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. This article synthesizes the key treatments, their targets, how they work, and what to expect during therapy.
Topical minoxidil: first-line option for many types of hair loss
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) and alopecia areata, telogen effluvium, anagen effluvium, hypotrichosis, and some forms of cicatricial or scarring alopecia.
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 and antiandrogen strategies for androgenetic alopecia
Oral finasteride is a prescription medication for men who have male pattern hair loss. 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.
Medications that inhibit androgens-sex hormones that damage or destroy hair follicles-may stop hair loss in female pattern baldness (female androgenetic alopecia). 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.
Immune-related hair loss and corticosteroid interventions
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. 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 your age and severity of symptoms.
For children who have been 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, with as many as 80 injections occurring 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 your hair doesn’t grow, or if 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. Topical and injected corticosteroids have side effects, including scalp irritation that may lead to a rash, thinning skin on the scalp, and a red or puffy face.
Antifungal and other targeted therapies
If a fungal infection called tinea capitis (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. Many types of hair loss are treated with a combination of medications for optimal results.
Diagnosis and assessment: how clinicians tailor treatment
Diagnosis begins with a physical exam and an exploration of diet, hair care routine, medical and family history. Tests may include blood work, a pull test, scalp biopsy, light microscopy, and other assessments to determine the cause and extent of hair loss. This informs whether medications, procedures, or lifestyle changes will be most effective.
Other treatment modalities and approaches
In cases of stubborn or permanent hair loss, hair transplant surgery can relocate healthy follicles from a donor area to a bald or thinning region. Laser therapy with low-level laser devices has FDA clearance for treating hereditary hair loss in men and women, with some studies suggesting improved hair density. Platelet-rich plasma injections provide another option, injecting high concentrations of components of the patient’s own blood into the scalp to stimulate hair growth, typically on a monthly basis for a initial period and then yearly follow-ups. Laser and light-based devices, supplements, and other therapies may be considered, but evidence varies and costs can be significant. Any of these treatments should be started as soon as hair loss is detected, since prolonged follicle inactivity reduces the likelihood of recovery.
Preparing for treatment often includes a candid discussion with a dermatologist about expectations, potential side effects, and whether therapies can be combined for best results. Lifestyle and home remedies can also help improve the appearance and feel of hair during treatment, such as using volume-adding styling products, adjusting hairstyles to minimize visible thinning, or considering wigs or extensions as temporary measures.
What to expect from an appointment and ongoing care
Your doctor will guide you through diagnosis, treatment planning, and progress monitoring. Effective treatments vary by condition, and some may reverse hair loss or slow its progression, while others require ongoing use to sustain benefits. For some conditions, hair regrowth may occur spontaneously within a year, particularly in patchy hair loss (alopecia areata).
In summary, treatment choices range from topical minoxidil and oral finasteride to antiandrogens, corticosteroids, antifungals, and advanced procedures like transplantation, PRP, and laser therapy. The best outcomes typically arise from early intervention, personalized plans, and a combination of therapies under professional supervision.