If you’ve just started noticing your hairline creeping back, your crown looking a little thinner, or a few too many strands circling the shower drain, don’t panic. You’re definitely not alone, and you’ve just landed in the right place.
Hair loss can feel overwhelming at first. There are lots of treatment options (not all of which are clinically proven), plenty of strong opinions online, and more scientific-sounding words (looking at you, dihydrotestosterone) than a biology textbook.
So if you’re a complete beginner to hair loss and want a simple, no-nonsense explanation of what’s happening to your hair, and what you can actually do about it, this guide is for you.
What is androgenetic alopecia
Hair loss can be caused by a lot of factors: hormonal imbalances, stress, illness, nutritional deficiencies, to name a few.
But the most common kind is androgenetic alopecia, known as male pattern baldness (MPB) which affects up to 80% of men at some point in their lives.
Some men start experiencing MPB earlier than others, and that mostly comes down to genetics - your DNA determines if you’ll lose hair and when it starts.>
It’s usually pretty easy to spot male pattern baldness because it follows a very recognizable pattern. Most guys first notice an ‘M’-shaped recession at the temples, and thinning often happens at the crown too. Over time, these areas can gradually expand.
Doctors classify the progression of MPB using the Norwood–Hamilton scale, which ranges from Stage 1 (little to no recession) all the way to Stage 7 (advanced thinning with complete baldness on the top of the head). The hair on the back and sides of the scalp is typically resistant to DHT, which is why it usually stays put even in men with severe hair loss.
Why am I losing my hair?
Now that you know what it is, we’ll look at why it happens.
Dihydrotestosterone, which we’ll call DHT to keep things simple, is a by-product of testosterone metabolism, and it’s the main culprit. The hormone is important during fetal development and puberty for developing male sexual characteristics, but in adult men it doesn’t do much other than cause prostate enlargement and male pattern baldness.
DHT binds to hair follicles on the scalp, which shortens the anagen (growth) phase of the hair growth cycle, leading to a process called ‘miniaturization’. Basically, the follicle shrinks over time until it can no longer produce healthy, thick hairs. When the follicle has stopped growing healthy hair, this leads to noticeable bald spots.
How to stop hair loss
If you’re not ready to say goodbye to your hairline here are the medications which can stop hair loss.
Finasteride
Finasteride is one of the two licensed treatments for male pattern baldness. The 1mg daily tablet lowers DHT levels by up to 70%, which helps protect hair follicles from shrinking.
Research shows that finasteride stops hair loss in around 90% of men, making it one of the most reliable options out there.
5% Minoxidil Spray
Minoxidil spray is the other licensed treatment for MPB. It works by increasing blood flow to the follicles and extending the anagen (growth) phase, helping more hairs stay in the growth cycle for longer. It’s been shown to both slow hair loss and support regrowth in 84% of users. It can be used by itself, but combining with finasteride is recommended for best results. Weekly derma rolling (microneedling) has also been shown in studies to help improve hair regrowth when used with minoxidil spray. If you don’t know what derma rolling is, we have a blog dedicated to what it is, how to do it, and why you should.
Oral Minoxidil
Minoxidil is increasingly used in a capsule version as an alternative to topical spray. Oral minoxidil comes as a low dose capsule (typically 2.5mg daily) and has been shown in studies to be just as effective as minoxidil spray. It is prescribed ‘off-label’ for hair loss, which means it does not have a license in the UK for hair loss (it does for treating high blood pressure though), but prescribers can still offer it as a treatment for hair loss in men. It can be a great option if:
- you struggle to apply the spray consistently, or
- you’ve had irritation or dryness from the topical version.
Early research also suggests oral minoxidil may work for men who don’t respond to the spray due to low levels of a scalp enzyme called sulfotransferase. This enzyme is needed to convert minoxidil into its active form (minoxidil sulphate). Because sulfotransferase is present in the liver, oral minoxidil may still activate properly in people who don’t respond to the spray.
Topical Finasteride
A finasteride spray (instead of a tablet) works in a very similar way but is absorbed far less into the bloodstream. That means it can offer the same DHT blocking benefits with a lower chance of systemic side effects, including the sexual side effects that, while uncommon, can occur with the tablet.
Dutasteride
Dutasteride works like finasteride but is stronger. It blocks both types of the enzyme (5α-reductase) that convert testosterone into DHT, reducing DHT levels by up to 90%. This means it could be a suitable option for somebody who is not responding to finasteride after a long time, or wants a more powerful DHT-blocking effect. However, it is worth bearing in mind that dutasteride may have a higher chance of side effects, compared to finasteride.
Non-medicinal options
Hair Transplant
A hair transplant works by taking hair follicles that are naturally resistant to DHT and moving them into thinning or bald areas to create thicker, fuller looking hair. It can make a big aesthetic difference for men with more advanced hair loss but it’s important to know that a transplant isn’t a cure.
The transplanted hairs are permanent, but your native (original) hairs can still continue to thin over time. That’s why surgeons almost always recommend combining a transplant with ongoing hair loss treatments. Medications like finasteride or minoxidil can help protect the rest of your hair and slow down further loss, while the transplant restores density where you need it.
In short: a transplant can rebuild what you’ve already lost, and medication can help you keep what you still have. They usually work best as a team.
Natural remedies
Natural ingredients like rosemary oil and pumpkin seed oil might have some benefits for reducing hair loss or supporting regrowth - but the research so far is limited, mixed, and nowhere near as strong as what we have for actual hair loss medications. A lot of what you see online is based on anecdotal stories, influencer hype, or marketing claims rather than solid clinical evidence.
That doesn’t mean these natural options are harmful - most people tolerate them well but it does mean you shouldn’t expect dramatic results. Compared to treatments like minoxidil or finasteride, natural remedies simply haven’t been studied as extensively, so their effects are harder to rely on.
Do you have to take the medications forever?
Some people are put off the idea of starting hair loss treatment because they think they will have to use them forever. This is true, in a sense, as the medications will only work for as long as you are taking them. To put that into context – just like exercising or applying moisturiser, it takes repeating this every day to see the benefits. If you stop these daily habits, you’re likely to stop seeing the rewards. In the same way, the above medications can be effective at stopping hair loss and/or regrowing hair while you are regularly using them, but they will stop working if you stop taking them.
There is no ‘cure’ for hair loss. In other words, there is not a single solution which means you will never go bald. But there are treatments which are safe to be used long term to keep baldness at bay, for as long as you want to keep using them. A lot of men get to a point in their lives when they decide they’re happy to go bald, but not everybody is ready for this step when they start losing their hair, which is why treatment like these are so popular.
Still not sure which medication is best for you? Take our free online consultation for personalised recommendations.
Source List:
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· Pietrauszka K, Bergler-Czop B. Sulfotransferase SULT1A1 activity in hair follicle, a prognostic marker of response to the minoxidil treatment in patients with androgenetic alopecia: a review. Postepy Dermatol Alergol. 2022 Jun;39(3):472-478. doi: 10.5114/ada.2020.99947. Epub 2020 Oct 16. PMID: 35950120; PMCID: PMC9326921.
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