Hair loss

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Hereditary hair loss (androgenic alopecia)

Hair loss is a natural process. About 50% of men have significant hair loss by the age of 50. Most men with hair loss are entirely healthy. Early male pattern hair loss often runs in families. Hair loss is not often caused by a hormone imbalance or lack of testosterone.

A good general overview about male pattern hair loss can be found at DermNet New Zealand, and links to further information about male hair loss can be found at the bottom of this page.

Rapid hair loss

Rapid hair loss over a period of less than a year should be investigated. It is unlikely to be caused by hereditary hair loss so see your GP who may want to carry out thyroid and other blood tests. Hair loss in patches, or associated with irritation and soreness of the scalp, also needs to be investigated by your GP or a dermatologist.

Hair loss treatments

Dr Fox can prescribe 2 treatments for male pattern hair loss:

• Finasteride tablets (Propecia 1mg)
• Minoxidil 5% (Regaine Extra Strength)

Men can use both Propecia/finasteride 1mg tablets and Regaine Extra Strength/minoxidil 5% topical at the same time. They should not be used for hair loss from other causes e.g. chemotherapy, head shaving, total alopecia (loss of hair over entire body).

Propecia/finasteride 1mg

• Branded Propecia and lower cost generic Propecia - called finasteride 1mg - are both available.
• Propecia/finasteride 1mg are daily tablets, only available on prescription.
• Propecia/finasteride 1mg tablets are for men only.

Response to Propecia/finasteride 1mg

Hair growth usually starts to improve after about three months, and is usually noticeable after 4-6 months. Two thirds of men who take Propecia will benefit from renewed hair growth. Maximum benefit is seen after one to two years (see study details).

How does Propecia/finasteride 1mg work

Propecia/finasteride 1mg tablets reduce the levels of the hormone DHT (Dihydrotestosterone) and this in turn stimulates new hair growth.

Who benefits

Men at any stage of male pattern hair loss are likely to benefit.

Propecia/finasteride 1mg is most effective for hair loss over the top of the scalp (vertex).

Propecia/finasteride 1mg has NOT been proven to:

• Reverse a receding frontal hairline.
• Reverse hair loss which is ONLY in the temple regions (the area at sides of the forehead).
• Restore hair to entirely bald areas.

Clinical studies were conducted on men aged 18 to 41 with mild to moderate hair loss, but not complete hair loss.

The best results of Propecia/finasteride 1mg treatment are seen after one to two years, at which time renewed hair growth is likely to be at its thickest.

Propecia/finasteride 1mg side effects and cautions

• If hair loss has been rapid and recent (less than a year), or where there are symptoms of serious illness, such as unexplained weight loss, fevers, persistent diarrhoea, or excessive fatigue, your GP should be consulted.
• Where hair loss is patchy or irregular, or hair comes out in clumps, or there is scalp inflammation the scalp should be examined by your GP or a dermatologist.
• If you are having a PSA test, to detect prostate cancer, tell your doctor that you are taking Propecia/finasteride, as the results can be misleading when Propecia/finasteride is being taken.
• If treatment is stopped, the beneficial effects begin to reverse by 6 months and return to baseline by 9-12 months.
• Pregnant women should not come into contact with Propecia/finasteride tablets. It may affect the baby's genital organ development. For this reason tablets are film-coated.
• Propecia/finasteride side effects are usually mild. Reduced libido and erectile dysfunction are possible. Extremely rarely patients report symptoms linked to post-finasteride syndrome.
• If low mood or depression develops, stop treatment and consult your doctor straight away.

See patient leaflet for full list of side effects.

Minoxidil 5%

• Applied to the scalp (hair roots) twice daily.
• For men only.

Regaine foam is not licensed for use in men over 49 years, but Regaine and minoxidil 5% solution are licensed for men up to 65 years. In practice they can all be used by men up to 65 years and even beyond this age.

Response to treatment

With minoxidil 5%, hair becomes fuller and thicker. Around 60% of men using minoxidil 5% twice daily experienced an increased scalp coverage after 48 weeks.

Read more information on the Pharmacological Properties of Regaine and Minoxidil.

How minoxidil 5% works

Both Regaine Extra Strength and minoxidil 5% contain the active ingredient minoxidil. The exact way in which minoxidil works is not fully understood. It increases blood flow to hair follicles, reducing hair loss and stimulating new growth. This produces thicker, longer, more visible hair. Very little of the active ingredient is absorbed into the body.

Timescales

With minoxidil 5% results may be seen after 8 weeks, but remember that everyone is different so you need to be patient. Studies suggest that minoxidil 5% should be tried for 6-12 months before deciding whether to continue.

Men can use Propecia (finasteride) tablets at the same time as minoxidil 5%.

Preparations of minoxidil 5%

• Regaine Extra Strength Foam
• Regaine Extra Strength Solution
• Sons minoxidil 5%

One pack is enough for one month's use. Using more than the standard dose does not give better results and increases the risk of side effects.

Side effects and cautions

• You may notice a temporary increase in hair loss in the first 2-6 weeks. This is entirely normal.
• Minoxidil 5% occasionally causes skin irritation that usually resolves when the treatment is stopped.
• Very little of the active ingredient, minoxidil, is absorbed into the circulation and therefore general side effects are not expected. You should stop using minoxidil 5% and see a doctor if you develop faintness or dizziness, you have signs of low blood pressure, or if you experience chest pain, rapid heartbeat, sudden unexplained weight gain, swollen hands or feet, or persistent redness.
• People with known heart disease or raised blood pressure even if treated, should contact their regular doctor before using minoxidil 5%.
• Very occasionally minoxidil 5% may cause unwanted hair growth in areas where it is applied regularly by accident. Always wash your hands thoroughly after applying and follow instructions about use.
• Minoxidil 5% should not be used by women.
• Minoxidil 5% should not be used for hair loss from other causes, e.g. chemotherapy, head shaving, total alopecia (loss of hair over entire body).
• Do not use if your scalp is inflamed or you have another skin condition.
• Do not use if also using any other scalp creams, ointments, or lotions.
• Do not use under dressings or bandages.
• Do not apply more than the recommended dose - this will not improve the effectiveness but risks absorption with an increased risk of side effects.
• Minoxidil 5% must be kept away from children as swallowing it could lead to serious heart toxicity.

Dr Fox supplies medication for hair loss on prescription - you are required to answer a short medical questionnaire before your order can be completed.

Authored 18 February 2010 by Dr Tony Steele
MB ChB Sheffield University 1983. Former hospital doctor and GP. GMC no. 2825328

Reviewed by Dr B. Babor, Dr A. Wood
Last reviewed 10 March 2021
Last updated 19 January 2024
Editorial policy

1. Medical questions
2. Choose treatment
3. Complete order