- Best Results4-6 months
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistMedical Dermatologist
- Duration of ResultsDecades
- Back to WorkNA
Topical Treatments for Hair Loss
Simple topical treatments such as minoxidil can markedly slow down hair loss in men & women. In many cases hair regrowth can be seen within 4- 6 months of therapy. This is a cost-effective alopecia treatment. Topicals can be used pre & post follicular unit extraction & hair transplantation. Topicals can also be used with lasers & PRP to improve hair density.
FactsFacts on Topical Treatment for Hair Loss
- Minoxidil is an over-the-counter lotion or foam for male/female pattern hair loss
- The 5% concentration is better than 2%
- Minoxidil works best for early stage hair loss
- Other topicals include finasteride & dutasteride lotion
- Shampoos include topical ketoconazole
- Minoxidil with finasteride topically is a promising combination for male & in some cases female pattern hair loss
- Topical treatments are best combined with medical therapy including PRP, low level lasers & fractional thulium
- Advanced cases are treated with follicular unit extraction & transplantation
What types of hair loss are amenable to topicals?
Topicals work best for early-stage androgenetic alopecia or male/female pattern baldness. The most widely used & studied topical is minoxidil, also known as Regaine or Rogaine.
Minoxidil is best used to slow down hair loss, however up to 40% of uses will obtain regrowth. This regrowth is best seen in the vertex or crown areas. Topicals are less effective for growing hair in the hairline or sides.
What is minoxidil & does it work?
Minoxidil is a hair loss treatment approved by the FDA since 1988. It comes as a liquid or foam applied to the scalp twice a day to slow or stop the progression of male & female pattern baldness.
To maintain results, it must be used continuously — if you stop using the medication, the new hair growth may reverse, and hair loss will continue.
Minoxidil tends to work best in early stage androgenetic alopecia (balding). Once hair loss spreads over a large area and has persisted for a long time, minoxidil is less likely to produce benefits. Basically, the younger you are, and the sooner you start minoxidil, the better the results tend to be.
The effects of minoxidil can be compounded with supplementation, oral medications, as well as procedures such as PRP, & lasers.
How does minoxidil work?
Minoxidil was initially prescribed as an oral medication to treat high blood pressure. By coincidence researchers discovered that some patients developed hair regrowth. The use of topical minoxidil was approved in 1988. Fast forward to 2021, minoxidil is now trending as an oral medical treat yet again (The Hairy Pill).
Minoxidil seems to work as a peripheral vasodilator. That means it helps improve blood flow to the hair follicles. This provides nutrients to the hair follicles, stimulating hair growth.
Unlike finasteride—which works by suppressing the androgen DHT, which can attack hair follicles—minoxidil has no effect on hormones.
Clinically minoxidil increases the hair’s growth cycle (anagen) & reduces the hair’s sleeping cycle (telogen). This results in thicker hair follicles with less miniature follicles per square area.
How long does it take for topicals to take effect?
4 to 6 months. This applies to minoxidil as well as combinations with finasteride. The 5% formulation works faster than 2%.
Some people may experience paradoxical hair loss when they first start using minoxidil. This is normal and is a result of the hair follicles shifting from the resting to the growth phase.
If your hair loss hasn’t slowed after several months of using minoxidil, it’s a good idea to consult a medical dermatologist. Ideally topicals should be combined with medical therapy.
What does a basic hair loss topical routine look like?
This guide refers to male/female pattern androgenetic alopecia.
Stage 1: Minoxidil 5% once to twice a day. Supplement with saw palmetto. Shampoo with Nizoral 3-5 times per week. You can obtain this from any pharmacy.
Stage 2: As above. Option to add minoxidil 1-2 mg orally. Men: option for finasteride/dutasteride. Women: option for cyproterone acetate / spironolactone.
Stage 3: As above. Option to add PRP monthly for 3 months, followed by 6 mth PRP. Option to add low level lasers or thulium fractional laser.
Stage 4: As above. Option for FUE- follicular unit extraction
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What is the difference between minoxidil OTC vs compounded minoxidil?
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.
What is topical finasteride?
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.
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Do products from ‘hair loss clinics’ work?
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.
Can shampoos treat hair loss?
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.
What is the evidence with PRP topically & hair loss?
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
How can you optimise topicals for hair loss?
There are several methods dermatologists use to enhance topical absorption for hair loss products.
- Enhanced topical penetration can be achieved with addition of ingredients such as propylene glycol & tretinoin.
- 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.
- 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.
Do supplements help?
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.
What is the cost of topical therapy?
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.
What are proven adjunctive medical treatments for hair loss?
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.
Who should you see for hair loss?
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
Davin’s Viewpoint on Topical Hair Loss Treatments
Topicals for hair loss are akin to sunscreen for skin. Prevention is the aim of treatment.
The human scalp contains approximately 100,000 follicles. In time this number decreases. Over 80% of men, & 24% of women will experience clinically evident balding. Slowing down the progression of hair follicle miniaturization early in the process is the most effective & cost-effective way to treat hair loss. This applies to early-stage alopecia all the way to post hair transplant maintenance.
If there is a family history of hair loss, especially in males, start topical treatments early. This may be as early as in the late teens to early 20s. A simple routine is once daily 5% minoxidil to the vertex or crown areas, & if indicated to the frontal hairline & sides (frontoparietal areas). Remember, the aim is to slow down the progression of hair loss. In 40% of cases, hair may re-grow. This is usually in the vertex area.
From there add supplementation with saw palmetto, obtained from any pharmacy. If there is progression of hair loss, you may benefit from medical intervention from a dermatologist. Oral medications for men include 5 alpha reductase blockers. These tablets block the formation of dihydrotesterone or DHT. For females, anti-androgens can be used, including cyproterone acetate, spironolactone & newer analogues of flutamide.
Physical modalities such as low-level laser, platelet rich plasma & fractional thulium laser can preserve the hairline, & in most cases regrow hair. Follicular unit extraction is the end treatment. Even after FUE, topicals are paramount in preserving the remaining follicles.
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