At NYU Langone, dermatologists who specialize in hair loss and scalp disorders have treated thousands of people with all types of hair loss. They often recommend medication to help prevent further hair loss and, whenever possible, to regrow hair. Topical minoxidil stops hair from thinning and stimulates new hair growth. This medication can help people with many different types of hair loss, including male and female pattern hair loss (androgenetic alopecia), alopecia areata, telogen effluvium, anagen effluvium, hypotrichosis, and some forms of cicatricial (scarring) alopecia.
Minoxidil: Over-the-Counter and Use Guidelines
The way this medication works is not well understood, but many people see significant results. Although it is available without a prescription, you may have better results if you use it while seeing a dermatologist. He or she can diagnose the exact cause of hair loss and determine whether a 2 percent or 5 percent concentration of minoxidil is right for you. The dermatologist can also show you how to apply it correctly.
Available as a foam or a liquid, minoxidil is applied directly to the scalp, twice a day for best results. It may take four months to a year for hair to noticeably thicken. Increased shedding may initially be observed soon after the medication is begun and may continue for a month or two. After six months, dermatologists assess how well the medication is working by counting the number of new hairs on the scalp and comparing current photographs with those taken at the start of treatment. If you like the results, treatment can continue indefinitely.
Oral Finasteride: For Men with Male Pattern Hair Loss
Oral finasteride is a prescription medication for men who have male pattern hair loss, or androgenetic alopecia. Finasteride slows the rate of hair loss and stimulates new hair growth by inhibiting the body’s production of a hormone that destroys hair follicles. This medication is taken once a day by mouth and is most effective when taken at the same time each day.
Finasteride starts to work after about four months, but you may not notice significant hair growth for as long as a year. Your dermatologist measures this progress after six months to determine whether to continue treatment. If the medication is working, treatment may continue for as long as new hair growth is desired.
Antiandrogens for Women with Female Pattern Hair Loss
Medications that inhibit androgens-sex hormones that damage or destroy hair follicles-may stop hair loss in female pattern baldness. Antiandrogen medications are available by prescription only and include spironolactone and oral contraceptives (birth control pills) that contain estrogen. Antiandrogens usually start to work after four months. Long-term treatment is necessary to prevent hair loss from recurring.
Antiandrogens can produce side effects, including irregular menstrual periods and drowsiness. Some types of hair loss are caused by an autoimmune disease and are treated differently than hormonally induced hair loss. With an autoimmune condition, the body’s immune system attacks healthy organs and tissues, including the skin. Sometimes the body destroys healthy hair follicles.
Corticosteroids and Autoimmune-Associated Hair Loss
Corticosteroid medications are used to treat people with alopecia areata, lichen planopilaris, and discoid lupus erythematosus. These immune system suppressors can counteract the effects of an autoimmune disease, allowing hair to grow. Steroids are available as topical solutions or injections, and all require a prescription. Dermatologists determine which type of treatment is most appropriate based on age and severity of symptoms.
For children diagnosed with alopecia areata, a topical steroid cream can be applied to the skin or scalp. For adults, the doctor may inject steroids into the skin or scalp. As many as 80 injections may occur during one appointment. Steroid treatments can take place every four to six weeks, and you may see hair regrowth in one or two months. If hair doesn’t grow, or you can’t tolerate needles, a dermatologist may prescribe corticosteroid to be taken by mouth for 8 to 10 weeks. If it doesn’t have a visible effect after six months, this treatment should be stopped.
Fungal Infections and Antifungal Treatments
If a fungal infection called tinea capitis, or scalp ringworm, is the cause of hair loss, a dermatologist prescribes an antifungal medication to be taken by mouth daily. Often, it takes one or two months before you can see results, and treatment usually lasts for several months in order to fully eliminate the fungus.
Combination Therapies and Individual Variability
Many types of hair loss are treated with a combination of medications for optimal results. Women often face a “Catch-22” with drug treatments for androgenic alopecia: while many drugs may work to some degree, doctors may hesitate to prescribe systemic treatments, and drug companies may not have robust data for women. Physicians often choose topical treatments to minimize systemic effects. That said, results depend on the person and the cause, and early treatment tends to yield the best outcomes.
Below is a concise overview of common options and their typical contexts:
- Minoxidil 2% for women; some clinicians may consider 5% under supervision, mostly for men.
- Spironolactone or birth control pills for female androgenetic alopecia, with attention to side effects and pregnancy considerations.
- Ketoconazole shampoo (Nizoral) as an adjunct for anti-androgenic effects and scalp conditions; 2% prescription strength and 1% OTC versions exist.
- Finasteride (Propecia) for men with male pattern baldness; not for women who are pregnant or may become pregnant.
- Oral antiandrogens and estrogens-containing contraceptives for select female patients, with medical supervision.
- Topical corticosteroids and intralesional injections for alopecia areata; systemic steroids for extensive disease with caution.
Alopecia Areata: Focused Treatments and Emerging Options
Alopecia areata is an autoimmune condition where the immune system attacks hair follicles. Treatments include topical immunotherapy, topical minoxidil, topical anthralin, corticosteroid injections, systemic corticosteroids, and, in some cases, JAK inhibitors or other emerging therapies. Each option carries specific benefits, risks, and monitoring needs, and results vary between individuals.
Practical Considerations: Diagnosis, Monitoring, and When to Seek Help
Diagnosis typically involves physical exam, history, and tests such as blood work, pull tests, scalp biopsy, and light microscopy. Treatments depend on the cause and may range from lifestyle adjustments to prescription medications. The best results occur when treatment begins early after hair loss starts, as prolonged androgenic alopecia may destroy hair follicles. Regular follow-up helps adjust therapies based on response and tolerability.
Other Therapeutic Approaches and Emerging Trends
Laser therapy has received FDA clearance for hereditary hair loss in some cases, with small studies suggesting improved density. Platelet-rich plasma (PRP) injections use the patient’s own blood components to stimulate growth. Hair transplant surgery, microneedling, and laser devices are options for certain patients, with varying degrees of invasiveness and success. Newer systemic approaches, including JAK inhibitors, are under investigation and show promise for some patients with alopecia areata.
Lifestyle, Supplements, and Supportive Care
Maintaining vitamin and mineral levels can support treatment, though no supplement substitutes for medical therapy. Nutritional deficiencies (iron, zinc, vitamin D, protein) can contribute to hair loss, and addressing these may aid recovery alongside medical treatments. Styling choices, wigs, and supportive care can help with self-esteem and quality of life while undergoing treatment.
Preparing for Your Appointment and Communicating with Your Doctor
Be prepared with questions about permanency, expected timelines, and whether to see a specialist. Doctors typically ask about diet, hair care routines, medical history, and family history. A collaborative approach-understanding causes, setting realistic goals, and selecting evidence-based treatments-offers the best chance for meaningful improvement.
Key Takeaways on Over-the-Counter Treatments and Medical Options
- Minoxidil is widely used and can slow hair loss and promote regrowth, with differences in concentration for men and women.
- Finasteride is effective for men but not suitable for women who are pregnant or may become pregnant.
- Antiandrogens and hormonal therapies may help some women, with careful monitoring for side effects.
- Corticosteroids address autoimmune components but require medical supervision due to potential side effects.
- Fungal infections require antifungal therapy and may be mistaken for other forms of hair loss.
- Emerging therapies (e.g., JAK inhibitors, PRP) offer hope but require professional guidance and ongoing evaluation.