Hair Loss in Men: A Dermatologist on What Actually Works

There are two body parts men care about the most, and one is hair. The other, I’ll let you fill in the blank. Today we’re talking about hair.

The most important thing in treating hair loss in men is to treat it early. It’s far easier to keep the hair you have than to try to resurrect dead or dying follicles. Start early, and the whole game gets easier.

The honest hierarchy

So what works best: hair transplant, oral medications, topical preparations, laser lights, or injections?

To me, the topicals, lasers, and injections are far inferior to the top two. Hair transplant and oral medications are what actually move the needle. Transplants are the most expensive route, and a lot of men wait until they’ve lost a significant amount of hair before considering one. That’s backwards. What we want to do is keep what you’ve got.

First: make sure it’s actually pattern baldness

If a medical condition is affecting your hair, the first thing to do is look at your scalp very closely. Most medical conditions, like lupus, lichen planus, alopecia areata, and fungal infections, present differently than standard male pattern balding. See a healthcare provider if you have:

• any scaling or redness in the scalp
• patches of hair loss
• sudden shedding
• a scalp that is extremely itchy or has sores in it

If you have the classic pattern instead, thinning at the temples and the crown with a completely normal scalp, then chances are you have typical androgenetic (male pattern) baldness, and everything below applies to you.

Keep what you’ve got: the foundation

Start with being healthy. It sounds basic because it is:

• Exercise
• Get good sleep
• Keep stress down

And here’s the supplement truth most people don’t want to hear: vitamins and supplements are not necessary if you’re not deficient and you eat a good diet. You can test the relevant things: B12, biotin, iron, thyroid, and zinc. But if you eat well and you’re not deficient, supplements are unlikely to grow hair. And don’t take biotin if you’re not deficient in it. It can interfere with lab results and will offer you no benefit.

The oral medications that really help

There are three:

• Finasteride
• Dutasteride, which, like finasteride, blocks the enzymes that convert testosterone into DHT, the hormone that shrinks hair follicles
• Oral minoxidil, which works differently: it’s a vasodilator, widening blood vessels to deliver more oxygen and nutrients to the follicle and extending the hair’s growth phase

Worth knowing: a new form of minoxidil is expected in the next year or two, a sustained-release tablet. The current version has a short half-life, and the sustained-release form has outperformed it for hair growth in development. This category is still improving.

One expectation to set before you start: give the oral medications six months before judging whether they’re working. Hair moves on a slow clock, and quitting at month two tells you nothing.

The supporting cast

• PRP or PRF injections help approximately 50% of patients with hair loss.
• Low-level laser light therapy, including medical-grade laser caps, can be complementary.
• Shampoos can help if you’re just starting to thin: ketoconazole shampoo, Dercos, Anaphase, shampoos with saw palmetto or caffeine, and KeraFactor. But a shampoo will not produce a big change for someone with significant hair loss.
• There have also been reports of rosemary oil and microneedling helping hair growth.

These are the milder treatments. In my opinion, the oral medications and hair transplantation offer a more aggressive and effective approach for men with hair loss.

The bottom line

Treat early. Keep what you’ve got with the medications that actually work, live like your follicles depend on your health, and save the heroics for later. The men with the best outcomes at 50 are the ones who started paying attention at 30.

Exploring your options? See our guide to what works for hair loss and compare PRP hair restoration providers by city.