Pattern Hair Loss
Slow thinning at the temples and crown, or a widening part, usually inherited. Not a disease, but it can sting. Treatments can slow it and regrow some hair, but only while you keep using them.
How common: about 30–50% of men have pattern hair loss by 50. In an Australian study, crown or full baldness rose from 31% of men aged 40–55 to 53% at 65–69. Women get it too, usually as thinning across the top with a widening part.
Is it normal shedding? losing 50–100 hairs a day is normal. Sudden heavy shedding after illness, stress, weight loss or low iron is usually temporary. Round bald patches are a different condition.
Diagnosis: a GP can often tell by looking. Blood tests for iron or thyroid if the story suggests them. Women with irregular periods, acne or extra body hair should be checked for PCOS.
The hair loss ladder
Judge any treatment at 12 months, not 12 days, and expect the benefit to fade within months of stopping.
- Step 1 · PharmacyMinoxidil foam or solutionApplied to the scalp, once or twice a day.
- Works
- Women: about 26 in 100 get moderate regrowth vs 14 in 100 on placebo, and 2% works as well as 5%. Men: 5% twice daily works better than 2%
- Cost
- About $30–60 a month
- How long
- 6–12 months to judge; benefit fades within 4–6 months of stopping
- Watch for
- Extra shedding in the first 2–8 weeks (it settles), itchy scalp, facial hair. Not in pregnancy or breastfeeding.
The early shed is annoying, and usually a sign it’s working.
- Step 2 · PrescriptionFinasteride 1 mg (men only)A daily tablet that blocks the hormone that shrinks hair follicles.
- Works
- In a 5-year trial, men on placebo lost about a quarter of their hair count, while men on finasteride stayed slightly above where they started
- Cost
- Private script; generics are fairly cheap
- How long
- Ongoing; benefit is lost if you stop
- Watch for
- Lower sex drive or erection problems in about 1–2 in 100 (vs about 1 in 100 on placebo). Rarely, mood changes or depression: stop and see your GP. It also affects PSA test results.
The best-tested option for men, with side effects worth knowing.
- Step 3 · PrescriptionLow-dose minoxidil tabletsAn off-label tablet version for people who can’t manage the topical one.
- Works
- Small studies show regrowth; increasingly used
- Cost
- Private script; inexpensive
- How long
- 6–12 months to judge
- Watch for
- Extra hair on the face and body in about 15 in 100; fluid retention or a fast heartbeat are uncommon.
Easier than the foam, with fuzzier side effects.
- Step 4 · ProcedureHair transplantMoves hair from the back of the scalp, which resists balding, to thinning areas.
- Works
- Modern techniques achieve graft survival above 90%
- Cost
- Private; often thousands to tens of thousands of dollars
- How long
- Months for results
- Watch for
- Choose a qualified doctor. Surrounding hair can keep thinning.
Real results, real price tag.
- Step 5 · Self-careWigs, toppers and camouflageSynthetic or real-hair pieces, scalp fibres and styling.
- Works
- Instant and reliable
- Cost
- Varies widely; real-hair wigs cost more
- How long
- Synthetic wigs last 6–9 months; real hair 3–4 years
- Watch for
- Synthetic wigs can be hot and itchy.
Zero side effects. Excellent hair days.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Laser combs and capsIn women’s trials they weren’t clearly better than a fake device for how people rated their regrowth. Expensive for an uncertain gain.
- Biotin and “hair vitamins”No good evidence for pattern hair loss, and biotin can scramble thyroid blood tests.
- Commercial hair-loss clinicsOften expensive packages. See your GP first to confirm what’s going on.
- Finasteride for womenNot recommended for women, and in trials of female pattern hair loss it did no better than placebo.
What you can do
- Take photos every 3 months in the same light. Mirrors lie; photos don’t.
- Pick one treatment and stick with it for 12 months before judging.
- If you have heavy periods, ask for an iron check.
- If it’s getting you down, say so. Your GP can arrange support.
See your GP if
- Hair loss is sudden, patchy or rapid
- Your scalp is sore, red, scaly or scarred
- You also feel tired, have weight changes or other new symptoms
- You’re a woman with irregular periods, acne or extra body hair
- It’s affecting your mood or confidence
Not pattern hair loss? Sudden shedding, round bald patches, a sore or scaly scalp, or hair loss with other symptoms needs a GP check, because the cause and treatment are different.
Common questions
Does minoxidil regrow hair?
It can. In women, about 26 in 100 had moderate regrowth with minoxidil compared with 14 in 100 on placebo. It takes 6 to 12 months to judge and works only while you use it.
Do I have to use hair-loss treatment forever?
Yes, if you want to keep the benefit. Hair gained with minoxidil is lost within 4 to 6 months of stopping, and finasteride’s benefit also fades when stopped.
Does finasteride cause sexual side effects?
In trials, lower sex drive or erection problems affected about 1 to 2 in 100 men on finasteride, compared with about 1 in 100 on placebo. Rarely it can affect mood. Tell your GP if you notice changes.
Can women use finasteride for hair loss?
It is not recommended for women, and trials in female pattern hair loss found it worked no better than placebo. Minoxidil is the main option.
Helpful resources
- NHS: Hair lossCauses, treatments and wig options in plain English. Free, UK.
- Cochrane: Treatments for female pattern hair lossPlain-language summary of what works for women. Free.
Evidence and more information
- NHS: Hair loss
- NHS: Finasteride
- Cochrane 2016: Treatments for female pattern hair loss
- Endotext: Male androgenetic alopecia
maladywise.com/hair-loss/