Male hair loss

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Overview of male pattern hair loss

Male pattern hair loss is the most common type of hair loss in men. It is due to a combination of factors including genetic inheritance and hormones (androgens), hence the name 'androgenic alopecia'.

Men usually notice a gradually receding hairline with hair loss at the front and sides (temples), and an area on the top (crown) of the head. This is a natural ageing process and not due to ill health. Approximately 60% of men notice some hair loss by 50 years of age.

Early onset male pattern hair loss can affect men as early as their mid-20s and several family generations may be affected. This is due to a genetically inherited scalp sensitivity to the male hormone dihydrotestosterone (DHT).

Who CAN use male hair growth treatments?

• Adults (aged 18+)
• Assigned male at birth
• Affected by male pattern hair loss

Who should NOT use male hair growth treatments?

• Rapid hair loss (within 12 months). This is not likely due to male 'pattern' hair loss and may indicate an underlying medical condition.
• Localised patchy hair loss, hair loss in clumps, scalp redness, soreness, itching or pustules. These symptoms may indicate an underlying skin condition.
• Hair loss following chemotherapy, hair loss affecting the entire body (total alopecia) or hair loss at the site of localised trauma.

If you are unsure whether you are experiencing male 'pattern' hair loss you should seek a review with your GP.

Starting treatment

Please note when using hair growth treatments a temporary increase in hair loss over the first 2-6 weeks of treatment is NORMAL and should be expected. Treatment moves hairs from the resting phase into the growth phase of the hair growth cycle which causes shedding of old hairs.

Once improved hair coverage has been achieved, continued treatment is required to sustain the benefits. If treatment is stopped, pre-treatment appearance will likely return within 3-6 months.

Treatments available for male pattern hair loss

Dr Fox can prescribe 3 treatments for male pattern hair loss:

• Propecia 1mg/finasteride 1mg oral tablets
• Regaine Extra Strength topical solution/foam & Sons 5% minoxidil topical solution
• Dr Fox Hair Growth Spray - finasteride 0.3% and minoxidil 5% topical solution

Oral Propecia/finasteride 1mg tablets can be used together with topical Regaine Extra Strength OR Sons minoxidil 5% as complementary treatments. Dr Fox Hair Growth Spray should not be used with other hair loss treatment medication.

When can I expect to see results?

Positive changes may be seen as early as 3 months of using male hair growth treatment. After 6 months of treatment excess hair loss has usually stopped and changes are more obvious. Maximum benefit is usually seen at 1-2 years of treatment.

In the unlikely event your hair loss continues beyond 12 months with no notable increase in hair thickness or coverage, you are likely to be a 'non-responder' and should stop treatment.

---

Propecia/finasteride 1mg tablets

Branded Propecia and generic finasteride 1mg tablets both contain the same active ingredient (finasteride 1mg).

How finasteride works

Finasteride reduces the conversion of testosterone to dihydrotestosterone (DHT), the male hormone (androgen) which affects hair growth. If less DHT reaches hair follicles, hair is allowed to reach its full growth potential.

Please note: Finasteride has not been proven to reverse a receding frontal hairline, hair loss at the temples only (the area at sides of the forehead), nor restore hair to entirely bald areas.

Cautions for Propecia/finasteride use

• Women who are pregnant or could become pregnant should not come into contact with Propecia/finasteride tablets. It may affect the baby's genital development.
• Finasteride is excreted in semen. Use of a condom is recommended if your sexual partner is pregnant, likely to become pregnant, or you are trying to conceive a baby.
• Finasteride can decrease blood levels of prostate cancer markers such as prostate-specific antigen (PSA). If you are to have a PSA test you must inform your GP as the reference values for the PSA test may need adjustment.

Dr Fox is unable to supply Propecia/finasteride if you have the following, or a history of the following conditions:

• Difficulty passing urine (either starting or slow flow).
• Prostate cancer.
• Depression, or a history of severe depression and or suicidal thoughts (symptom monitoring is required after starting treatment).
• Liver disease (as removal of finasteride from the body may be affected).
• Male breast enlargement (gynaecomastia).

If the following symptoms occur during treatment, they may be due to an underlying medical condition and you are strongly encouraged to consult your GP:

• Difficulty passing urine (either starting or slow flow).
• Unexplained weight loss or fevers.
• Persistent diarrhoea.
• Excessive fatigue.
• Male breast changes. Rarely male breast cancer has been reported. Any changes in breast tissue, enlargement (gynecomastia) or nipple discharge should be reported to your GP.
• Rapid or patchy hair loss.

Potential side effects of Propecia/finasteride

Possible

• Reduced libido (sex drive) and/ or erectile dysfunction (erection difficulties). These will usually reverse on stopping treatment.
• Depression, low mood.

Possible

• Reduced male infertility - advise stop treatment 3 months before planned pregnancy.
• Suicidal thoughts. Advise stop treatment immediately and seek GP review, or if there is concern for safety attend the emergency department.
• Extremely rarely, patients report side effects persisting after stopping treatment (post-finasteride syndrome).

For the full list of potential side effects please read the Patient Information Leaflets (PIL): finasteride 1mg patient leaflet and Propecia patient leaflet.

---

Regaine Extra Strength and Sons minoxidil 5% topical treatment

Regaine Extra Strength and Sons minoxidil 5% both contain the same active ingredient (minoxidil 5%).

How minoxidil works

Minoxidil relaxes small blood vessels where applied to the scalp, increasing blood flow to hair follicles. Blood carries essential oxygen and nutrients which stimulate new hair growth, encouraging thicker, longer, more visible hair.

Minoxidil products available

• Regaine Extra Strength foam - minoxidil 5% topical foam
• Regaine Extra Strength spray - minoxidil 5% topical solution
• Sons Minoxidil 5% topical solution

Minoxidil should be applied to the scalp twice daily - one pack is one month's supply. Using more than the standard dose does not provide better results and increases the risk of side effects.

When can I expect to see results?

9 out of 10 men reported reduced hair loss and 8 out of 10 men reported hair regrowth with regular use of minoxidil.

Who can use minoxidil?

• Minoxidil foam is licensed for use in males aged 18 to 49 years.
• Minoxidil solution is licensed for use in males aged 18 to 65 years.
• If you are over the age of 49 years wanting to use the foam, or over 65 years wanting to use the solution, Dr Fox can supply these products 'off label'. Both products have been used safely beyond the ages in which these products were initially licensed for.

DO NOT use minoxidil if you have:

• An allergy or hypersensitivity to minoxidil.
• Are susceptible to severe scalp infections or psoriasis
• Phaeochromocytoma (a rare tumour).

Cautions

• Keep away from children and animals. If swallowed, minoxidil can lead to heart toxicity.
• Avoid contact with broken, infected, shaved, or inflamed skin.

If you have been diagnosed with the following conditions you should seek advice from your usual GP practice before ordering topical minoxidil:

• Heart disease, palpitations (abnormal heart rate).
• High blood pressure.
• Symptoms of low blood pressure (feeling lightheaded/dizzy/faint).

Possible side effects of minoxidil

Very little of the product is absorbed through the skin therefore side effects are rare. If you experience the following, stop treatment and consult your GP if your symptoms don't settle:

• Low blood pressure (dizziness or lightheadedness/feeling faint).
• Skin irritation.

Stop using and seek medical advice if you experience any of the following:

• Allergic reaction.
• Chest pains, palpitations.

Please see the patient information leaflet for the full list of possible side effects.

---

Dr Fox Hair Growth Spray - finasteride 0.3% and minoxidil 5% topical solution

The Dr Fox Hair Growth Spray is an unlicensed 'specials' medicine developed by Dr Fox and produced by a licensed UK specials medicines manufacturer.

How it works

The spray contains 2 active ingredients: finasteride and minoxidil. Tretinoin is added which makes minoxidil more effective and allows for once-daily use:

Finasteride reduces the conversion of testosterone to dihydrotestosterone (DHT), the male hormone (androgen) which affects hair growth. If less DHT reaches hair follicles, hair is allowed to reach its full growth potential.

Minoxidil relaxes small blood vessels where it is applied to the scalp, increasing blood flow to hair follicles. Blood carries essential oxygen and nutrients which stimulate new hair growth.

Tretinoin is a vitamin-A derivative that promotes hair growth indirectly by increasing minoxidil uptake. Minoxidil alone is used twice daily, but combined with tretinoin is as effective used once daily.

DO NOT use Dr Fox Hair Growth Spray if you have:

• An allergy or hypersensitivity to finasteride, minoxidil or tretinoin.
• Are susceptible to severe scalp infections or psoriasis.
• Phaeochromocytoma (a rare tumour).

Cautions

• Keep away from children and animals. If swallowed, minoxidil can lead to heart toxicity.
• Women who are pregnant or could become pregnant should avoid handling as finasteride may affect development of a baby's genitals.
• Avoid exposure to UV light (sunlight) as tretinoin can make the skin more likely to burn.
• Do not use more than the recommended dose. Treatment will not be more effective and the risk of side effects will increase.
• Avoid contact with broken, infected, shaved, or inflamed skin.

If you have been diagnosed with the following conditions you should seek advice from your usual GP practice before ordering Dr Fox Hair Growth Spray:

• Heart disease, palpitations (abnormal heart rate).
• High blood pressure.
• Symptoms of low blood pressure (feeling lightheaded/dizzy/faint).

Possible side effects of Dr Fox Hair Growth Spray

Very little of the product is absorbed through the skin therefore side effects are rare.The active ingredients are delivered directly to the skin, with little entering the bloodstream. If you experience the following, stop treatment and consult your GP if symptoms don't settle:

• Low blood pressure (dizziness or lightheadedness/feeling faint)
• Skin irritation (itching, dryness, redness) at the application site is most likely due to the alcohol base of the product, but may be due to minoxidil or tretinoin. Irritation usually settles with continued use.
• Rarely: reduced fertility, reduced libido, erectile dysfunction, low mood/depression, nausea, weight gain.

Stop using and seek medical advice if you experience any of the following:

• Male breast tissue growth (gynecomastia). This is an uncommon side effect of finasteride (usually in higher doses when taken in tablet form).
• Allergic reaction.
• Chest pains, palpitations.

For the full list of potential side effects read the Patient Information Leaflet (PIL).

Buy treatment

Dr Fox supplies treatment for hair loss on prescription - you are required to answer a short medical questionnaire before your order can be completed.

Further information

Reporting side effects

Report side effects online at MHRA Yellow Card scheme, also available via their app which can be downloaded from Apple App Store or Google Play Store.

1. Medical questions
2. Choose treatment
3. Complete order

Answer medical questions to order(male pattern hair loss)

Men only

Honest & accurate responses are necessary for safe medical assessment