OTC minoxidil has the trade name of Regaine. There are many generic forms.

Originally branded as 2% for women & 5% for men, it is now widely accepted that the stronger formulation is better for both.

Compounded minoxidil usually ranges from 5 to 8% minoxidil most often with retinoic acid/tretinoin. It is postulated that the addition of a retinoid can increase the potency of topical. Minoxidil can also be combined with finasteride or dutasteride. Recent papers have shown that this combination works better than either formulation as a stand-alone.

*Caution in patients allergic to propylene glycol.

**Disclaimer: I do not prescribe medications for hair loss as my work is procedural. For compounded solutions discuss with your medical dermatologist.

Finasteride is a medication prescribed by dermatologists to treat male pattern baldness. It works by reducing the conversion of testosterone to dihydrotesterone via the inhibition of 5 alpha reductase (as opposed to minoxidil which works by prolonging the growth phase of hair follicles).

Traditionally, finasteride is prescribed as an oral medication with dose ranges from 1 to 5 mg daily. Side effects include loss of libido & fatty breast tissue (rare). Nevertheless, many male patients would like to avoid taking finasteride orally. Recent studies have suggested that a combination of finasteride 0.25 to 1.0%, combined with minoxidil 5% may give optimal results compared to monotherapy.

Topical formulations of finasteride can also be prescribed for some cases for hair loss in females. The risk benefit ratio can be discussed with your medical dermatologist. 

Yes, but you are paying a premium for rebranded topicals & orals. The majority of clinics rebrand topicals such as minoxidil, & triple the price. They often do the same for oral therapy & vitamins.

A DIY hack that will save you money is-

• Minoxidil 5% from Chemist Warehouse. Bulk 180 ml, 3 month supply.
• Saw palmetto vitamins from chemist
• Option for minoxidil 1-2 mg daily (GP prescription)
• Option for *finasteride 5 mg tab, break in half, take every second day (GP prescription)

*Oral minoxidil & finasteride can be obtained from any general practitioner. Finasteride use for males only. Female pattern hair loss can be treated with oral minoxidil with the option for anti-androgens.

Shampoos can be effective if hair loss is secondary to inflammatory conditions such as seborrheic dermatitis (dandruff) or psoriasis.

In the context of male & female pattern baldness/alopecia the answer is not clear cut. There are many formulations containing zinc, biotin, niacin, caffeine, keratin, & botanicals. The most active ingredients inhibit conversion of testosterone to dihydrotestosterone (DHT).

• A study in 2004 showed that ketoconazole shampoo can effectively block the formation of DHT.
• Another study found that using a 2% ketoconazole shampoo was nearly as effective for hair growth as 2% minoxidil (Piérard-Franchimont, 1998). That’s pretty significant, as shampoo is directed to be washed off after a few minutes, while minoxidil is left on the scalp all day.
• An animal study comparing ketoconazole to minoxidil and minoxidil with tretinoin had a “significant stimulatory” effect on hair growth, although minoxidil was found to be more effective (Aldhalimi, 2014).

My viewpoint: in the scheme of things, shampoos are cost effective- even if the true effects are marginal. The most robust scientific backing is the use of ketoconazole 2% shampoo, namely Nizoral. This can be purchased from most pharmacies & cost less than $12.

PRP stands for platelet rich plasma. This naturally sourced topical treatment provides growth factors & anti-inflammatory chemokines to both hair & skin. I have been using PRP for the past 8 years, initially for scar revision & skin rejuvenation. The outcomes were marginal at best (in the context of skin directed therapy)

On the contrary, PRP for hair regrowth is much more successful (as reflected in the scientific literature). PRP increases hair counts, hair diameter & reduces miniaturization of the hair follicle.

Indication: Early onset androgenetic alopecia in men & women.

Frequency: Monthly of 3 months, spacing out to q 4-6 months to maintain.

Ideally: Used with FUE & medical treatments

There are several methods dermatologists use to enhance topical absorption for hair loss products.

1. Enhanced topical penetration can be achieved with addition of ingredients such as propylene glycol & tretinoin.
2. Simple at home microneedling can markedly improve cutaneous absorption of minoxidil, finasteride & topical Use a 0.2 to 0.25 DermaRoller or stamper (eBay or Amazon). Prices range from $2 to $6. Roll weekly, apply topicals post treatment. With proper technique this can be a highly effective way to enhance topicals for hair growth. 
3. Lasers can be useful. Dermatologists employ topical enhancing lasers including Thulium 1927 low density for enhanced penetration of topicals. Laser therapy without topicals have been shown to markedly improve hair counts, reduce miniaturization of follicles, as well as improve hair density. We often use lasers in combination with topicals & PRP as this has enhanced efficacy compared to either therapy alone.

You can add supplements to your routine. Recent studies have shown that saw palmetto (vitamin supplements) combined with topical minoxidil increases hair growth more than either treatments used as monotherapy.

Vitamins including B12, biotin, D, E, C & iron are indicated if you have deficiencies. Regardless, they are banal & cost effective.

Topicals are super affordable. Minoxidil (Previously branded as Regaine) is ¼ the price it was 2 decades ago. As a guide-

• Minoxidil 5% 30mls $15: about 50 cents a day.
• Compounded Minoxidil 5-7% + Retinoic Acid: about $1.20 a day
• Topical Finasteride. Approx $1.50 a day
• Finasteride/ dutasteride. Approx. $1 a day
• Minoxidil orally. Approx. $80 cents a day
• Ketoconazole  /Nizoral shampoo. $12 for 1-2 months

* A cost-effective routine based upon research is the use of minoxidil 5% daily (up to twice a day) & 2% ketoconazole shampoo. This cost approximately 60 to 70 cents/day.

Ideally topical treatments should be combined with other modalities aimed at preserving follicles, & in some cases regenerating hair growth.

Oral medications include oral minoxidil, finasteride & dutasteride. We also prescribe antiandrogens in women, namely cyproterone acetate or spironolactone.

Light based treatments include LLLT or low-level laser treatments, using diode based sources.

Laser treatments include the use of LaseMD, thulium 1927 low density, often in combination with growth factors & or PRP.

PRP or platelet rich plasma is best for early onset hair loss. This can be applied with microneedling, laser therapy as well as injections.

FUE or follicular unit extraction is a surgical procedure used to treat advanced cases of hair loss. This procedure has essentially replaced older techniques such as follicular unit transplantation & strip harvesting.

If you have early & mild hair loss, due to androgenetic alopecia, early treatment can slow down this process. Minoxidil 5% can be obtained from any major pharmacy.

For more complex treatment strategies, discuss medical options with your dermatologist. They can initiate medical therapy including topical or oral finasteride / dutasteride in men as well as anti-androgen in females.

Dermatologists can also supervise PRP, PRP microneedling, low level laser therapy & laser procedures to stimulate hair growth. In advanced cases they can discuss the option for follicular unit extractions. Inflammatory conditions including complex lichen planopilaris, lupus, FDC & alopecia areata are also managed by medical dermatologists.

Disclaimer: My work is procedural. In the context of hair conditions, I only see complex cases of alopecia for the option of surgical management. I do not prescribe medical treatments. Please make an appointment with our medical team @cliniccutis