem like low testosterone, a hormonal imbalance, or an autoimmune condition. The good news? A licensed provider, like a dermatologist, doctor, or nurse practitioner, can run lab work and offer medical treatment to either slow or reverse your hair loss.