Hair loss

Medical information

Hereditary hair loss

Hair loss is a natural process. About 50% of men have significant hair loss by the age of 40. Most men with hair loss are entirely healthy. Early male pattern hair loss often runs in families. Hair loss is not often caused by a hormone imbalance or lack of testosterone.

Rapid hair loss

Rapid hair loss over a period of less than a year should be investigated. A doctor may want to carry out thyroid and other tests. Hair loss in patches, or associated with irritation and soreness of the scalp, also needs to be investigated.

A good general overview about male pattern hair loss can be found at DermNet New Zealand, and links to further information about male and female hair loss can be found at the bottom of this page.

Hair loss treatments

Dr Fox can prescribe 2 treatments for hair loss to men only:

• Finasteride 1mg tablets (Propecia)
• Minoxidil 5% (Regaine extra strength topical)

Men can use both Propecia/finasteride 1mg tablets and Regaine topical at the same time.

Propecia/finasteride 1mg

• New lower cost generic Propecia called finasteride 1mg now available – medically identical to branded Propecia.
• Propecia/finasteride 1mg are daily tablets, only available on prescription.
• Propecia/finasteride 1mg tablets are for men only.

Response to Propecia/finasteride 1mg

Hair growth usually starts to improve after about three months, and is usually noticeable after 4-6 months. Two thirds of men who take Propecia will benefit from renewed hair growth. Maximum benefit is seen after one to two years (see study details).

How does Propecia/finasteride 1mg work

Propecia/finasteride 1mg tablets reduce the levels of the hormone DHT (Dihydrotestosterone) and this in turn stimulates new hair growth.

Who benefits

Men at any stage of male pattern hair loss are likely to benefit.

Propecia/finasteride 1mg is most effective for hair loss over the top of the scalp (vertex).

Propecia/finasteride 1mg has NOT been proven to:

• Reverse a receding frontal hairline.
• Reverse hair loss which is ONLY in the temple regions (the area at sides of the forehead).
• Restore hair to entirely bald areas.

Clinical studies were conducted on men aged 18 to 41 with mild to moderate hair loss, but not complete hair loss.

The best results of Propecia/finasteride 1mg treatment are seen after one to two years, at which time hair growth is likely to be at its thickest.

Propecia/finasteride 1mg side effects and cautions

• If hair loss has been rapid and recent (less than a year), or where there are symptoms of serious illness, such as unexplained weight loss, fevers, persistent diarrhoea, or excessive fatigue, a doctor should be consulted.
• Where hair loss is patchy or irregular, or hair comes out in clumps, or there is scalp inflammation the scalp should be examined.
• Blood tests carried out to detect prostate cancer (PSA) can give misleading results when Propecia/finasteride 1mg is being taken.
• If treatment is stopped, the beneficial effects begin to reverse by six months and return to baseline by 9 to 12 months.
• There have been reports of depression and, in rare cases, suicidal thoughts in men taking finasteride 1mg.
• If low mood or depression develops stop treatment and consult your doctor straight away.

Propecia/finasteride 1mg side effects are usually mild. Reduced libido and erectile dysfunction are possible. See patient leaflet for full list of side effects.

Minoxidil 5% (Regaine extra strength)

• Regaine topical is applied to the scalp twice daily.
• Regaine Extra Strength is available as a foam or scalp solution and is for for men only.

Response to treatment

With Regaine, hair becomes fuller and thicker. 2 out of 3 people who used Regaine show re-growing of hair at 8 months. In user surveys 4 in 5 reported a slowing or stopping of hair loss (see study details).

Read more information on the Pharmacological Properties of Regaine and Minoxidil, Regaine's active ingredient.

How Regaine works

Regaine contains the active ingredient Minoxidil. The exact way in which Minoxidil works is not fully understood. It increases blood flow to hair follicles reducing hair loss and stimulating new growth. This produces thicker, longer, more-visible hair. Very little of the active ingredient is absorbed into the body.

Timescales

There is no hard and fast answer. With Regaine Extra Strength results may be seen after 8 weeks. Clinical studies have shown that for Regaine Regular Strength or Regaine Gel for men regrowth can occur as early as 16 weeks. But remember that everyone is different so you need to be patient. Studies suggest that Regaine should be tried for 6-12 months before deciding whether to continue.

The extra strength is for use only by men. Men can use Propecia (finasteride) tablets at the same time.

Regaine Extra Strength preparations

Regaine Extra Strength Solution and Foam Extra Strength for men, contains 5% minoxidil, one pack of either being enough for one month's use.

Regaine side effects and cautions

• You may notice a temporary increase in hair loss in the first 2-6 weeks. This is entirely normal and is good news – it shows that your hair is shifting from a dormant phase to an active growing phase.
• Regaine occasionally causes skin irritation that usually resolves when the treatment is stopped.
• Very little of the active ingredient, minoxidil, is absorbed into the circulation and therefore general side effects are not expected. You should stop using Regaine and see a doctor if hypotension (low blood pressure) is detected or if you experience chest pain, rapid heartbeat, faintness or dizziness, sudden unexplained weight gain, swollen hands or feet or persistent redness.
• People with known heart disease should contact their regular doctor before using Regaine Extra Strength for men.
• Very occasionally Regaine may cause unwanted hair growth in areas where it is applied regularly by accident. Follow instructions about use.

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

Authored 18 February 2010 by Dr Tony Steele
Last updated 16 August 2019

Reviewed by Dr Tony Steele
Last reviewed 15 August 2017