What are the best medications for treating androgenetic alopecia (hair loss)?

Best Medications for Treating Hair Loss (Androgenetic Alopecia)

Primary Recommendation

For men with androgenetic alopecia, start with combination therapy of topical minoxidil 5% twice daily plus oral finasteride 1 mg daily, as this provides superior efficacy compared to either medication alone. 1, 2

Treatment Algorithm by Sex and Severity

For Men with Androgenetic Alopecia

First-Line Therapy:

• Combination therapy is most effective: Apply topical minoxidil 5% twice daily AND take oral finasteride 1 mg daily 1, 2
• This combination achieves improvement in 94% of patients at 12 months, compared to 80% with finasteride alone and 59% with minoxidil alone 2
• The combination shows significantly higher hair density increases (+81 hairs/cm² at 6 months) compared to monotherapy 1

Monotherapy Options (if combination not tolerated):

• Oral finasteride 1 mg daily: Arrests hair loss in >80% of patients at 12 months, superior to minoxidil monotherapy 3, 2
• Topical minoxidil 5%: Apply 1 mL twice daily to dry scalp; less than 40% respond by 24 weeks 4, 3
• Topical finasteride 0.25% spray: Can be combined with topical minoxidil 5% (morning minoxidil, evening finasteride) for those avoiding oral finasteride 1

Alternative Oral Options (off-label, ranked by efficacy):

• Oral dutasteride 0.5 mg daily (most effective, approved in Japan/South Korea) 5
• Oral finasteride 5 mg daily 5
• Oral minoxidil 5 mg daily 5
• Oral minoxidil 0.25 mg daily (least effective of oral options) 5

For Women with Androgenetic Alopecia

First-Line Therapy:

• Topical minoxidil 2-5%: Apply twice daily; this is the American Academy of Dermatology's recommended first-line treatment 6, 7
• Women should NOT use minoxidil 5% solution formulated for men, as it works no better than 2% in women and may cause facial hair growth 4

Enhanced Therapy:

• Add platelet-rich plasma (PRP) to minoxidil: Combination shows superior efficacy compared to minoxidil alone 6, 8
• PRP protocol: 3-5 sessions at 1-month intervals, then maintenance every 6 months 6
• Use 5-7 mL PRP at 0.05-0.1 mL/cm², injected at 90-degree angle, 2-4 mm depth, 1 cm apart 6

Timeline Expectations

Critical counseling points to prevent premature discontinuation:

• Initial hair shedding may occur for up to 2 weeks when starting minoxidil (this is normal and indicates old hairs being replaced) 4
• Earliest results appear at 2 months, but most patients require 4 months minimum to see improvement 4, 7
• Hair grows only 0.5-1 inch per month, so regrowth takes time 4
• Treatment must continue indefinitely; discontinuation reverses all benefits 6

Adverse Effects to Monitor

Oral Finasteride:

• Sexual dysfunction and neuropsychiatric side effects (rare: 1.8% in Chinese study) 5, 2
• Half-life ~4.5 hours 5

Oral Minoxidil:

• Dose-dependent hypertrichosis (unwanted body hair growth) 9, 5
• Cardiovascular symptoms/signs 5
• Half-life ~4 hours 5

Topical Minoxidil:

• Minimal systemic effects when used as directed 4
• Local scalp irritation possible 2

Oral Dutasteride:

• Similar to finasteride but longer half-life (~5 weeks), making side effects slower to resolve 5
• More potent DHT suppression than finasteride 5

Common Pitfalls to Avoid

• Don't use men's 5% minoxidil formulations in women - no additional benefit and causes facial hair 4
• Don't stop treatment during initial shedding phase - this is expected and temporary (up to 2 weeks) 4
• Don't expect results before 4 months - premature discontinuation is the most common cause of treatment failure 4
• Don't forget that treatment is lifelong - stopping reverses all gains 6
• Don't use minoxidil for frontal baldness or receding hairline - it only works for vertex (crown) hair loss 4

Monitoring Response

Assess treatment efficacy using:

• Standardized before-and-after photographs 6
• Trichoscopy to evaluate hair density and diameter 6
• Patient self-assessment questionnaires 6
• Evaluate at 3-month intervals initially, then every 6 months 1