Treating male pattern baldness
Lots of people have asked me about hair loss/male pattern baldness and how to prevent/reverse it, so I thought I’d write it up.
tl;dr
Finasteride and minoxidil are the mainstays of treating hair loss. Typically finasteride is a tablet and minoxidil is a topical solution.
Note that a hair transplant is not a ‘cure’ for hair loss; the transplanted hair will stay but you’ll continue to lose the existing hair.
My recommendation is a compounded topical solution of minoxidil and finasteride which you apply to the scalp once a day. You can buy this from MinoxidilMax who have a range of products with various combinations of minoxidil and finasteride.
Classic
The recommended doses of finasteride and minoxidil.
finasteride – 1mg daily
minoxidil 5% solution – 1mL twice a day, applied topically to the scalp
Lazy
All tablet, but oral minoxidil for male pattern baldness is off-label.
finasteride – 1mg daily
minoxidil – 2.5mg daily (oral)
Cautious
Reduced risk of side effects compared to oral finasteride.
finasteride 0.1% + minoxidil 10% solution – 1mL daily (topical)
The side effects of finasteride are overhyped and the research into them is generally low-quality, but if you’re worried, you can try a low dose (1mg, 3x per week instead of daily) or use topical finasteride which in small studies is found to be as effective as the oral formulation.
Framing the problem
Balding is progressive. It can’t be cured (yet!) – so long as you have androgens like testosterone and DHT in your bloodstream, your hair follicles will miniaturise and vanish if you’re genetically inclined to balding.
For this reason a hair transplant isn’t a “cure” to balding. The transplanted hair comes from the sides and back of the head – hair in this area is resistant to androgens. But your hairline will continue to recede.
So the most important thing to do if you’re balding is to prevent further hair loss. Once it’s gone, it can’t be brought back.
Why do we go bald?
Hair follicles have androgen receptors to which androgens (like testosterone, DHT, and anabolic steroids) can bind. Molecules which bind to these receptors will, over time, cause the hair follicle to miniaturise, meaning the hair coming out of the follicle becomes progressively thinner and thinner until it disappears.
As the hair on the back and sides of your head is resistant to androgens, hair transplants involving taking hair from these areas (the “safe donor area”). This means this transplanted hair is lifelong.
Preventing further hair loss
The two drugs that can prevent hair loss this are finasteride and minoxidil. Mostly everything else is a distraction; those two form the mainstay of any hair loss stack.
Finasteride (or its stronger cousin dutasteride) inhibits the activity of 5-alpha reductase, the enzyme that converts testosterone into DHT, which is much more androgenic than testosterone and so causes much more hair loss. (Dutasteride inhibits the activity of more subtypes of this enzyme and so causes a larger decrease in DHT levels, but at the cost of more side effects.)
It’s usually taken as a 1mg pill daily. This is a dose much smaller than what’s usually taken for prostatic hyperplasia, which is what it was originally developed for.
Some people get side effects, particularly sexual ones (as you’re reducing the amount of an androgen, after all). There’s also a lot of scaremongering online from people who have long-term side effects even after stopping the medication, but the research on these is usually extremely low-quality and I think shouldn’t be a worry.
If you’re worried about side effects, some suggest starting with a lower dose like 1mg, three times per week.
Alternatively, use a topical formulation which you apply to the scalp. It’s less convenient than a pill, but exposes you to much lower levels of finasteride systemically and seems to work just as well based on early research.
Minoxidil is a blood pressure medication which causes increased blood flow to the area it’s applied to – hence promoting hair growth.
My recommendation, for simplicity and minimal side-effects, is a compounded topical solution of minoxidil and finasteride. You can buy this from MinoxidilMax1 who have a range of products with various combinations of minoxidil and finasteride.
I don’t get a commission or kickback from this link.