Inherited hair loss can be treated with medicines or hair transplant surgery. Other types of hair loss are treated by dealing directly with the cause. Finasteride is only effective for hair loss caused by androgenetic alopecia (AA), which is also known as male-pattern or female-pattern hair loss. 

Medications

Options for treatment with medication include:

1. Finasteride: Oral pill taken once daily, more effective than topical minoxidil alone
2. Minoxidil (Oral):Taken once daily as a low-dose pill - an option for those who prefer not to apply topical treatment. 
3. Minoxidil (Topical): Topical, used twice daily, not as effective as finasteride
4. Combo of finasteride + topical Minoxidil: This is the gold standard for hair loss treatment and over 90% effective!

Finasteride

Also known by its brand name Propecia® or Proscar®, is used to help hair growth in people assigned male at birth (AMAB). It may take three months to see the full effect. It decreases the production of DHT, the hormone that causes hair loss in AMAB people.

Finasteride Dosing

• Tablet may be taken with or without food.
• If you miss a dose, take the tablet as soon as you remember. If it is less than 12 hours till your next dose, skip the dose and resume your usual dosing time. Do not double dose.

Finasteride Side effects / Safety Considerations:

• Less than 2% of people experience side effects, including sexual side effects (decreased libido, erectile dysfunction), swelling in the hands and feet, and light-headedness. Side effects are generally reversible when the medication is stopped, except in rare instances where they may persist.
• Finasteride has been found to decrease your overall chances of acquiring prostate cancer. However, in the case that you do acquire it, it may increase the risk of forming a more aggressive form of prostate cancer by 0.5%.
• Small increase in risk of anxiety/depression in all persons (<1%) or worsening of symptoms in those with pre-existing mental health issues
• Rare, but may have a potential to increased suicidal ideation (suicidal thoughts). Stop medication and seek Emergency Care if this occurs.
• Might take up to three to four months to notice results. Continue for at least 12 months to assess full effect; continued daily use is required to sustain benefit.
• 90% effective at stopping hair loss.
• Can affect fertility and should be avoided in men interested in conceiving.
• If showing positive results, continue medication for as long as new hair growth is wanted.
• Hair loss may reoccur once medication is stopped.
• If you have not seen positive results after one year of continuous use, finasteride will likely not be effective for you.
• Pills should never be handled by people who are or may be pregnant.

Topical Minoxidil

Also known as Rogaine®. How this medication works is not well understood, but topical minoxidil stops hair from thinning and stimulates new hair growth.

Topical Minoxidil Dosing

• Available as liquid or foam
• Apply directly to scalp, not just hair
• Apply twice per day for best results

Topical Minoxidil Side effects/ Safety Considerations:

• Side effects are rare but may include scalp redness and irritation and the growth of facial hair.
• Can take up to three to four months to notice results. Continue for at least 12 months to assess full effect; continued daily use is required to see ongoing effect (hair loss will return when stopped).
• If showing positive results, continue medication for as long as new hair growth is wanted.
• Hair loss may reoccur once medication stopped.
• You may notice increased shedding of hair in the first couple months of use - this is only temporary and usually a good sign the medication will work!
• Minoxidil 5% has been shown to be more effective than a 2% concentration.
• Minoxidil seems to be most effective for men under 40 who have been balding for 5 years or less and do not have large areas of baldness.

Minoxidil Oral

Low-dose oral minoxidil is an alternative to the topical form for people with androgenetic alopecia. Originally developed as a blood pressure medication, it works by relaxing blood vessels around hair follicles, increasing blood flow and nutrients that prolong the active hair growth phase (anagen). It is taken as a once-daily pill at a much lower dose than used for blood pressure.

Minoxidil Oral Dosing

• Taken once daily, with or without food
• Take at the same time each day for best results
• If you miss a dose, take it when remembered. If it is less than 12 hours until your next dose, skip it. Do not double dose.

Minoxidil Oral Side Effects / Safety Considerations:

• Unwanted hair growth (hypertrichosis) is the most common side effect (~15%), typically appearing on the face, chest, or limbs. It is dose-dependent and usually resolves if the medication is stopped.
• Fluid retention (swelling of the ankles or legs) occurs in 1.3–10% of people, most often within the first 1–3 months. Let your clinician know if swelling is significant or worsening.
• Lightheadedness or low blood pressure affects approximately 2% of people, particularly when standing up quickly. Rise slowly and stay well hydrated.
• Palpitations or faster heartbeat occur in less than 1% of people. Seek care if persistent or accompanied by chest discomfort.
• You may notice temporary increased shedding in the first 1–2 months — this is normal and usually a sign the medication is working.
• If you are already using topical Minoxidil, we can overlap topical and oral Minoxidil for a few weeks in an attempt to offset the initial period of oral minoxidil-induced hair shedding.
• Can take up to three to four months to notice results. Continue for at least 12 months to assess full effect; continued daily use is required to maintain benefit.
• Hair loss may return once medication is stopped.
• Do not take oral minoxidil if you have been diagnosed with a pheochromocytoma (a tumour on the adrenal gland) You have untreated or unstable heart failure, angina, or had a heart attack within the last 6 months.
• Seek emergency care immediately if you experience chest pain, shortness of breath at rest, fainting, or sudden severe swelling of the face or hands.
• If you take medications for erectile dysfunction like, sildenafil (Viagra) or tadalafil (Cialis) or medications to lower your blood pressure - combining these with oral minoxidil may increase the risk of low blood pressure, dizziness, or lightheadedness, as both medications widen blood vessels. Your clinician will assess this before prescribing. Do not start oral minoxidil without disclosing use of these medications.