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Minoxidil is a widely used medication for treating androgenic alopecia (AGA) in both men and women. Originally developed as a treatment for high blood pressure, minoxidil was found to improve hair growth outcomes as a side effect, making its topical form one of only two (the other being finasteride) FDA-approved treatments for AGA. 

Minoxidil is primarily available in two forms: topical and oral. The topical form, which includes both solutions and foams, is more commonly used and can be purchased over the counter. Oral minoxidil, however, is prescription only and is typically given at doses of 2.5 mg or 5 mg for hair loss treatment.

While minoxidil is generally considered safe, it’s important to understand its potential side effects and who might be more at risk from them. In this article, we will examine the side effects of topical and oral minoxidil and discuss how you can adjust your treatment regimen to mitigate these.

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How Does Minoxidil Work?

Minoxidil was originally developed as an antihypertensive medication. However, when treated participants started experiencing hypertrichosis (excessive hair growth), studies were conducted to find out if it could improve hair regrowth outcomes in humans (spoiler alert – it could!).^[1]Bryan, J. (2011). How minoxidil was transformed from an antihypertensive to hair-loss drug. The Pharmaceutical Journal. Available at: … Continue reading

Minoxidil’s mechanism of action is not fully understood, but it is thought to work through two main mechanisms:

• Vasodilatory effects: It activates vascular endothelial growth factor (VEGF), increasing blood flow, oxygen, and growth factor delivery to the hair follicle.^[2]Alhayaza, G., Hakami, A., AlMarzouk, L.H., Al Qurashi, A.A., Alghamdi, G., Alharithy, R. (2023). Topical minoxidil reported hair discoloration: a cross-sectional study. Dermatology Reports. 16(1). … Continue reading 
• Potassium channel activation: This prolongs the growth (anagen) phase and shortens the resting (telogen) phase. 

Research also shows that minoxidil can act on androgenic receptors, suppressing the expression of the androgen receptor and CYP17A1 and boosting the activity of CYP19A1. This decreases the formation and binding of dihydrotestosterone and enhances the production of estradiol, which may also benefit those with AGA.^[3]Shen, Y., Zhu, Y., Zhang, L., Sun, J., Xie, B., Zhang, H., Song, X. (2023). New Target for Minoxidil in the Treatment of Androgenetic Alopecia. Drug Design, Development and Therapy. 17. 2537-2547. … Continue reading 

How is Minoxidil Activated in the Body?

Minoxidil needs to be converted into its active form, minoxidil sulfate, by sulfotransferase enzymes before it can effectively stimulate hair growth.^[4]Dhurat, R., Daruwalla, S., Pai, S., Kovacevic, M., McCoy, J., Shapiro, J., Sinclair, R., Vano-Galvan, S., Goren, A. (2021). SULT1A1 (Minoxidil Sulfotransferase) enzyme booster significantly improves … Continue reading This conversion primarily occurs in the scalp for topical minoxidil and in the liver for oral minoxidil.

However, enzyme activity varies significantly among individuals, meaning that some people naturally produce higher levels of sulfotransferase, allowing for better activation and increased effectiveness of the drug, while others have lower enzyme activity, which can limit its impact. You can read our article on how your genetics can influence sulfotransferase activity here.

Topical Minoxidil Vs. Oral Minoxidil: Activation Pathways

Topical minoxidil and oral minoxidil differ in application and effectiveness. Topical minoxidil is applied directly to the scalp, while oral minoxidil is taken as a pill. 

The efficacy of these two treatment routes differs because of their distinct metabolic pathways. 

Topical Minoxidil

Topical minoxidil is applied directly to the scalp, presenting a challenge for drug activation. The drug requires conversion to its active form, minoxidil sulfate, by sulfotransferase enzymes in the scalp. However, research has shown that 40-60% of people may lack sufficient enzyme levels to effectively activate the medication. This enzymatic variability means that for many users, topical minoxidil may not be 100% effective.

Around 1.4% of topical minoxidil is systemically absorbed, further limiting minoxidil efficacy. To counteract this limitation, researchers have explored combining minoxidil with treatments like microneedling or retinoic acid. It was found that with these combinations, minoxidil efficacy can significantly increase.^[6]Lama, S.B.C., Pérez-González, L.A., Kosoglu, M.A., Dennis, R., Ortega-Quijano, D. (2024). Physical Treatments and Therapies for Androgenetic Alopecia. Journal of Clinical Medicine. 13(15). 4534. … Continue reading 

Oral Minoxidil

Oral minoxidil, however, is metabolized in the liver, where sulfotransferase enzymes are abundant. The activated minoxidil sulfate then enters the bloodstream, where it reaches the hair follicle. Studies consistently demonstrate higher response rates for oral minoxidil compared to topical.^[7]Gupta, A.K., Talukder, M., Venkataraman, M., Bamimore, M.A. (2022). Minoxidil: a comprehensive review. Journal of Dermatological Treatment. 33(4). 1896-1906. Available at: … Continue reading However, because oral minoxidil involves systemic absorption, it comes with a broader potential for side effects.

What Are the Side Effects of Topical Minoxidil?

Common Side Effects

While topical minoxidil typically has a great safety profile, there are some side effects that people can experience.

Common side effects include:

• Scalp Irritation and Contact Dermatitis: Redness, itching, flaking, and burning sensations. 

These are the most frequently reported side effects from minoxidil. One retrospective study found that 6.4% of men reported mainly irritant and allergic reactions to minoxidil.^[8]Shadi, Z. (2023). Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia. Dermatology and Therapy (Heidelb). 13(5). 1157-1169. Available at: … Continue reading These effects are typically due to an allergic reaction to propylene glycol rather than the minoxidil itself.^[9]Lessmann, H., Schnuch, A., Geier, J., Uter, W. (2005). Skin-sensitizing and irritant properties of propylene glycol. Contact Dermatitis. 53(5). 247-259. Available at: … Continue reading 

To mitigate the negative skin effects of topical minoxidil, you can do several things. Starting with a lower concentration, such as 2% instead of 5%, can reduce the risk of irritation while still providing benefits. Additionally, reducing application frequency from twice to once daily can limit exposure. Switching to a foam-based minoxidil product can be particularly effective, as these formulations typically don’t contain propylene glycol, which is often responsible for uncomfortable side effects like irritation, redness, and scalp burning. Furthermore, incorporating a moisturizer into your scalp care routine can help keep the skin hydrated and comfortable, further alleviating potential irritation.

• Shedding Phase: Temporary increase in hair loss when starting treatment.

One study reported that 55% of topical minoxidil users experience minoxidil shedding.^[10]Ghonemy, S., Bessar, H., Alarawi, A. (2019). Efficacy and safety of a new 10% topical minoxidil versus 5% topical minoxidil and placebo in the treatment of male androgenetic alopecia: a trichoscopic … Continue reading This is considered a normal side effect and usually indicates that the treatment is working. The shedding phase typically begins 2 to 4 weeks after starting treatment and subsides within 6 to 8 weeks as the hair cycle normalizes. After a few months of continuous use, most users should start seeing visible new hair growth.^[11]Kaiser, M., Abdin, R., Gaumond, S.I., Issa, T. N., Jiminez, J.J. (2023). Treatment of androgenetic alopecia: current guidance and unmet needs. Clinical Cosmetic and Investigational Dermatology. 16. … Continue reading 

• Facial Hypertrichosis: Unwanted excess facial hair. 

Women, especially those over 50 or with pre-existing facial hair, seem to be at higher risk of developing hypertrichosis from topical minoxidil use, and as with other side effects, it is more common when using the 5% than the 2% concentration.^[12]Dawber, R.P.R, Rundegren, J. (2003). Hypertrichosis in females applying minoxidil topical solution and in normal controls. Journal of the European Academy of Dermatology and Venereology. 17(3). … Continue reading 

There are several theories for why hypertrichosis occurs in people using topical minoxidil. 

1. Product application: The product wasn’t applied carefully enough or was not completely dried before bed, leading to product transfer from the pillow to the face. However, this doesn’t account for hypertrichosis seen away from the site of application and is unlikely to cause the effects seen in case studies.
2. Percutaneous absorption: Although topical minoxidil is primarily intended for local effects, a small amount can be absorbed systemically through the skin. This can lead to circulating minoxidil reaching hair follicles in distant areas of the body. 
3. Follicular hypersensitivity: Some people may have hair follicles that are exceptionally responsive to minoxidil. In these cases, even minimal systemic exposure might be sufficient to stimulate hair growth in distant follicles. This hypersensitivity appears to occur randomly, depending on the person.
4. Dose-dependent response: Higher concentrations are more likely to cause hypertrichosis.

While hypertrichosis can occur, it is generally reversible once minoxidil treatment is stopped and typically resolves within 3-4 months.

There are a number of ways that hypertrichosis can be avoided or treated once it occurs. 

Starting with a lower concentration can reduce the risk, especially for women and those with a history of excess facial hair. Careful application to the scalp only, allowing proper drying time, and adhering to the recommended dosage can also minimize systemic absorption and unintended spread.

Switching to a foam version may help those experiencing side effects. If you are experiencing mild hypertrichosis and don’t want to stop using minoxidil, you could use hair removal methods while continuing treatment. 

For more severe cases, spironolactone (~25 mg daily) ando/or low-dose bicalutamide (~10 mg daily) have shown promise in managing minoxidil-induced hypertrichosis. However, these medications should be used under medical supervision.^[14]Darendeliler, F., Bas, F., Balaban, S., Bundak, R., Demirkol, D., Saka, N., Gunoz, H. (1996). Spironolactone therapy in hypertrichosis. European Journal of Endocrinology. 135(5).604-608. Available … Continue reading,^[15]Moussa, A., Kazmi, A., Bakhari, L., Sinclair, R.D. (2022). Bicalutamide improves minoxidil-induced hypertrichosis in female pattern hair loss: a retrospective review of 35 patients. Journal of the … Continue reading 

• Headaches

Some people also experience headaches after using topical minoxidil. One study found that in users applying 2% minoxidil solution, 0.6% reported headaches, compared to 3% of participants using 5% minoxidil solution.^[16]Suchonwanit, P., Thammarucha, S., Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. 13. 2777-2786. Available at: … Continue reading

Some people may simply experience headaches due to the smell of the product they are using, in which case, switching to an alcohol-free or unscented alternative may help. Others may be particularly sensitive to minoxidil and its vasodilatory effects, which might contribute to headaches. In this case, switching to a lower concentration or consulting with a healthcare provider might be preferable.

Some of our members have also switched to nanoxidil, an analogue of minoxidil that may offer a better safety profile (you can read more about the research quality of nanoxidil here), and found that their headaches resolved.

The above side effects are more often seen in the 5% than 2% solutions and are typically considered to be non-serious.^[17]Nestor, M.S., Ablon, G., Gade, A., Han, H., Fischer, D.L. (2021). Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of … Continue reading

Some of the rarer side effects include:

• Water Retention

While less common than with oral minoxidil, topical minoxidil application can lead to water retention. Some topical minoxidil users have reported under-eye bags, which may be due to increased water retention near the application areas. There are also anecdotal reports of “puffy face” from topical minoxidil application, suggesting localized fluid retention.^[18]Gungor, S., Kocaturk, E., Topal, I.O. (2015). Frontal Edema Due to Topical Application of %5 Minoxidil Solution Following Mesotherapy Injections. International Journal of Trichology. 7(2). 86-87. … Continue reading 

Anecdotally, there have also been reports of swollen feet and weight gain from using topical minoxidil; however, we couldn’t find these reports reflected in peer-reviewed literature. These effects may also stop with continued use of the drug, so some people keep an eye on the symptoms and wait to see if they go away.

However, you can try reducing the concentration or frequency of usage if the symptoms continue longer than you are comfortable with. Furthermore, excessive salt intake can exacerbate symptoms of edema. Limiting salt intake may help you resolve the edema without having to stop using minoxidil.^[19]Patel, P., Nessel, T.A., Kumar, D. (2023). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482378/ (Accessed: … Continue reading

• Cardiovascular Issues

Some people also experience cardiovascular side effects. One case study found that applying large amounts of 2% topical minoxidil led to hypotension (low blood pressure) and feelings of faintness.^[20]Ponomareva, M.A., Romanova, M.A., Shapshnikova, A.A., Piavchenko, G.A. (2024). Topical Minoxidil Overdose in a Young Man with Androgenetic Alopecia: A Case Report. Cureus. 16(6). E62382. Available … Continue reading Another case also documented low blood pressure and fainting after applying 12.5% topical minoxidil daily.^[21]Dubrey, S.W., vanGriethuysen, J., Edwards, C.M.B. A hairy fall: syncope resulting from topical application of minoxidil. BMJ Case Reports. 1-2. Available at: https://doi.org/10.1136/bcr-2015-210945 

Other people may experience heart palpitations, feelings of the heart beating rapidly or “skipping a beat”. While this is rare, one study found that 3.5% of women developed heart palpitations or a rapid heart rate after usage of 2% topical minoxidil solution compared to 1.8% who were using a 5% foam.^[22]Blume-Peytavi, U., Hillmann, K., Dietz, E., Canfield, D., Bartels, N.G. (2011). A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the … Continue reading

Therefore, we would recommend seeking medical advice and potentially finding a new treatment for hair loss if you experience these side effects.

So we’ve covered the side effects of topical minoxidil, but what about oral?

What Are the Side Effects of Oral Minoxidil?

Oral minoxidil side effects are similar to those of topical minoxidil, and both forms exhibit dose-dependent effects. However, oral administration leads to significantly greater systemic exposure to the drug than topical application. As a result, oral minoxidil typically produces more pronounced hair regrowth and more pronounced systemic side effects. It should be noted that use of oral minoxidil to improve hair regrowth is an off-label use of the drug and it is not FDA-approved for this indication.

Common Side Effects

• Hair Shedding

Like with topical minoxidil, you may experience increased hair shedding when you start taking minoxidil. This is considered to be a normal part of the hair cycle remodeling process, typically beginning two to four weeks after starting treatment and subsiding within six to eight weeks as the hair cycle normalizes. 

• Hypertrichosis

While rare with topical minoxidil use, one of the most frequently reported side effects of oral minoxidil is hypertrichosis, which involves excessive hair growth on various parts of the body. This effect is dose-dependent, with some studies showing that increasing the dosage of oral minoxidil by just 1 mg daily is associated with a 17.6% increased risk of hypertrichosis.^[23]Gupta, A.K., Hall, D.C., Talukder, M., Bamimore, M.A. (2022). There is a Positive Dose-Dependent Association between Low-Dose Oral Minoxidil and Its Efficacy for Androgenetic Alopecia: Findings from … Continue reading 

Hypertrichosis frequently occurs on the face (sideburns, temples, upper lip, and chin), with rarer cases of generalized hypertrichosis occurring over the whole body.^[24]Desai, D.D., Nohria, A., Brinks, A., Needle, C., Shapiro, J., Lo Sicco, K.I. (2024). Minoxidil-induced hypertrichosis: Pathophysiology, clinical implications, and therapeutic strategies. JAAD … Continue reading 

• Fluid Retention

Fluid retention is another common side effect of oral minoxidil, occurring in about 1.3% of patients.^[25]Trueb, R.M., Caballero-Uribe, N., Luu, N.N.C., Dmitriev, A. (2022). Serious complication of low-dose oral minoxidil for hair loss. JAAD Case Reports. 30. 97-98. Available at: … Continue reading This can manifest as mild swelling in the face, hands, or feet. In some cases, it may lead to rapid weight gain. 

This weight gain can be significant and sudden, with some patients experiencing up to 20 pounds of weight gain (as water weight) in as little as one month.^[26]Patel.K., Omar, J. (2023). Low dose oral minoxidil causing peripheral edema and rapid weight gain. Journal of General Internal Medicine. 38(Suppl 3). S592. Available at: … Continue reading

Fluid retention can manifest in several ways:

1. Peripheral edema: Swelling in the extremities, particularly in the legs, ankles, and feet.
2. Facial swelling: Puffiness or swelling in the face.
3. Overall weight gain: A sudden increase in body weight, often 5 pounds or more.

This rapid retention can be concerning for patients and may lead to additional health risks if left unmanaged. Excess fluid in the body can potentially lead to congestive heart failure if not properly addressed.

To mitigate these side effects, there are a number of options:

• Use of diuretics: Doctors can prescribe a diuretic (water pill) alongside minoxidil to help counteract fluid retention. This is typically a low-dose loop diuretic.
• Sodium restriction: Limiting sodium intake can help reduce fluid retention. Patients are often not advised about this when starting minoxidil, which can exacerbate the problem.
• Dose adjustment: If fluid retention becomes severe, temporarily discontinuing minoxidil or significantly reducing the dose may be necessary. This allows the edema to resolve naturally before restarting at a lower dose.
• Regular monitoring: Daily weight monitoring can help identify fluid retention early, making it easier to manage.
• Gradual titration: Slowly increasing the dose of minoxidil over time, rather than starting with 5 mg, can help minimize side effects.

If these symptoms don’t resolve when trying these strategies, then it’s recommended to visit your doctor and potentially stop taking minoxidil.

• Lightheadedness, Tachycardia (high heart rate), Headache and Insomnia

Oral minoxidil can cause several cardiovascular and neurological side effects, including lightheadedness, tachycardia, headache, and insomnia.^[27]Trueb, R.M., Caballero-Uribe, N., Luu, N.N.C., Dmitriev, A. Serious complication of low-dose oral minoxidil for hair loss. JAAD Case Reports. 30. 97-98. Available at: … Continue reading These effects are generally dose-dependent and more common at higher doses.

Lightheadedness has been reported to occur in 1.7% of patients, tachycardia in 0.9%, headache in 0.4%, and insomnia in 0.2% of patients. These can all be symptoms of decreased blood pressure due to minoxidil’s vasodilatory properties. 

Headaches and insomnia are reported in around 0.4% and 0.2% of patients, respectively, using low-dose oral minoxidil. While the exact mechanism of these side effects is not clear, it is thought that it could be related to the vasodilatory effects of the drug.

What Are The Cardiovascular Concerns of Oral Minoxidil Usage?

The severity and frequency of cardiovascular side effects are closely tied to the dosage of oral minoxidil. A meta-regression analysis found a positive dose-dependent correlation between low-dose oral minoxidil and the risk of cardiovascular adverse events.

Low Dose (0.25-1.25 mg/day)

At lower doses, oral minoxidil is generally well-tolerated. Women typically start with doses ≤ 1 mg, which minimizes the risk of significant side effects. Lower doses are considered to be a safer starting point for most patients, and even very low doses (0.25 mg/day) have shown efficacy in some studies.^[28]Ramírez-Marín, H.A., Tosti, A. (2022). Role of oral minoxidil in patterned hair loss. Indian Dermatology Online Journal. 13(6). 729-733. Available at: https://doi.org/10.4103/idoj.idoj_246_22 If you are experiencing side effects at higher doses, you can reduce your dose at home using a pill cutter.

Moderate Dose (2.5-5 mg/day)

Men may be prescribed up to 5 mg of minoxidil daily, which can increase the likelihood of side effects such as dizziness and fluid retention. A recent study examined the effects of 7.5 mg/day oral minoxidil in patients with normal blood pressure and AGA.^[29]Sanabria, B.D., Perdomo, Y.C., Miot, H.A., Ramos, P.M. (2024). Oral minoxidil 7.5 mg for hair loss increases heart rate with no change in blood pressure in 24 h ambulatory blood pressure monitoring. … Continue reading The results showed a mild increase in heart rate but no significant changes in blood pressure, suggesting that doses slightly higher than the typical 5 mg can be tolerated. However, this should only be considered under medical supervision.

High Dose (10 mg/day and above)

Doses above 10 mg daily are associated with a higher risk of serious cardiac events and are typically not recommended for hair loss treatment. The hypotensive effect of oral minoxidil becomes more significant at these higher doses and is often prescribed alongside beta blockers and diuretics to manage the side effects.

How Can I Mitigate Oral Minoxidil Side Effects?

We have covered a number of ways to mitigate oral minoxidil side effects, but there are some further ways that you can adjust the use of minoxidil to reduce your risk.

Split-Dosing

Splitting the daily dosage of oral minoxidil into two administrations, one in the morning and one in the evening, can potentially optimize its efficacy while minimizing side effects. This approach is based on the pharmacokinetics of oral minoxidil, which has a relatively short half-life of approximately 3-4 hours.^[31]Vano-Galvan, S., Pirmez, R., Hermosa-Gelbard, A., Moreno-Arrones, O.M., Saceda-Corralo, D., Rodrigues-Barata, R., Jiminez-Cauhe, J., Koh, W.L., Poa, J.E., Jerjen, R., de Carvalho, L.T., John, J.M., … Continue reading 

By dividing the total daily dose, you can maintain more consistent blood levels of minoxidil throughout the day, potentially leading to more stable hair growth stimulation. For example, if 5 mg is prescribed daily, taking 2.5 mg in the morning and 2.5 mg in the evening may be more beneficial than a single 5 mg dose.

Sublingual Minoxidil

Some recommend using sublingual minoxidil as an alternative to traditional oral minoxidil. Sublingual administration involves a tablet that dissolves under the tongue. One 2021 randomized, double-blind, placebo-controlled phase 1b clinical trial investigated this delivery method.^[32]Bokhari, L., Jones, L.N., Sinclair, R.D. (2021). Sublingual minoxidil for the treatment of male and female pattern hair loss: a randomized, double-blind, placebo-controlled, phase 1B clinical trial. … Continue reading The study tested daily doses of 0.45 mg to 4.05 mg of sublingual minoxidil. 

This method offers several advantages:

1. Bypasses first-pass metabolism in the liver.
2. It allows for direct entry into the bloodstream, which can travel inactivated to the scalp and be activated by sulfotransferase at the site.
3. Reduces systemic side effects.
4. Improves bioavailability.

Key findings from the study included a dose-dependent improvement in hair parameters, with reduced side effects compared to oral minoxidil and no significant effect on blood pressure. In the blood, peak serum concentrations of minoxidil were only 10% of those seen with typical oral minoxidil.

At the 24-week follow-up, approximately 45% of patients in the 0.45 mg sublingual minoxidil group experienced improvements in frontal hair density, and 55% showed vertex improvement. Higher doses (4.05 mg) led to further results, with nearly 67% of patients experiencing improvements in both frontal and vertex hair density. 

Sublingual minoxidil appears to be particularly beneficial for people concerned about the side effects of oral minoxidil. The medication was undetectable in plasma after 24 hours, and the mean peak minoxidil plasma concentration was significantly below the threshold associated with changes in blood pressure.

While the results are promising, it should be noted that this is the only study using sublingual minoxidil for AGA, and further studies with larger patient numbers are needed.

Switch To Topical Minoxidil

There is a chance that none of these options will work out for you, so you can try to switch to topical minoxidil. The side effects are more manageable for topical treatments, meaning that you can increase the dose and try to pair them with other treatments like microneedling or retinoic acid to further improve hair growth outcomes.

Can I Use Minoxidil If I Am Planning a Family?

Medical professionals generally advise against using both topical and oral minoxidil for both men and women when planning a family and for women during pregnancy and while breastfeeding.

While there is limited data on human pregnancies, animal studies have shown potential risks, including evidence of increased fetal resorption at high doses, one case report of fetal malformation associated with topical minoxidil use, and neonatal hypertrichosis reported following exposure during pregnancy.^[34]Drugs. (2023). Minoxidil pregnancy and breastfeeding warnings. Drugs.com. Available at: https://www.drugs.com/pregnancy/minoxidil.html (Accessed: February 2025),^[35]Smorlesi, C., Caldarella, A., Caramelli, L., Di Lollo, S., Moroni, F. (2003). Topically applied minoxidil may cause fetal malformation: a case report. Birth defects research. Part A, Clinical and … Continue reading 

There is a significant lack of well-controlled studies on minoxidil use during pregnancy and lactation. However, given the animal studies, medical professionals typically recommend avoiding minoxidil use when planning pregnancy, during pregnancy, and while breastfeeding, using adequate contraception if taking minoxidil, and discontinuing minoxidil use before attempting to conceive.^[36]National Institute of Health and Care Excellence. (2021). Topical minoxidil. NICE. Available at: … Continue reading

Does Minoxidil Affect Male Fertility?

Current research suggests that minoxidil has minimal to no direct impact on male fertility. However, some research has linked minoxidil with oxidative stress and morphological changes to the testicles, which could indicate a potential negative impact.^[37]Santana, F.F.V., Lozi, A.A., Goncalves, R.V., Silva, J.D., Matta, S.L.P.D. (2023). Comparative effects of finasteride and minoxidil on the male reproductive organs: A systematic review of in vitro … Continue reading 

If you’re thinking about trying minoxidil and you are trying to conceive or have a pregnant partner, then it is advisable to talk to a medical professional before starting any treatment.

What if I’m Still Experiencing Side Effects?

Fortunately, minoxidil is just one of several treatment options available. If you’ve tried all of them and still experience side effects, you might consider exploring alternative therapies.

We have a wealth of information available so you can weigh your options and find out exactly how each treatment works and what your regrowth roadmap might look like. If you have any questions, reach out in the dedicated discussion thread below.

Final Thoughts

While minoxidil remains one of the most widely used treatments for AGA, both topical and oral formulations present unique challenges. The choice of which to use should be weighed carefully against the side effects, varying from mild scalp irritation to more significant cardiovascular effects. Ultimately, while the research supports minoxidil’s efficacy, it is not the only option out there, and if it isn’t working for you, then it is important to find the right one.

Research continues to show that oral minoxidil is an effective off-label treatment for men with pattern hair loss. The general rule-of-thumb: the bigger the dose, the better hair regrowth. But there’s a catch…

Higher dosages of oral minoxidil come at a risk of higher risk of side effects: excessive body hair growth, limb swelling, low blood pressure, and even heart palpitations.

Knowing this, is there a “best dose” for oral minoxidil (in mg) for men with pattern hair loss? More specifically, which dose of oral minoxidil maximizes our chances for hair regrowth and minimizes our risks of adverse events?

This Quick Win uncovers the latest research. The short answer: studies show that 2.5mg daily seems to be a tolerable, effective dose for most men with pattern hair loss. But the right dose for you will depend on (1) your severity of hair loss, and (2) your tolerance with side effects (not all of them are bad).

Note: Quick Wins are short articles focused on answering one question about hair loss. Given their specificity, these articles are written in a more scientific tone. If you’re new to hair loss education, start with these articles.

Interested in Oral Minoxidil?

Low-dose oral minoxidil available, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

Click Here For 15% Off

*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Oral minoxidil: research at a glance

To date, there have been fewer than 10 studies published on oral minoxidil for androgenic alopecia (AGA). Doses studied range from 0.25mg to 5.0mg daily, and study durations (at least the ones we evaluated) range from 24-52 weeks.

Across studies, there is a clear trend: the higher the dose of oral minoxidil, the better the hair regrowth. But this relationship doesn’t tell the whole story ­– as these higher dosages seem to confer with higher reports of side effects.

So, here’s what you should know before starting any daily dose of oral minoxidil.

#1: Oral minoxidil dosages from 0.25mg to 5mg improve pattern hair loss

The three most recent (and most robust) studies on oral minoxidil all varied dosing by 0.25mg, 2.5mg, and 5.0mg daily. All of them showed benefit – with higher dosages demonstrating visual improvements. Just see these photos of a male who took 5mg of oral minoxidil daily for 3 months.^[1]Jimenez-Cauhe, Juan et al. Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. Journal of the American Academy of Dermatology, Volume 81, Issue 2, 648 – 649

Male with AGA: improvement with 5mg oral minoxidil over 3 months

So, let’s organize the findings of these three studies by dosage. Then, let’s evaluate their results in terms of:

1. Response rates (i.e., the percent of people who experienced an improvement), and…
2. Side effects (i.e., unintended effects of the drug)

Do we see any trends in data? Specifically, is there a “sweet spot” where most men can maximize their chances of hair regrowth from oral minoxidil while minimizing their risk of serious side effects?

Yes.

Oral minoxidil for AGA: study results by dosage

See each study’s summaries.

Daily Dose (Duration)	Response Rate	Side Effects
0.25 mg (6+ months)[2]Pirmez, Rodrigo et al. Very-low-dose oral minoxidil in male androgenetic alopecia: A study with quantitative trichoscopic documentation. Journal of the American Academy of Dermatology, Volume 82, … Continue reading	60%	90%: increased beard growth (52%), increased body hair (20%), hair shedding (16%), pedal edema (4%)
2.5 mg to 5 mg (6-12 months)[3]Jimenez-Cauhe, Juan et al. Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. Journal of the American Academy of Dermatology, Volume 81, Issue 2, 648 – 649	90%	29.3%: increased body hair (24.3%), lower limb edema (4.8%), hair shedding (2.4%)
5 mg (6 months)[4]Efficacy and safety of oral minoxidil 5 mg daily during 24-week treatment in male androgenetic alopecia. Journal of the American Academy of Dermatology, Volume 72, Issue 5, AB113	100%	100%: increased body hair growth (93%), pedal edema (10%), heart / EKG alterations (10%)

At first glance, the risk of side effects across even small dosages seems ridiculously high (90%+).

However, not all of these side effects are bad.

For instance, of the side effects reported in these studies, the overwhelming majority of them constituted increased body/facial hair growth. Most men aren’t going to care about this. In fact, man men might even prefer more body or facial hair.

Secondly, increased hair shedding was generally only reported at the beginning of each study. This is because, when starting minoxidil (topical or oral), the drug can “kickstart” a new anagen (growth) phase of hairs affected by androgenic alopecia (AGA). This can lead us to shed any hairs that were already primed to fall out soon anyway – specifically, catagen or telogen hairs – thereby giving the illusion of thinner hair in the first 1-2 months of treatment. However, as these hairs grow back, they’re usually much thicker, and thereby improve hair density. Long-story short: in most cases, hair shedding from minoxidil isn’t long-lived.

So, for this exercise, let’s discount increased body/facial hair growth and increased hair shedding as temporary and/or non-problematic side effects. Instead, let’s re-run our analysis and only consider serious side effects – edema, EKG alterations, etc.

Within this context, are all dosages of oral minoxidil as scary?

No. In fact, it seems like there’s a “sweet spot” for oral minoxidil where we can maximize hair regrowth while minimizing our risk of bad side effects: at 2.5mg daily.

Keep in mind the following chart is based on preliminary data on low-dose oral minoxidil, and that this article reflects the clinical studies available on oral minoxidil for androgenic alopecia as of 2020. As better-designed studies are published, these numbers will evolve:

Moreover, it’s really only at dosages of 5mg that we see an appreciable increase in concerning side effects – namely, edema (water retention / swelling) and cardiac alterations (i.e., lower heart rates).

So, 2.5 mg daily of oral minoxidil might be the “sweet spot” for most male pattern hair loss sufferers.

#2: Oral minoxidil’s efficacy may vary depending on hair loss severity

Most clinical trials on androgenic alopecia will select study participants who all have similar severities of hair loss. This is known as standardization. And for most trials, investigators usually prefer men who have medium-severity androgenic alopecia (i.e., Norwood 3-4). This is usually because men with Norwood 3-4 level hair loss (1) are representative of the population of hair loss sufferers who may later opt for this treatment, and (2) have enough hair follicle miniaturization and hair loss to effectively evaluate cosmetic improvements to hair thinning.

Having said that, most studies on oral minoxidil aren’t standardized to Norwood 3-4 participants. So, it’s a bit disingenuous to make comparisons across studies for response rates and side effects. In other words, please take our above analysis with a grain of salt.

With that said, with different age and/or hair loss severity across studies, we can get more granular data on who tends to respond well to oral minoxidil.

Based on the above studies (and others we looked into for our analysis), the trend aligned with intuition: if you don’t have severe hair loss, you can get away with lower dosages of oral minoxidil. If you do have severe hair loss, you’ll need a higher dose.

In other words:

• If you have mild male pattern baldness, 0.25mg daily might work fine as a starting point
• A more moderate case of hair loss might require a dose of 1-2.5mg daily
• If you have severe male pattern baldness, you’re probably going to need closer to 5mg daily
• If other treatments haven’t worked for you (resistant hair loss), you may also need a higher daily dose (2.5-5mg) or combination treatments with finasteride

Then again, higher doses come with more side effects. This is where dosing gets hyper-specific.

#3: If you’re going to try oral minoxidil, you’ll need to work with a doctor to figure out your unique risk profile and the right dose

Oral minoxidil is an antihypertensive drug (lowers blood pressure). It can also cause fluid retention. Therefore, if your health history indicates problems surrounding low blood pressure, fainting spells, or edema (swelling), you may be at a higher risk of complications from taking the drug.

Moreover, oral minoxidil can stimulate hair growth everywhere… not just on the scalp. For some men, this may be a bonus. For others, it might be a drawback. If this is a drawback for you, then it’s worth noting that reports of increased body / facial hair even occurred at lower dosages (0.25 mg) of oral minoxidil. So, if you’re concerned about this, maybe oral minoxidil isn’t right for you.

Long-tory short: for the safest and most effective use of oral minoxidil, discuss your medical history and preferences with your doctor. Then convince him or her to prescribe you oral minoxidil.

Note: a dermatologist specializing in hair loss is much more likely to write you a prescription. So, if you don’t want to waste any time, make a list of dermatologists in your area, call them to see if they’re open to prescribing oral minoxidil, and then only visit the ones who prescribe the drug.

#4: Like topical minoxidil, oral minoxidil likely works better alongside other treatments

When it comes to treating pattern hair loss, combination treatments tend to almost always outperform mono-treatments.

In some cases, combination therapies allow us to use the lowest dose of a drug possible without sacrificing results. Some studies suggest this is the case for women with pattern hair loss who take 0.25mg of oral minoxidil + 25mg of spironolactone: they minimize the risk of side effects of either drug while getting hair regrowth that often exceeds that of high dosages of either drug.

In other cases, combination therapies can actually enhance the efficacy of drugs. This tends to be true of men taking topical minoxidil, and who then add in once-weekly microneedling, thereby making topical minoxidil 400% more effective (according to some investigation groups). ^[5]English RS Jr, Ruiz S, DoAmaral P. Microneedling and Its Use in Hair Loss Disorders: A Systematic Review. Dermatol Ther (Heidelb). 2022 Jan;12(1):41-60. doi: 10.1007/s13555-021-00653-2. Epub 2021 Dec … Continue reading

While there aren’t many studies that exhaustively explore this relationship for oral minoxidil, the odds are that this medication also works better as a combination therapy. So, if you’re going to commit to oral minoxidil, consider stacking it with other therapies.

Again, research here is limited, but there are a host of things you can try in combination with oral minoxidil that might increase results.

• DHT reducers (finasteride, saw palmetto, etc.)
• Microneedling
• Massage
• Ketoconazole shampoo
• Low-level laser therapy (LLLT)
• Platelet-rich plasma therapy (PRP)

…and more.

The bottom line

When it comes to oral minoxidil, the best daily dosage for men with pattern hair loss may vary depending on(1) your tolerance for certain side effects, and (2) your severity of hair loss. Consider these recommendations a mere starting point until more research emerges:

• Men with mild AGA, men at a higher risk of complication, or men who don’t want extra hair growth on their body/face: 0.25-1mg.
• Men with moderate AGA: 1-2.5mg.
• Men with resistant AGA (you’ve tried other treatments and they haven’t worked) or severe AGA: 2.5-5mg.

Although these guidelines are a rough ballpark, chances are you fit into one of these categories and, with the help of a doctor, can find the best oral minoxidil dosage for you.

Questions? Comments? Please reach out in the comments section.

Vitamin B1 – also known as thiamin (or thiamine) – is part of the B-vitamin complex. Marketers claim that vitamin B1 can help support healthy hair growth, reduce hair shedding, and even prevent hair loss. Then again, marketers also make the same claims about B-vitamins like biotin, niacin, and vitamin B12. And typically, the claims are just plain wrong.

So, is vitamin B1 any different? In this article, we’ll dive into the evidence (and answers).

First, we’ll uncover why some people that vitamin B1 helps support hair growth. Then, we’ll dive into the evidence on the vitamin B1 / thiamin-hair loss connection. Finally, we’ll dive into evidence that might implicate vitamin B1 as an accelerator of hair loss… and steps to take if you suspect you’re deficient.

By the end, you’ll have a better idea of whether vitamin B1 is a worthy investment for your hair, or just another marketing gimmick. If you have any questions or comments, please post them below!

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What is Vitamin B1?

Vitamin B1 (also thiamin or thiamine), is one of the many members of the B vitamin family.  

Vitamin B1/thiamine

Researchers first identified this essential micronutrient through the study of beri beri, a serious disease of the nervous system that was common in South East Asia prior to the 1900s.

Unlike most diseases in that time, beri beri was much more common among wealthy citizens than it was among poorer citizens. Upon further investigation, researchers found the reason for the perplexing discrepancy was actually attributed to the differences in rice consumption. 

While poorer individuals tended to consume brown rice, richer individuals tended to consume milled white rice — devoid of the husks, bran, and germ.

Through experimentation with this brown rice, a Polish biochemist, Casmir Funk, was able to isolate the compound that prevented beri beri. This compound? He termed it thiamine, meaning sulfur-containing amine — what we now know as vitamin B1.

Fast forward to today: we now know that vitamin B1 plays a crucial role in mitochondrial health, metabolism of macronutrients, and energy production — processes that are essential for the normal functioning of almost every cell in the body (1).

But, beyond the prevention of serious neurological conditions, does vitamin B1 have any benefit to our hair? 

Let’s explore the evidence.

Vitamin B1: might it help support hair growth?

There’s no doubt that vitamin B1 is critical for important processes, like (1):

• The production of ATP, the energy molecule that fuels cellular activity
• The synthesis of amino acids
• The creation of NADPH, a co-factor necessary for steroid hormone production, fatty acid synthesis, and more.

And similar to other B-complex vitamins, vitamin B1’s role in these processes often form the basis of the claim that vitamin B1 can influence hair loss. After all, if you can’t produce amino acids — the raw material our hair is actually made of — how can you grow hair?

But, is this actually true? Are there any other ways that B1 might influence our hair? And what does this mean in the context of diet in the developed world?

Let’s explore the evidence.

Does a thiamine / vitamin B1 deficiency cause hair loss?

Maybe. But this isn’t the right question to ask. Rather, we need to ask this question in two parts:

1. Does a vitamin B1 deficiency cause hair loss?
2. Does a vitamin B1 deficiency within realistic parameters cause hair loss?

Why would we do this? Because at the extremes, almost anything causes hair loss. For instance, a “water deficiency” can cause hair loss. If we don’t drink water, we die. If we’re dead, we can’t grow hair. But that doesn’t mean that drinking water will regrow our hair. It also doesn’t mean we should warn people that hair loss is a side effect of a water deficiency.

The truth is that these types of logic leaps are what marketers use to claim that deficiencies in selenium, vitamin E, and iodine can all cause hair loss. Yes, this is true – but only if our scope of deficiency includes the endpoints: malnourished poverty-stricken children, people with genetic disorders who can’t absorb these nutrients, and people with certain chronic conditions that make nutrient assimilation nearly impossible.

All this is to say that we should ask if a thiamine deficiency, in the absolutes, causes hair loss. But the better question is: does a thiamine / vitamin B1 deficiency within realistic parameters cause hair loss, too?

Let’s take these one-by-one.

1. Does a thiamine deficiency, at the extremes, cause hair loss?

Maybe (in rodent models).

This 1968 study (2) sought to determine what happens in mice fed a diet that rapidly induces a thiamine deficiency. After two and a half weeks, some mice began to experience rapid weight loss, followed by abnormal hair shedding. Soon thereafter, neurological function began to decline. After four weeks, the mice were confused and could barely walk – symptoms similar to those seen in humans with beri beri.

However, it was unclear if the hair loss was caused by the vitamin B1 deficiency or the rapid weight loss.

2. Does a thiamine deficiency, within realistic parameters, cause hair loss?

Probably not.

For starters, people with beri beri rarely reported hair shedding (even despite their rapid weight loss). Moreover, when we expand our scope to human studies, we haven’t found any hard evidence that causally links a vitamin B1 deficiency to hair loss.

We could close the case right there, and say the article is done. At the same time, the absence of evidence doesn’t always imply evidence of absence.

For instance, there’s always the possibility that vitamin B1 might exacerbate certain chronic conditions linked to hair loss, or certain disease states associated with shedding disorders.

In fact, we could assert that since a vitamin B1 deficiency can lead to rapid neurological decline and thereby weight loss, and because rapid weight loss can trigger excessive (but temporary) hair shedding, then vitamin B1 deficiencies might be indirectly related to hair loss. The deficiency causes the weight loss; the weight loss causes the hair loss.

But again, if you’re so deficient in vitamin B1 that you start losing weight, you’ve got bigger things to worry about than your hair (like rapid impending neurological deterioration).

So, do we see any other circumstances where vitamin B1 is indirectly linked to hair shedding or hair loss?

Potentially. We can find them by look at the role of vitamin B1 in the body, and then comparing this to how different types of hair loss actually develop.

Vitamin B1 deficiency may exacerbate autoimmunity

At present time, there have been several animal studies conducted to investigate a link between vitamin B1 and autoimmunity. In general, these studies have suggested that vitamin B1 deficiencies may exacerbate autoimmunity in certain autoimmune disorders – specifically, multiple sclerosis (3, 4). It stands to reason that improving vitamin B1 deficiency may also improve these autoimmune conditions.

So, how could these effects translate to hair loss?

There are several forms of hair loss that seem to be mediated by autoimmune processes. These include alopecia areata as well as some forms of scarring alopecia.

If thiamine deficiencies happened to exacerbate the autoimmune processes involved in these hair loss disorders, it’s possible that restoring thiamine levels could improve these conditions.

Again, there’s no evidence that vitamin B1 deficiency is related to these hair-related autoimmune conditions. And while all autoimmune conditions involve autoimmune processes, not all autoimmune conditions develop in the same way. Thus, we can’t necessarily extrapolate the results from the animal studies, which primarily looked at multiple sclerosis, to the autoimmune conditions that lead to hair loss.

There’s also another point to consider: the effects of certain compounds reflected in animal studies are also traditionally very difficult to extrapolate to humans. Take our rodent study from earlier: thiamin-deficient rodents developed weight loss, neurological decline, and hair loss; whereas humans with beri beri – a sign of a thiamin deficiency – typically only develop weight loss and neurological decline.

That leaves us with one last piece of evidence to consider when it comes to linking autoimmune hair loss to vitamin B1: a case series on three human patients with autoimmune thyroid conditions (5).

Vitamin B1, autoimmune thyroid disorders, and hair shedding: a possible connection?

Autoimmune conditions that affect the thyroid – like Graves’ disease and Hashimoto’s thyroiditis – can have a domino effect on hair growth which is, in part, controlled by thyroid hormones. When these hormones get too high (i.e., Graves’ disease) or too low (i.e., Hashimoto’s thyroiditis), it can cause telogen effluvium – a form of diffuse hair shedding.

Interestingly, vitamin B1 might have relevance here, especially in the context of Hashimoto’s thyroiditis.

In one case series, doctors administered vitamin B1 to three patients with Hashimoto’s thyroiditis. They hypothesized that vitamin B1 could help relieve one of the hallmark symptoms of low thyroid hormone: fatigue. 

Amazingly, that’s exactly what vitamin B1 did. In just a few hours to a few days, administration of B1 drastically improved the patients’ fatigue. 

But, this wasn’t because of a subsequent improvement in the underlying autoimmune condition.

Instead, the authors hypothesized that the autoimmune processes involved in Hashimoto’s thyroiditis may have resulted in a vitamin B1 deficiency, subsequently leading to a reduction in energy production and, thus, fatigue.

In other words, the vitamin B1 deficiency likely isn’t a contributor to the development of Hashimoto’s thyroiditis. Instead, vitamin B1 deficiency, in this case, is a consequence of the condition.

As such, we can’t expect vitamin B1 to actually improve Hashimoto’s thyroiditis or the hair loss that occurs as a result. Instead, vitamin B1 can only improve symptoms related to a vitamin B1 deficiency that may occur alongside the condition.

So, we’ve established that vitamin B1 may or may not improve autoimmune forms of hair loss. We’ve also ruled out vitamin B1 as a means to improve Hashimoto’s thyroiditis and the hair shedding that ensues as a result.

But, are there any other pathways by which B1 might influence hair loss? Maybe… and that leads us to point number two.

Vitamin B1 deficiency may impair glutathione synthesis

Glutathione is a sulfur-containing compound with powerful antioxidant activity. Unlike antioxidants we consume in our diet (like polyphenols in green tea, berries, and other health-promoting foods), glutathione is manufactured by our own cells from amino acids like cysteine, glycine, and glutamic acid. This process requires NADPH, which requires vitamin B1 (along with various other B vitamins) (6).

So, how does this relate to hair loss?

Glutathione deficiency is associated with many conditions including diabetes, cardiovascular disease, as well as autoimmune diseases (7). Some studies also show low glutathione is associated with androgenic alopecia (AGA) (8).

As an anti-inflammatory agent, it’s possible that glutathione deficiency could exacerbate the microinflammation in AGA follicles — a process that drives the hair loss observed in AGA (7, 9). 

In this context, it’s possible that through a possible increase in glutathione, vitamin B1 could reduce inflammation in AGA and, thus, improve AGA.

But there’s a difference between possible and plausible. Yes, if we stretch our imagination, it’s possible that a vitamin B1 deficiency might decrease glutathione production, and that if enough of this occurs in balding hair follicle sites, this decrease might exacerbate inflammation in AGA.

Possible, yes. But plausible?

Probably not.

While B1 deficiency seems to be related to low glutathione levels, vitamin B1 deficiency is extremely rare amongst most of the population. So, in this context, vitamin B1 is probably not something that most AGA patients need to worry about.

In these cases, glutathione deficiency is more likely to be related to co-morbidities seen in AGA: conditions like diabetes, obesity, and cardiovascular disease (all of which we know can deplete glutathione) (10).

So, while vitamin B1 deficiency could, technically, lead to or exacerbate a glutathione deficiency, it’s safe to say this is probably not the case for most AGA patients with low glutathione.

A quick recap

So far, we’ve established that B1 is an essential micronutrient. We’ve also established that in its complete absence, it can cause hair loss in rodents. Aside from that, it doesn’t appear that a vitamin B1 deficiency is a major driver of hair loss in humans.

The reason for this is three-fold: 

• Vitamin B1 deficiency is extremely uncommon in the general hair loss population.
• In the rare cases where vitamin B1 levels are depleted and associated with hair loss, improving vitamin B1 levels only improves symptoms associated with vitamin B1 depletion. In other words, vitamin B1 improves nervous system abnormalities like fatigue but not the underlying conditions that lead to hair loss.
• When looking at the relationship between vitamin B1, glutathione, and AGA, it’s unlikely that vitamin B1 deficiency contributes to low glutathione levels that may exacerbate hair loss. Rather, low glutathione levels observed in some patients appear to be a consequence of some common co-morbidities associated with AGA. 

So, that leads us to this conclusion: in the overwhelming majority of cases, vitamin B1 is not likely to confer any benefit in hair loss.

This leaves us with one last question worth asking before we close the books on the vitamin B1-hair health connection…

Could increasing vitamin B1 levels beyond normal levels have any negative effect on hair loss?

Maybe, maybe not. Let’s look at the research.

Why vitamin B1 might be bad for hair: the NADPH-DHT connection

Vitamin B1 is an essential cofactor in the production of the molecule, NADPH.

NADPH – or nicotinamide adenine dinucleotide phosphate – is a cofactor for enzymatic reactions. In other words, it’s a molecule that helps kickstart processes in the body. Earlier we established that NADPH was crucial for glutathione production. But that’s not all that NADPH does. NADPH is also essential for the production of steroid hormones.

Specifically, NADPH is a key molecule of the enzymatic process that converts testosterone into dihydrotestosterone, or DHT. Without NADPH, the enzyme that performs this conversion cannot function (11).

So, what does this mean for hair?

If you’ve done any research into androgenic alopecia (AGA), you probably already know that DHT is a significant contributor to the development of pattern hair loss (12). As such, any increase in DHT conversion could potentially worsen or speed up the balding process.

But, this would require NADPH to increase beyond what’s considered “physiological” — or what’s considered normal. So, does vitamin B1 do this?

Probably not. But we just don’t know.

What we do know is that, oftentimes, enzymes that produce molecules like NADPH have negative feedback mechanisms in place. This means that when their end-products increase, the body automatically reduces the activity of the enzymes that produce them. The net product is no increase in production.

However, this isn’t always the case. In some cases, these negative feedback loops are dysfunctional.

So, it’s possible that vitamin B1 doesn’t increase NADPH beyond what’s considered normal. As such, it’s also possible that vitamin B1 has no impact on DHT levels. At the same time, it’s also possible that it could.

In either case, the solution is the same: leverage diet to ensure vitamin B1 sufficiency and address a vitamin B1 deficiency if it’s present — but don’t go overboard.

If we’re deficient in B1, what should we do?

It’s important to note that an overwhelming majority of individuals likely aren’t deficient in vitamin B1. But, that doesn’t mean it’s impossible. Of the small pool of individuals B1 deficiency seems to affect in the modern world, risk factors appear to be:

• Hashimoto’s thyroiditis (5)
• Gastric bypass surgery (13)
• Anorexia (13)
• Severe crash dieting (13)
• Marked impairments in nutrient absorption, as in severe inflammatory bowel disease (13)
• Alcoholism (13)
• Septic shock (14)

But, again, it’s important to underscore that, even in these cases, we shouldn’t expect vitamin B1 to regrow our hair. This is because a vitamin B1 insufficiency is highly likely to present alongside other contributors to hair loss – like low thyroid hormone, zinc deficiency, iron deficiency, and severe calorie deficit. So, an improvement in B1 levels alone isn’t going to override these other factors. If anything, the thiamine deficiency-hair loss connection is more association than it is causation.

In any case, maintaining sufficient vitamin B1 levels is essential for overall health. So, you should aim to hit the recommended daily intake (RDI) everyday.

The good news is that you’re probably already doing this without even thinking about it – especially with all of the B-complex fortified foods out there. And if you find yourself falling into any of the risk categories, it’s not hard to find a supplement containing thiamine; nearly every multivitamin includes it as an ingredient.

At the same time, there could be a small minority of B1 deficiencies that go undetected, as was the case with the case series of Hashimoto’s thyroiditis patients. So, if you find yourself with fatigue that isn’t responding to standard treatment for Hashimoto’s thyroiditis, it may be worth discussing the possibility of vitamin B1 supplementation with your doctor.

Summary 

Vitamin B1 is an essential vitamin. It ensures our body can effectively produce amino acids, glutathione, and other cofactors that are crucial for cellular function.

Deficiencies in vitamin B1 have been linked to weight loss, neurological decline, and hair loss in rodents. In humans, the evidence points more so toward neurological decline and weight loss than it does hair shedding. Having said that, a vitamin B1 deficiency might indirectly exacerbate hair loss through:

1. Rapid weight loss
2. Autoimmunity
3. Glutathione impairment

But the bottom line is this: if your thiamine / vitamin B1 levels are low enough to associate with hair loss, you’ve got bigger problems than hair… like mental debilitation, neurological deterioration, and impending death.

Needless to say, 99.9% of us probably don’t need to be supplementing with vitamin B1 as a hair loss preventive. In fact, given vitamin B1’s relationship to NADPH production, and NADPH’s relationship to DHT, we could make a similar logic-leap argument that too much vitamin B1 may exacerbate hair loss.

This leaves us with one firm conclusion: maintain sufficient vitamin B1 levels by consuming the recommended daily intake. In the developed world, nearly every single diet will do this for you… provided you don’t have any of the hallmarks that increase your risk of a B1 deficiency (i.e., alcoholism, gastric bypass surgery, anorexia, etc.).

In the rare case that you are deficient, work with a doctor to address why your levels might be decreased in the first place and, if needed, to increase your levels with supplementation.

Have any questions about Vitamin B1 and hair health? Please leave them below in the comments!

Subscription services have gained popularity in recent years for all types of products, from home cleaning supplies to underwear, razors, and even toothpaste. These services make the most sense for products used consistently, saving the consumer time and money. Hair regrowth treatments certainly meet the criteria. For the most part, they only work as long as you keep using them. So, it was only a matter of time before startups put men’s hair care on autopay. 

Of the telemedicine providers focusing on men’s health, Hims, Keeps and Roman have risen to the top of  this competitive market. But which one is best? We offer an objective side-by-side comparison of these 3 hair loss subscription companies. In the process, you’ll learn about the following:

• About the Products Sold
• What Differentiates the Providers
• Why Choose One Over The Other

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*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

About the Products

Hims, Keeps, and Roman all offer the same hair regrowth products, namely Finasteride and Minoxidil. These are the only two medications approved by the FDA to treat androgenic alopecia (AGA), or male pattern baldness.

Finasteride

Finasteride, also known by the brand name Propecia, is one of the most well studied, and most powerful, drug for AGA.  The daily pill stops the progression of hair loss in 80-90% of men and, on average, leads to a 10% increase in hair count over two years.^[1]https://www.sciencedirect.com/science/article/pii/S0022202X15529357​​

Oral finasteride is an FDA-approved treatment for AGA that inhibits the enzyme type II 5-alpha reductase, and thereby reduces dihydrotestosterone (DHT) levels in the body. While it’s effective in slowing, stopping, and partially reversing AGA’s progression, some men can experience side effects associated with the systemic reduction in DHT levels.

Topical Finasteride aims to avoid such side effects by localizing the drug’s effects to the scalp. Research on topical finasteride is still in its infancy, but the drug does appear to be effective for lowering DHT in the scalp. Real world results vary widely in part because method of delivery, dilution ratios and carrier agents (non-active ingredients) used to deliver the drug, also vary widely. 

Minoxidil

Minoxidil, also known by the brand name Rogain, is the other FDA-approved drug for the treatment of AGA. Although available orally, it’s most popular as a topical. Over half of those who try topical minoxidil respond to the drug within 3-6 months. Of those, research reports hair count increases of up to 12% over 48 weeks.^[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/

Among the downsides of Minoxidil is that the treatment’s effectiveness does wane over time. When that happens, those who quit tend to lose any and all gains they had from the drug, ending up back where they started before ever having used it.

Having Trouble Separating Follicle Facts from Fiction?

One reason why Minoxidil’s effectiveness might taper is that it doesn’t address hair follicle miniaturization. So, while it does increase hair counts by kicking hair back into the growth cycle, hair continues to thin over time.

When combined with additional therapies, however, most if not all of these downsides can be mitigated. Minoxidil may work better when combined with scalp exfoliators such as retinol or retinoic acid. Research also finds minoxidil is up to four times more effective when combined with microneedling.^[3]http://www.ijtrichology.com/article.asp?issn=0974-7753;year=2013;volume=5;issue=1;spage=6;epage=11;aulast=Dhurat

The effectiveness of Minoxidil may be best when used with Finasteride. These two treatment options can be combined. 

• Minoxidil Response rate: 30-40% alone; 70+% if combined with microneedling and/or finasteride
• Minoxidil Regrowth rate: ~10% alone; 25-40% if combined with microneedling and/or finasteride

Both Finasteride and Minoxidil require ongoing, daily application for results maintenance. Hence, the appeal of subscription services. So let’s take a closer look at the three biggest players offering Finasteride and Minoxidil online.

Hims vs Keeps vs Roman 

Hims, Keeps and Roman are telemedicine providers who, after a phone or video consultation, provide prescriptions for hair loss treatments. Products are shipped discreetly to the buyer’s home, with savings available for ongoing, subscription-based delivery.

Hims 

Hims brands themselves as ‘all about personal wellness.’ The company offers products not only for hair loss, but also for men’s sexual health. They sell both prescription-based and over-the-counter solutions.

Roman

Roman is the men’s health wing of Ro.co, a consumer healthcare company with a mission to make healthcare accessible and convenient. The digital healthcare provider wants to make it easier for more men to seek preventative care. Of these 3 companies, they treat the widest range of men’s health conditions.

Keeps

Keeps focuses only on treating hair loss, versus general men’s health. Founded in 2018, the company aims to ‘help more men keep more hair.’ In addition to selling prescription treatments and hair care products, Keeps will link clients to hair restoration surgeons.

Each of the above companies sells generic Finasteride and Minoxidil, but the products differ slightly between sites. Below is a closer look at what’s on offer. 

Subscription-Based Hair Loss Products

Hims Products 

Of the 3 providers, Hims sells the greatest variety of products and hair treatment packages. The Hair Power Pack includes a combination of oral finasteride and 5% Minoxidil, plus Biotin gummies and a thickening shampoo. 

Hims is also the only of the three companies to offer a topical Finasteride. The topical combines 0.3% finasteride with 6% Minoxidil. Active ingredients are diluted in alcohol (ethanol), propylene glycol and citric acid and delivered via spray bottle.

Propylene glycol as a carrier does lead to skin irritation in up to 6% of users, although this is considered a very mild side effect.^[4]https://pubchem.ncbi.nlm.nih.gov/compound/Propylene-glycol

Keeps Products

Keeps does not offer a topical finasteride, but does include options for either foam or serum-based Minoxidil just as Hims does. They are also the only provider to sell a 2% ketoconazole shampoo. Alongside finasteride and minoxidil, ketoconazole is considered one of the “big three” treatment options for pattern hair loss.

Despite its popularity, however, ketoconazole is not actually FDA-approved for pattern hair loss, nor is it as well-researched as minoxidil or finasteride. However, the low-cost, low-effort treatment (used 2-3 times per week) seems to carry little (if any) risk of side effects.

Roman Products

Roman is the biggest generalist of the companies we’re comparing here. Hair loss is not necessarily their primary focus and they have the least number of hair-related products on offer. Roman offers oral finasteride, a Propecia generic made by Ascend in India, as well as a solution-based Minoxidil made by Pure Source, LLC. They do not offer a foam-based Minoxidil as Hims and Keeps do.

The Subscription & Cost

Topical minoxidil is an over-the-counter product and can be purchased directly without a telemedicine consult. Finasteride, whether oral or topical, and 2% ketoconazole do, however, require a prescription. How this process works differs slightly between Roman, Hims and Keeps.

The Hims Consultation Process

Hims begins with a free online consultation that includes a few personal questions, and offers quick access to a licensed medical provider, in all 50 states. Subscribed medications are then filled at a licensed pharmacy, and shipped to you directly. 

Shipping info and billing frequency??

The Keeps Process

Keeps also begins with a free online consultation. After answering a few questions online, Keeps requires an upload of photos, which are then reviewed by a licensed provider. Treatments are shipped every 3, 6 or 12 months.  Continued on-demand access to a live medical professional is available via their app for $10/month.

The Roman Process

Like the rest, Roman’s process begins with a free online visit. Depending on the state, a phone or video chat with a doctor or nurse practitioner may be required. Prescriptions are filled via the Ro Pharmacy Network, and shipped directly in discreet packaging. Roman offers free, unlimited follow-ups if needed. Prescriptions are available in monthly or quarterly auto-shipments.

Cost Comparison

Pros and Cons

Whether Roman, Hims, or Keeps is best is a personal decision that depends on the treatment sought, any extra over-the-counter shampoos, vitamins or other add-ons desired, and what state the patient lives in. 

Hims Pros & Cons

Of the three companies in our comparison, Hims offers the most treatment options and is the only one to offer topical finasteride. Topical finasteride is also available from the following, lesser known companies:

• Happy Head: 0.25% Finasteride + 8% Minoxidil 8% + 0.01% Retinoic Acid + 1% Hydrocortisone. The formula is customizable and available for $79+/month
• Strut: Strut offers a customizable gel or solution-based topical with the following options, Finasteride 0.1-0.25%, Minoxidil 0.0%-7.5%, Tretinoin 0.0%-0.0125%, available starting at $59/month

On the other hand, Hims also ranks as the most expensive for either Finasteride or Minoxidil.

Keeps Pros & Cons

Keeps is the only provider on our list to offer Ketoconazole shampoo. So for those interested in trying the ‘Big 3’ protocol for hair loss, Keeps is a good bet. It’s also the least expensive provider of Finasteride and Minoxidil.

The main drawback of Keeps is that it’s not yet available in every state. They can, however, fill prescriptions in every state. So if you have a prescription from another doctor, Keeps may be able to fill it for a lower price. 

Roman Pros & Cons

Of these 3 digital medicine providers, Roman is doing its best to position itself as a one-stop-shop for all things health-related. Contact with a licensed healthcare professional is available in every state, and you can go to Roman for nearly all things health-related.

The downside is that Roman is not focused on hair loss prevention nor hair regrowth alone, and they offer the most limited treatments options out of the 3 on our list.

Summary

Roman, Hims, and Keeps are all telemedicine providers who have risen to the top of the competitive men’s wellness market in part due to their focus on hair loss prevention and treatment.

Each company focuses primarily on oral finasteride and topical (OTC) minoxidil and will prescribe the former after a brief online consultation. 

Subscription services and products vary. Which is best may depend on the state the patient lives in, and exactly which treatments are being sought.

If you’re experiencing hair loss, and you’re searching for a solution to help regrow hair, you’ve likely read several articles that reference different parts of the scalp. But what would you say if you were asked where on your scalp you’re losing hair? And how well do you understand the various parts of the scalp that lay beneath the skin, as well as their roles in hair loss?

In this article, we’ll give a quick introduction to the scalp. After that, we’ll take a tour of the scalp, starting with the different regions on the surface; then moving beneath the skin through the various layers of scalp tissue; then exploring the bones that lay beneath the tissue; then discussing the arteries, veins, nerves, and lymph vessels than run through those layers of tissue; and then examining the muscles that pull on the scalp. After touring the different areas of the scalp, we’ll discuss some ways that scalp mechanics may impact hair growth. Finally, we’ll look at some clinical evidence that has opened up the possibility of new treatments for androgenic alopecia. 

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Introduction to the Scalp

The scalp consists of layers of skin and subcutaneous tissue that cover the human cranium. It extends from the supraorbital foramina (i.e. two openings in the bone just above the eye sockets and just beneath the eyebrows) to the superior nuchal line (i.e. one of four curved ridges on the exterior surface of the occipital bone, which lies at the back of the head). It is bordered on the front by the face and on the sides and back by the neck. 

The scalp acts as a physical barrier to protect the cranium against physical trauma and potential pathogens. It is also the area where human hair typically grows in order to 1) aid in heat conservation, and 2) play a role in aesthetic appearance and sexual signaling.   

A Tour of Your Head: Regions of the Scalp

If someone were to ask you where on your scalp you’re losing hair, would you know how to answer them? If you’re unsure how to answer that question, check out the descriptions below.

The surface of your head has seven main areas, or regions, which are described below:

• Temples: The temples are located on either side of the head, behind the eye and between the forehead and ear. Each of the two temples is a latch where four skull bones – the frontal, parietal, temporal, and sphenoid bones – fuse together. Male pattern baldness typically starts at the temples, then continues to recede into the scalp, resulting in an M-shaped hairline. 
• Frontal Region: If you were to draw an imaginary vertical line through your head, with the line positioned just in front of your ears, that line would demarcate the border between the frontal and mid-scalp regions. The part of the scalp that lies in front of that line is the frontal region. Also called the forelock, this region includes the hairline and the hair above the temples. If you’re losing hair due to male pattern baldness, this is often one of the first places you can expect to see hair loss. 
• Mid-Scalp Region: If you were to draw two imaginary vertical lines through your head, with the first line positioned just in front of your ears and the second line positioned just behind them, the relatively flat area between those two lines would be the mid-scalp region. Unless you’re at an advanced stage of male pattern baldness, you probably won’t experience much hair loss in the mid-scalp region.  
• Vertex Transition Zone: Also called the vertex transition point, this area is located between the mid-scalp region and the vertex. The vertex transition zone is the area where the scalp goes from a horizontal to a vertical plane posteriorly. For this reason, it is often referred to as the posterior hairline. Although this area is technically part of the vertex (see next bullet), it is often listed as a separate region. 
• Vertex (Crown): Also called the crown, the vertex is the highest point on your scalp (the word “vertex” literally means “highest point”), which is located towards the back of your head. On non-balding heads, the vertex is typically identified by a swirl pattern of hair. In addition to losing hair around the temples and in the frontal region, many folks see noticeable hair loss on the crowns of their heads. 
• Sides (Temporal Regions): Also known as the temporal regions (because they sit over the temporal bones and muscles), these are the areas on either side of the head that are positioned just above and behind the ears. Because the sides of the head have a different subcutaneous anatomy than the rest of the scalp, they are sometimes treated as separate from the scalp. However, the temporal regions generally grow hair, so we’ve chosen to include them in this tour of the scalp. Hair loss is much less common in this region. 
• Back (Occipital Region): Also known as the occipital region (because it sits over the occipital bone and muscle), this area covers the back of the head, underneath the crown. As with the sides of the head, hair loss is much less common in this region. 

Digging into the Anatomy: Layers of the Scalp

While the previous section provides a good overview of the various areas on the surface of the scalp, there is a lot more going on beneath the surface.

The scalp consists of the following five layers:

1. Skin: The first layer of the scalp is the skin, which acts as a protective barrier to the rest of the scalp, helps prevent the loss of moisture, and helps regulate body temperature, among other things. This layer is thick and contains numerous hair follicles and sebaceous glands (i.e. small, oil-producing glands).
2. Dense Connective Tissue: The second layer is the dense connective tissue layer, which connects the skin to the galea aponeurotica (described below). In addition to connective tissue, this layer contains arteries, veins, nerves, and lymphatic vessels. Hair follicles can also extend from the skin down into this layer. 
3. Galea Aponeurotica: Also known as the epicranial aponeurosis, the galea aponeurotica is a layer of dense, fibrous connective tissue that runs along the top of the cranium, connecting to the frontalis muscle at the front of the head and the occipitalis muscle at the back of the head.

The first three layers of the scalp are firmly attached to each other and move as a unified structure. 

1. Loose Areolar Connective Tissue: This layer forms a flexible connection to both the galea aponeurotica and the pericranium (described below), allowing the top three layers of the scalp to slide over the lower pericranium. The loose areolar connective tissue also contains numerous blood vessels. 
2. Pericranium: Composed of dense connective tissue, the pericranium is the deepest layer of the scalp, which tightly adheres to the calvaria (i.e. the bones that form the top of the skull). It also contains the vascular supply that’s essential to supporting the calvaria. 

The Scalp’s Foundation: The Calvaria and Other Cranial Bones

As noted above, the pericranium is firmly attached to the calvaria bones, which form the top of the human skull. In addition to the calvaria, there are some other cranial bones that play a role in scalp function. We discuss these bones below.

The neurocranium, which is pictured in the image above, consists of the upper part of the skull that surrounds the cranial cavity and contains the brain. There are eight bones that make up the neurocranium:

• The frontal bone forms a skeletal roof above the eye sockets and nasal cavity, and forms the main part of the forehead. 
• The left and right parietal bones sit behind the frontal bone. These bones form the top and sides of the cranium.
• The occipital bone forms the back and base of the skull. It has a large opening, called the foramen magnum, where the spinal cord passes into the skull.  
• The left and right temporal bones help form the sides and base of the skull, where they protect the temporal lobe of the brain and surround the ear canal. 
• The sphenoid bone is situated in the middle of the skull towards the front. It helps form the base and sides of the skull, and has a shape that resembles a butterfly. 
• The ethmoid bone is a cube-shaped bone located in the center of the skull between the eyes. It helps form the walls of the eye sockets, as well as the roof, sides, and interior of the nasal cavity.

Although these are eight individual bones, they are joined together by various fibrous sutures.  

The neurocranium can be further divided into an upper and lower part:

• The upper part, known as the calvaria, consists of the flat bones of the skull that form a dome-like roof. This includes the frontal bone, parietal bones, and occipital bone.
• The lower part, known as the cranial base, includes the lower parts of the frontal bone, the sphenoid bone, ethmoid bone, temporal bones, and the lower parts of the occipital bone. 

Because the calvaria makes up the top part of the skull, these bones are more significant when discussing hair growth/loss. However, the muscles that attach to the temporal and sphenoid bones may also play a role in hair loss (more on that in a bit).

The Vertical Layer: Arteries, Veins, Nerves, and Lymphatic Vessels

We previously discussed the five layers of the scalp. There are also a number of arteries, veins, nerves, and lymphatic vessels that run through those layers. We discuss each of these below.

Arteries of the Scalp

The common carotid arteries, a pair of arteries on either side of the neck, provide the main supply of blood to the scalp. While still in the neck, each of the common carotid arteries splits into an internal and external carotid artery. Each of these branches supplies blood to different areas of the scalp. 

Internal Carotid Artery

The internal carotid artery (on either side of the skull) gives rise to an ophthalmic artery, which further branches into a supratrochlear artery and a supraorbital artery. Both the supratrochlear and supraorbital arteries rise through the supraorbital foramen  (i.e. an opening in the bone just above the eye socket and just beneath the eyebrow) and connect with their counterparts on the opposite side of the skull, as well as with the superficial temporal artery (also on either side of the skull), which provides most of the blood supply to the front of the scalp. 

External Carotid Artery

The external carotid artery (on either side of the skull) branches into the following arteries:

• The superficial temporal artery passes over the back of the cheekbone, where it splits again into a frontal and parietal branch. The frontal branch runs across the temple, supplying blood to the frontal and temporal regions of the scalp. The parietal branch continues over the top of the skull, supplying blood to the parietal region of the scalp. 
• The posterior auricular artery splits away from the external carotid artery just above/behind the jaw and just below the ear. The posterior auricular artery then passes underneath the ear and travels to the deep tissues that converge between the mastoid process (i.e. the protruding, cone-shaped bone found just below and behind the ears on either side of the head) and the cartilage of the ear. This artery supplies blood to the parts of the scalp located above and behind the ears. 
• The occipital artery splits from the external carotid artery at the back of the neck, passing under the ear and in front of the mastoid process. This artery supplies blood to the back of the scalp. 

Veins of the Scalp

The venous drainage of the scalp can be split into superficial and deep components.

Superficial Veins

The superficial veins follow their respective arteries. The supraorbital and supratrochlear veins (on either side of the skull) drain blood from the top of the scalp through the front of the face, while the superficial temporal, occipital, and posterior auricular veins (also on either side of the skull) drain blood from the scalp through the back of the head. Also, just like its arterial counterparts, the superficial temporal vein has a frontal and parietal branch. 

Deep Veins

The deeper regions of the scalp drain into the pterygoid venous plexus (on either side of the skull), which is a large plexus (i.e. a bundle of intersecting blood vessels, nerves, or lymphatic vessels) of veins situated between the temporalis (i.e. thin, fan-shaped muscles on either side of the skull) and lateral pterygoid (i.e. one of the muscles in the jaw that helps us chew) muscles. From there, the venous blood passes into the maxillary vein (on either side of the skull), then into the retromandibular vein (on either side of the skull), and then into the external jugular vein (on either side of the skull), which is the venous counterpart to the external carotid artery. 

The Connection Between Superficial and Deep Veins

It’s also worth noting that there is a drainage connection between the superficial and deep venous systems, whereby parietal emissary veins located in the loose areolar connective tissue layer of the scalp connect to diploic veins that penetrate the skull, eventually flowing into the dural venous sinuses (e.g. superior sagittal sinus) that drain venous blood from inside the cranial cavity. 

Nerves of the Scalp

The front and sides of the scalp are innervated by trigeminal nerves, while the back of the scalp is innervated by cervical nerves.

Trigeminal Nerves

There are two trigeminal nerves – one on each side of the skull. Each trigeminal nerve has three major branches:

• The ophthalmic nerve branches into the frontal nerve, which eventually splits into the following two branches:
• The supratrochlear nerve innervates the front, middle section of the forehead. 
• The supraorbital nerve innervates a large portion of the scalp including the top and sides of the forehead, as well as the vertex. 
• The maxillary nerve branches into the zygomaticotemporal nerve, which innervates the temple.
• The mandibular nerve branches into the auriculotemporal nerve, which innervates the skin in front of and above the ear. 

Cervical Nerves

Cervical nerves emerge from the spinal cord to innervate the rest of the body. There are four cervical nerves that innervate the scalp:

• The lesser occipital nerve (on either side of the skull) arises from the anterior ramus (i.e. front-facing branch) of the second cervical nerve and innervates the skin above and behind the ear. 
• The greater occipital nerve (on either side of the skull) arises from the posterior ramus (i.e. rear-facing branch) of the second cervical nerve and innervates the skin at the upper back of the scalp. 
• The great auricular nerve (on either side of the skull) arises from the anterior rami (i.e. front-facing branches) of the second and third cervical nerves and innervates the skin below and behind the ear. 
• The occipital nerve (on either side of the skull) arises from the posterior ramus  (i.e. rear-facing branch) of the third cervical nerve and innervates the skin at the lower back of the scalp. 

The Scalp’s Lymphatic Vessels

The lymphatic vessels of the scalp are located in the dense connective tissue layer and follow the venous drainage. In general, the front portions of the scalp drain lymphatic fluid through the parotid nodes (i.e. lymph nodes found in front of and just below each ear), which continue to drain through the submandibular lymph nodes (i.e. lymph nodes located just beneath the jaw bone) and deep cervical lymph nodes (i.e. lymph nodes located in the neck). 

The rear portions of the scalp drain lymphatic fluid through the posterior auricular lymph nodes (i.e. a small group of lymph nodes located just beneath the ear) and occipital lymph nodes (i.e. lymph nodes located at the back of the head, near the occipital bone). The posterior auricular lymph nodes drain the area of the scalp located directly behind the ear and flow into the occipital lymph nodes, while the occipital lymph nodes drain lymphatic fluid from the remaining regions in the back of the scalp.

Muscles that Act on the Scalp

There are a handful of muscles that act on the scalp.

The largest and most important muscle in the scalp is the occipitofrontalis muscle. The occipitofrontalis muscle is actually two sections of muscle, known as bellies, that connect to the front and back of the galea aponeurotica. The frontalis belly connects to the galea aponeurotica at the front of the head and inserts into the superior orbicularis oculi (i.e. the muscle that closes the eyelids) near the eyebrow. The occipitalis belly connects to the galea aponeurotica at the back of the head and attaches to the superior nuchal line (i.e. one of four curved ridges on the exterior surface of the occipital bone) and mastoid processes (i.e. the protruding, cone-shaped bones found just below and behind the ears on either side of the head) at the bottom of the scalp. These muscles, or bellies, work in conjunction to pull the scalp back and elevate the eyebrows (the contraction of the frontalis belly creates wrinkles on the forehead). 

The auricular muscles are a group of muscles of the auricle (i.e. the visible portion of the ear). Although there are nine total auricular muscles on either side of the skull, six of those muscles are intrinsic muscles located deep within the skull, while the other three are extrinsic muscles that are located more superficially. It is the three extrinsic muscles that we’re concerned with for this article. 

• The auricularis superior, the largest of the three extrinsic auricular muscles, is a thin, fan-shaped muscle located above the ear. It helps to elevate the ear, attaching to the galea aponeurotica at the top and a tendon just above the ear at the bottom.  
• The auricularis anterior, the smallest of the three extrinsic auricular muscles, is a thin, fan-shaped muscle located in front of the ear. It helps draw the ear upward and forward, attaching to the lateral edge of the galea aponeurotica at one end and cartilage at the top, front of the ear at the other.
• The auricularis posterior is a muscle located behind the ear. It helps pull the ear backward, attaching to the mastoid process (i.e. the protruding, cone-shaped bone found just below and behind the ears on either side of the head) at one end and the lower part of the cranial surface at the back of the ear at the other end. 

Although the auricular muscles play a minor role in fixing the position of the ear, they are considered vestigial in humans. Nevertheless, these muscles may play a role in restricting blood flow to the scalp (more on this in a bit). 

The temporoparietalis muscles are a pair of muscles located just above and in front of the auricularis superior muscles on either side of the head. These muscles lie over both the temporal and occipital bones, connecting to the fascia (i.e. a thin sheath of fibrous tissue enclosing a muscle or other organ) just above the ear on one end and the galea aponeurotica on the other. The temporoparietalis muscles help to fix the galea aponeurotic and elevate the ears. 

The temporalis muscles are broad, fan-shaped muscles located on either side of the head. These muscles cover most of the temporal bones and help produce movements of the mandible, or jawbone, when chewing. Although these muscles are more associated with the mandible than they are the scalp, the contraction of these muscles may restrict blood flow to the scalp, which could have an effect on hair growth/loss (more on this below).

Ways Scalp Mechanics May Impact Hair Growth

Now that you have a better understanding of scalp anatomy, we can examine ways that scalp mechanics may impact hair growth. In particular, the galea aponeurotica and the surrounding musculature may play a role in restricting blood flow (and oxygen) to the scalp. 

We know from previous studies that balding scalps tend to have 2.6 x less subcutaneous blood supply compared to non-badling controls. Moreover, several blood-pressure-lowering medications – such as minoxidil, diaoxide, and pinacidil – have been shown to improve androgenic alopecia – one of the world’s most common hair loss disorders. These findings implicate reduced blood supply as a potential contributor to pattern hair loss. And while it’s still debated just how much the reductions to blood flow are a cause or consequence of androgenic alopecia, there may be a therapeutic benefit to improving blood, oxygen, and nutrient levels to balding hair follicles. 

Below, we examine the impact of scalp musculature on arterial branches, as well as the impact of the galea aponeurotica and surrounding musculature on microcirculation (i.e. capillaries in the scalp).

The Impact of Musculature on Arterial Blood Flow

Dermatologists report that roughly 80% of men with androgenic alopecia tend to have “tight” scalps, suggesting that the muscles around the perimeter of the scalp have involuntarily contracted and are pinching the arterial branches, causing a reduction in blood supply. This is also supported by research measuring scalp hardness in balding versus non-balding men across a variety of scalp regions.^[1]https://www.researchgate.net/publication/338624064_Androgenetic_alopecia_is_associated_with_increased_scalp_hardness

So, do the muscles surrounding the scalp perimeter and anchored to the galea aponeurotica have anything to do with these phenomena? Some evidence suggests yes.

As noted previously, the supraorbital and supratrochlear arteries are two of the three arterial branches that supply the majority of blood to the frontal region of the scalp. These arteries pass through the cranial bone at the eyebrows, run underneath the frontalis muscle, then pierce through the frontalis muscle before running upward toward the hair line. When the frontalis muscle flexes, this flexing can compress the supraorbital and supratrochlear arteries, restricting blood flow to the scalp.^[2]https://academic.oup.com/asj/article-abstract/41/11/NP1599/6206455

In addition, the deep temporal artery resides between the cranium and the temporalis muscles. When these muscles contract, they can compress the deep temporal artery against the skull and constrict blood supply. 

Moreover, some branches of the auricularis anterior and posterior arteries weave between the auricular muscles and their supporting tendons. It is possible that the contraction of the auricular muscles may restrict blood flow in the same manner. 

Finally, while many of the scalp’s arteries reside in the fascia that overlies the scalp muscles, the contraction of the muscles underlying these arterial branches can still affect them. We know this because studies have shown that when the temporalis muscle contracts, the artery overlying it (the superficial temporal artery) constricts by 50%, thus leading to a ~75% decrease in blood supply in that arterial branch.^[3]https://n.neurology.org/content/11/11/935

But that’s not the whole story.

The Impact of the Galea Aponeurotica on Microcirculation

Despite the possible restriction of arterial blood flow described in the previous section, it is generally believed that reductions to blood flow in androgenic alopecia are mainly due to the loss/restriction of the microcapillary networks (i.e., the small blood vessels supporting the hair follicles themselves), rather than reductions from the carotid arterial branches supporting those microcapillary networks.

The microcapillary networks may constrict or compress as a result of mechanical stretch across the galea aponeurotica (mediated by the contraction of the scalp’s perimeter muscles). Because the top of the scalp is a fixed area, stretching of the galea aponeurotica would generate compression of the underlying microcapillary networks supplying hair follicles. 

How Relevant Is Blood Flow to Androgenic Alopecia?

We see hypoxia (i.e. insufficient supply of oxygen) as a trigger of hair loss in mouse models, but is it relevant to humans with androgenic alopecia? Unfortunately, we still don’t know (since there are also reductions to blood supply resulting from the hair follicle miniaturization that follows each re-entry into the anagen stage of the hair cycle). 

Interestingly, there used to be a surgery called “scalp reduction,” where surgeons would place a balloon underneath the galea aponeurotica, slowly inflate it over a series of weeks, and then give patients a surgery to “remove” bald regions and pull the hair-bearing stretched skin over to create the appearance of a fuller head of hair. In the 1990s, these surgeries were quietly abandoned after surgeons started voicing concerns of accelerated hair loss in patients following the procedure. Was this accelerated hair loss caused by skin tension? Did this tension lead to microcapillary compression? We still don’t know the answers, but the questions certainly are interesting.   

Clinical Evidence Suggests Possible New Hair Loss Treatment Targets

Despite the lack of certainty regarding the impact of blood flow (and oxygen) on androgenic alopecia, the results from a number of Botox studies show that when the muscles surrounding the scalp are forcibly relaxed in patients with androgenic alopecia, hair growth/loss improves. 

Botulinum toxin, which is commonly referred to by the brand name Botox, is an injectable neuro modifier that’s used as a therapeutic treatment for many clinical and cosmetic concerns. Specifically, Botox is used to help relax muscles and reduce certain inflammatory signaling proteins. 

Over the last decade, there have been five clinical studies published on the hair-promoting effects of Botox on men with androgenic alopecia. Four of those studies tested intramuscular Botox injections (i.e. injections directly into the scalp’s perimeter muscles), while the fifth study tested intradermal Botox injections (i.e. injections directly into balding regions of the scalp). We examine the results from both types of studies below.

The Results of Studies Testing Intramuscular Botox Injections

Across the four studies testing intramuscular Botox injections, 75-80% of participants responded favorably (i.e. hair growth) with an average hair count increase of 18-21% after 6 to 10 months. Injections into the scalp perimeter muscles were done once every 4-6 months, with results becoming cosmetically significant after the second round of injections. 

In addition to testing the use of Botox injections on their own, one of the four studies also examined using Botox injections alongside oral finasteride (i.e. the active ingredient in Propecia). This combined therapeutic approach led to improved response rates and hair count increases that average nearly 35%. 

Researchers suspect that two mechanisms contributed to these results:

• First, intramuscular Botox injections might relax involuntarily contracted muscles around the perimeter of the scalp. As noted previously, arterial branches run through those perimeter muscles in order to supply the scalp with blood. When perimeter muscles are contracted, they may pinch those arteries, restricting the supply of blood to the scalp. Researchers theorize that injecting those perimeter muscles with Botox helps to unclamp the pinched arterial branches, increasing the supply of blood (and oxygen). 
• Second, by relaxing those perimeter muscles, researchers also speculate that Botox injections might help reduce tension across the top of the scalp, and in doing so, potentially reduce tension-mediated inflammation and/or lower dihydrotestosterone (DHT) in the scalp. 

Despite researcher’s suspicions, it’s important to note that these suggested mechanisms are only speculative at this point. We will need more data in order to corroborate these suspicions. 

The Results of the Study Testing Intradermal Botox Injections

In the one study that tested intradermal Botox injections, 60-80% of participants responded favorably (i.e. hair growth) with an average hair count increase of 5% after 6 months. Injections into balding regions were done every four weeks. 

Although this study’s response rate is similar to the intramuscular studies above, the hair count increases were much lower. It’s worth noting that these results might improve with higher-dose injections. This study used just 30 units of Botox, spread across the entire scalp. When another investigator increased the amount of Botox injected from 30 units to 100 units, and also doubled the frequency of injections, they observed more significant hair growth.^[4]https://www.dovepress.com/getfile.php?fileID=73853  

While conducting the study of intradermal Botox injections, researchers also conducted a cell culture on human hair follicles. They found that Botox appears to decrease the expression of transforming growth factor beta 1 (TGFB-1), a signaling protein that acts as a negative regulator of the hair cycle. TGFB-1 also appears to be intimately tied to hair follicle miniaturization, causing researchers to speculate that intradermal Botox injections might be down regulating TGFB-1 in human hair follicle sites, and in doing so, allowing for hair loss improvements. 

It’s important to note that the reduction of TGFB-1 happens in a dose- and time-dependent manner. Given this fact, it makes sense that increasing both the volume and frequency of intradermal injections evokes a more robust improvement in hair count. 

As with the intramuscular studies above, it’s important to note that the suspected mechanism (i.e. the down regulating of TGFB-1) identified in the intradermal study is only speculative. In order to corroborate this suspicion, more data will need to be collected. 

How Reliable Are the Findings from the Botox Studies?

Although the results from the Botox studies look promising, the amount of evidence on Botox as a treatment for androgenic alopecia is still rather small. And while several research groups have found consistent results, these studies tend to score lower on the hierarchy of evidence. So, we should interpret those results with caution. 

There are at least three significant issues with the Botox studies:

• The Botox Studies Had a Small Number of Participants: To date, fewer than 200 participants have tested Botox to treat androgenic alopecia (in a clinical, peer-reviewed setting). For comparison, thousands of participants have tested the use of finasteride for treating androgenic alopecia. 
• None of the Botox Studies Used a Control Group: At this point, no Botox studies have used control groups (i.e. patients who receive a placebo treatment). Using placebo groups is important because they help researchers control for hair count improvements (and losses) due to seasonal hair shedding. 
• None of the Botox Studies Assessed Hair Diameter: While the Botox studies assessed hair count, they did not examine changes to hair diameter. Androgenic alopecia progresses through the process of hair follicle miniaturization, and we can effectively stop androgenic alopecia by reversing this process. Because we don’t know whether Botox has an effect on hair follicle miniaturization, we also don’t know whether Botox is an effective long-term solution for androgenic alopecia. 

In addition to the above three issues, it’s also worth noting that 1) there are currently no established best practices for the use of Botox to treat androgenic alopecia, and 2) Botox treatment can be rather expensive, with intramuscular injections costing $2,400 to $4,000 per year and intradermal injections running $4,800 to $12,000 per year. 

This isn’t to say we should dismiss the evidence in favor of using Botox to treat androgenic alopecia. At the same time, it’s important not to jump to any conclusions regarding the efficacy of using Botox versus other treatment options. 

Final Thoughts

In this article, we’ve shown how the scalp has a rather complex anatomy – including seven regions on the surface of the scalp; five tissue layers; several bones that the scalp attaches to; a number of arteries, veins, nerves, and lymphatic vessels running through the scalp; and a collection of muscles that pull on the scalp. We’ve also discussed ways that scalp mechanics may impact hair growth, and reviewed five studies that suggest Botox injections may improve hair loss by relaxing the muscles around the perimeter of the scalp.   

Although the findings from Botox studies are still preliminary, they have opened up the possibility of new treatment targets for androgenic alopecia. Any relevant treatment targets would need to relax the muscles around the scalp so that 1) arterial branches can deliver an adequate supply of blood (and oxygen) to the scalp, and 2) tension in the galea aponeurotica doesn’t restrict blood flow in the microcapillary networks that feed hair follicles. 

In addition to the results from the Botox studies, there’s mechanistic research to suggest that skin tension in balding regions (generated from the contraction of muscles around the scalp) might have something to do with the arrival of dihydrotestosterone (DHT) and the balding process itself.^[5]https://www.sciencedirect.com/science/article/pii/S0306987717310411

Finally, it’s worth noting that Botox injections are not the only way to relax the muscles around the scalp. Scalp massages may offer a viable, less-expensive method for treating androgenic alopecia that targets the same mechanisms as Botox injections. 

A rising interest has grown in topical finasteride as a middle ground between oral dihydrotestosterone (DHT) blockers and non-hormonal treatments like minoxidil. This shift is largely driven by individuals seeking similar efficacy to oral finasteride while minimizing the risk of systemic side effects.

Online transformation photos showcasing impressive regrowth have further fueled the trend, but these often highlight the most exceptional cases rather than typical results. As a result, perceptions of topical finasteride’s effectiveness can be skewed by outliers, making it difficult for prospective users to understand what to expect in real-world use.

We’ll take a closer look at this one later.

This article explores how topical finasteride fits within today’s hair loss treatment landscape, clarifying what current evidence supports, how much regrowth is realistically achievable, and how it compares to both oral finasteride and non-DHT-based alternatives like minoxidil.

Interested in Topical Finasteride?

Low-dose & full-strength finasteride available, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

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*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

What is Topical Finasteride?

Topical finasteride is a 5ɑ-reductase type II inhibitor formulated for direct scalp application. It is designed to inhibit DHT locally in the scalp. By blocking DHT conversion in the scalp, the hope is that it will reduce miniaturization and hair loss in androgenic alopecia (AGA) while minimizing the risk of sexual and hormonal side effects seen with oral administration.

Mechanism of Action

Topical finasteride selectively inhibits the type II 5ɑ-reductase enzyme, decreasing local DHT levels. Topical finasteride has been found to reduce serum DHT by approximately 24-48% depending on the dose, which is notably less than the 60-70% reduction seen with oral finasteride. Lower doses primarily inhibit scalp DHT, potentially minimizing systemic side effects.^[1]Caserini, M., Radicioni, M., Leuratti, C., Terragni, E., Iorizzo, M., Palmieri, R. (2016). Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men … Continue reading But, as the data shows, complete elimination of systemic impact is not guaranteed.

Formulations and Dosing

Compound strengths for topical finasteride vary, typically ranging from 0.005% to 0.2% (as Ulo does), with other companies offering doses as high as 2.5%; however, the higher the dose, the higher the risk of systemic absorption.

Why Expectation Setting Matters

Expectation setting is important when starting topical or oral finasteride for hair loss because online forums and before-and-after images tend to spotlight the most extreme results, rather than typical user outcomes. While finasteride has demonstrated high effectiveness on average, regrowth is generally gradual, with noticeable changes taking six months or more and reaching a plateau around 12-18 months.^[2]Piraccini, B.M., Blume-Peytavi, U., Scarci, F., Jansat, J.M., Falques, M., Otero, R., Tamarit, M.L., Galvan, J., Tebbs, V., Massana, E. (2021). Efficacy and safety of topical finasteride spray … Continue reading,^[3]Rossi, A., Magri, F., D’Arino, A., Pigliacelli, F., Muscianese, M., Leonici, P., Caro, G., Federico, A., Fortuna, M.C., Carlesimo, M. (2020). Efficacy of Topical Finasteride 0.5% vs 17ɑ-Estradiol … Continue reading

Overestimating likely results can lead to frustration, disappointment, and ultimately premature abandonment of therapy when expectations are unmatched by personal experience. Conversely, underestimating the drug’s potential may lead individuals to dismiss a therapy that could offer substantial stabilization or regrowth if given enough time and proper use.

Balanced, evidence-based expectations help users remain committed through the plateau period and recognize that slow, steady improvement, rather than dramatic changes overnight, is the most common pattern for most finasteride users.

What’s Possible ≠ What’s Probable

While topical finasteride can occasionally deliver dramatic regrowth, most users should expect moderate thickening and stabilization in hair density rather than extreme transformations. 

Outcomes are best thought of as falling along a distribution curve:

• A small portion of users are “hyper-responders” who achieve big, visible transformations.
• The majority see moderate, steady improvement, such as visible thickening or a reduction in hair loss.
• Some individuals are non-responders with little to no benefit, reflecting the variability in biology and clinical response.

Several factors influence where an individual might fall on this spectrum:

• Duration of hair loss: Early intervention typically yields better results, while longer-standing balding zones respond less robustly.
• Consistency: Adhering reliably to a treatment schedule increases the chances of improvement, as missed doses may lead to suboptimal outcomes.
• Adjunct therapies: Combining topical finasteride with minoxidil or microneedling can enhance benefits, especially in difficult cases.
• Genetic factors: Variations in androgen receptor (AR) gene sensitivity and baseline DHT levels can also help dictate who will be a strong or weak responder.^[4]Wakisaka, N., Taira, Y-I., Ishikawa, M., Nakamizo, Y., Kobayashi, K., Uwabu, M., Fukuda, Y., Taguchi, Y., Hama, T., Kawakami, M. (2005). Effectiveness of finasteride on patients with male pattern … Continue reading

Stronger Evidence = Greater Predictability

Finasteride is one of the most thoroughly studied hair loss medications, with clinical trial data supporting its reliability and predictability. This evidence base translates into a narrower distribution of user responses; most people see consistent moderate results, with fewer extremes compared to newer drugs.

By contrast, topical dutasteride has been studied less, limiting the ability to accurately predict outcomes and resulting in a wider variation of response. Clinical trials consistently show that dutasteride is more potent in DHT suppression and regrowth than finasteride, yet variability in regrowth and side effect profiles remains higher, especially in real-world use due to less standardization and a less robust evidence base.^[5]Almudimeegh, A., AlMutairi, H., AlTassan, F., AlQuraishi, Y., Nagshabandi, K.N. (2024). Comparison between dutasteride and finasteride in hair regrowth and reversal of miniaturization in male and … Continue reading

Finasteride’s consistent results and well-documented safety profile make it the first-line treatment for most men with AGA, as clinicians and users can anticipate a predictable, steady benefit with a lower risk of surprises. This predictability helps set realistic user expectations and avoids over- or under-estimation of results.

Real Case Studies: Topical Finasteride Before and After

Case #1: Male (32), 24 Months on Topical Finasteride 0.025% (1 ml nightly) + Minoxidil 5% Added After 12 Months

This 32-year-old male’s current protocol includes a 0.025% topical finasteride solution, dosed at 1 mL nightly. He incorporated 5% topical minoxidil at month 12. Adjuncts included weekly dermastamping, a conditioner-only washing routine, and occasional argan oil usage. He reported stabilization of hair shedding from months 0-3, strong thickening from months 3-12, and maintained density, improved texture, and shine from months 12-24. He reported no sexual or systemic side effects from topical finasteride. 

Case #2: Male (23) – 3.5 Months on Topical Finasteride 0.025% (Twice Daily) + Minoxidil 5% (twice daily)

This 23-year-old male applied a topical finasteride 0.025% solution compounded with minoxidil 5%, in addition to occasional, inconsistent derma-rolling over 3.5 months. He reported an initial shedding phase at months 1-2 of the protocol, followed by a sudden improvement in hairline density and thickness at month 3. By month 3.5, he noted significant regrowth and richer color and texture along the frontal hairline. The user noted that the topical regimen has been well-tolerated with no systemic side effects. 

Case #3: Male (34) – 12 Months on Topical Finasteride 0.3% + Minoxidil 6% (twice daily)

This 34-year-old male had tried numerous natural and supplement-based approaches (including pumpkin seed oil, saw palmetto, and rosemary) without success before starting pharmacologic therapy. He used a topical finasteride 0.3% spray compounded with topical minoxidil 6%, applied twice daily. He additionally used microneedling (1.5 mm depth) every 10 days. He described the first 2 months as a “rough” period, marked by noticeable shedding and even mild chest tenderness. 

At months 3-6, he noted steady improvement and early thickening, especially near the temples and mid-scalp. By months 7-8, he observed significant progress, and in months 9-12, coverage stabilized, with occasional light shedding cycles. At this point, he transitioned to an oral regimen for convenience. 

Case #4: Male, 8 Months on Topical Finasteride 0.25% (1 mL twice daily) + Minoxidil 8% (1 mL twice daily) + Microneedling 0.25mm (every three days)

This male user reported on his 8-month progress using topical finasteride, minoxidil, and microneedling. He applied a topical finasteride 0.25% solution compounded with topical minoxidil 8% twice daily to the target areas, with 0.25 mm microneedling sessions every 3 days. At month 1, he reported a mild, brief shedding period, and his first noticeable improvement with thicker strands by month 3. From months 4-8, the user continued to show thickening and increased density. He reported no side effects beyond scalp redness attributed to dermarolling. 

Case #5: Male (37) – 4 Months on Topical Finasteride 0.1% + Minoxidil 5% ( 1mL Daily)

This 37-year-old male opted for a topical combination for safety and convenience. The solution contained topical finasteride 0.5% and topical minoxidil 5%, which he applied 1 mL once daily over 4 months, exclusively to the crown. He noted a 4-week shedding phase from week 3 of treatment, followed by continued shedding and apparent thinning at month 2. By month 2.5, shedding ceased, and months 3-4 marked a period of steady regrowth and improved crown density. 

The user reported maintaining consistent adherence despite the discouraging shedding phase and did not report any systemic or local irritation or side effects. While he did not apply the solution outside the crown, he reported slight thickening near the frontal region.

Case #6: Male (23) – 3 Months on Topical Finasteride 0.3% + Minoxidil 6% (4 Sprays Nightly) + Microneedling 1 mm (Weekly)

This 23-year-old male chose a combination therapy of topical finasteride 0.3%/topical minoxidil 6%, which he applied as a spray 4 times nightly for 3 months. Additionally, he used 1 mm dermastamp once weekly, from which he reports mild temporary redness. At month 1, he reported mild shedding, with no change in his appearance. At month 2, he noticed the first signs of regrowth and thickening, especially along the temples. Month 3 was marked by significant visible improvement. The user described his hair as visibly denser and fuller and reported satisfaction after only 3 months of combination therapy.

Case #7: Male (46) – 4+ Months on Topical Finasteride 0.1% (0.5 mL front + 0.5 mL crown twice daily, TrichoSol) + Minoxidil 5% + Dermastamp 0.8–1 mm Weekly

Due to long-standing crown thinning, this 46-year-old male commenced a combination of topical finasteride 0.1% and minoxidil 5%, applied twice daily for 4 months. He complemented with microneedling (initially daily, then weekly), occasional rosemary oil, and regular biotin. He noted an initial skin reaction at the start of therapy, which caused him to stop it for around 4 weeks. He did not note any ongoing side effects since restarting, nor any shedding or unrelated side effects. He noted improvement in the mid-scalp despite limiting the application to that area, suggesting a possible systemic effect or local spread.

Case #8: Male (24), 4 Months on Topical Finasteride 0.3% + Minoxidil 6%

This 24-year-old male started the topical combination of finasteride 0.3% and minoxidil 6%, applied mainly to his hairline and temples via a serum. He did not observe any side effects, save for transient greasiness and a distinct smell from the serum. Between baseline and month 4 of therapy, he reported visible baby hairs and an early fill across his hairline. He did not notice any shedding across the 4 months. 

Case #9: Male, 9 Weeks on Low-Dose Topical Finasteride (0.01–0.02%) + Topical Minoxidil 5% (Daily)

This male documented his results after 9 weeks on low-dose topical finasteride combined with minoxidil. He created a 0.02% topical finasteride solution using crushed finasteride tablets, which he took from month 2 after initially trialing a 0.01% solution. He also applied a 5% minoxidil solution with a standard alcohol-based carrier. He noted a brief shedding phase at week 4 of the protocol, which he interpreted as a positive response indicator. From weeks 6-9, he noted visible regrowth at the front and thickening of the crown. He did not note any systemic or dermatologic adverse events.

Case #10: Male (43), 3 Months on Topical Finasteride 0.025% (1 ml daily) + Topical Minoxidil 5% (daily) + Microneedling 0.75mm (once every two weeks)

This 43-year-old male sought combination finasteride and minoxidil therapy to improve his hair loss. Over three months, he applied a 0.025% topical finasteride solution once daily to the affected areas, along with 5% minoxidil combined with the same solution. Additionally, he applied Dermastamp 0.75 mm every 2 weeks, avoiding topical application on stamping days. Additionally, he supplemented with magnesium, zinc, B-complex, vitamin D3+K2, lecithin, and followed a generally healthy diet with regular exercise.

At months 1-2, he noted early thickening and density improvements, and by month 3, he achieved increased coverage and shaft thickness at the vertex, with no shedding or side effects reported.

Probable Regrowth Timeline

Based on the available data, we’ve created a probable timeline of regrowth.

Months 0-6: No Cosmetic Changes

Most users will see little to no visible improvement in the first six months. During this period, finasteride is actively reducing DHT and stabilizing hair follicles, but hair regrowth is not yet apparent. Some individuals may notice decreased shedding, while others may experience temporary increased shedding as old hairs make way for newer ones.

Months 6-12: First Cosmetic Improvements

Between 6 and 12 months, initial improvements become visible for most responders. Hair density may be noticeably improved, with thicker strands and slower progression of hair loss.^[6]Piraccini, B.M., Blume-Peytavi, U., Scarci, F., Jansat, J.M., Falques, M., Otero, R., Tamarit, M.L., Galvan, J., Tebbs, V., Massana, E. (2021). Efficacy and safety of topical finasteride spray … Continue reading  

Months 12-24: Noticeable Regrowth in Responders

During the second year, responders typically achieve their most significant gains. Hair regrowth becomes more noticeable, and improvements in overall density continue to build. For many, this period yields the best results, though those who started with advanced hair loss may see stabilization rather than dramatic regrowth.^[7]Rossi, A., Magri, F., D’Arino, A., Pigliacelli, F., Muscianese, M., Leonici, P., Caro, G., Federico, A., Fortuna, M.C., Carlesimo, M. (2020). Efficacy of Topical Finasteride 0.5% vs 17ɑ-Estradiol … Continue reading

Months 24+: Maintenance and Plateau

After two years, most responders maintain their gains if they consistently use the medication. Regrowth typically plateaus, with ongoing use required to sustain results. Discontinuation leads to a gradual loss of regained hair within 6-12 months, returning to baseline levels. Some individuals may see marginal further improvement with combination or adjunct therapies. 

For most users, topical finasteride is a long-term commitment with gradual, steady gains and sustained maintenance. The timeline highlights the importance of patience and expectations aligned with clinical reality.

How To Maintain Realistic Expectations

Most topical finasteride users experience visible, but not dramatic, improvements in hair density and preservation. Rather than achieving total restoration, finasteride is more likely to “turn back the clock” by 1-3 years. 

Patience is important as results often take between 6 to 12 months to become noticeable. Initial changes may be subtle, such as reduced shedding or minor thickening, before more visible regrowth stabilizes over the course of a year.

To accurately assess progress, you can track your progress with photographs. However, it’s important to use the same lighting and angles each time you photograph your scalp. This approach reduces bias and helps clearly identify gradual changes that might otherwise go unnoticed day-to-day. Setting and maintaining realistic expectations can improve satisfaction and help sustain adherence to the long-term treatment plan.

Practical Takeaways

• Topical finasteride offers a clinically proven, lower-risk alternative to oral formulations for treating AGA.
• Multiple studies demonstrate that its efficacy is comparable to oral finasteride. 
• The key safety advantage of topical finasteride is its reduced systemic DHT suppression, potentially leading to a lower incidence of sexual and hormonal side effects commonly associated with oral therapy.
• Consistency in application and patience over many months remain the most important predictors of treatment success, as improvements are typically gradual and require ongoing commitment to daily use.

Final Thoughts

When evaluating topical finasteride, it’s important to consider both its proven efficacy and its measured expectations. Clinical studies consistently show that topical finasteride can deliver meaningful stabilization and regrowth with a lower likelihood of systemic side effects compared to oral therapy. However, like all hair loss treatments, results develop gradually and vary between individuals.

By grounding expectations in clinical averages rather than exceptional before-and-after photos, users can better appreciate the steady, cumulative improvements that typically occur over months, not weeks. Patience, consistency, and realistic goal setting are key; most users will experience visible thickening, reduced shedding, and sustained density when topical finasteride is used correctly and maintained long term.

Ultimately, topical finasteride represents a balanced, evidence-backed option in the modern hair restoration toolkit: one that offers both reliability and tolerability for those seeking to preserve and strengthen their existing hair with confidence.

Oral minoxidil has become a widely used off-label option for androgenic alopecia (AGA) in men and women, despite initially being approved only as an antihypertensive medication decades ago.

Oral minoxidil is increasingly offered to address specific unmet needs in AGA treatment: 

• Topical non-responders: Some people don’t see satisfactory results with topical minoxidil, possibly due to inadequate absorption, variations in scalp skin properties, or genetic factors affecting drug metabolism.
• Scalp sensitivity/irritation: Topical minoxidil can cause local side effects such as itching, flaking, or dermatitis due to the vehicle (especially propylene glycol) or the active ingredient itself. Switching to oral minoxidil bypasses these local reactions.
• Simpler routines/adherence: Oral dosing eliminates the need for daily topical application, which can be messy, time-consuming, or interfere with hair styling. For some, this leads to better long-term adherence and quality of life.

Regrowth with oral minoxidil can be variable, however. This variability mainly stems from biological differences between patients. Because minoxidil is a prodrug that requires conversion by the enzyme sulfotransferase (SULT1A1) into its active form, individual variation in enzyme activity strongly influences response.^[1]Ramos, P.M., Goren, A., Sinclair, R., Miot, H.A. (2020). Oral minoxidil bio-activation by hair follicle outer root sheath cell sulfotransferase enzymes predicts clinical efficacy in female pattern … Continue reading  

Interested in Oral Minoxidil?

Low-dose oral minoxidil available, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

Click Here For 15% Off

*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Unfortunately, what most people see online are extremely successful oral minoxidil before and after photos (which you’ll see below), which can lead people to believe that they will experience more regrowth than they actually might.

In this article, we will explore what the likely (not just possible) results are and what the clinical trials show.

But first, let’s have a quick refresher on what oral minoxidil is.

What is Oral Minoxidil?

Oral minoxidil is a tablet medication originally developed as a vasodilator for severe hypertension, but now increasingly used off-label at low doses to treat AGA and other hair loss conditions. It enhances scalp flow and prolongs the growth phase (anagen) of hair follicles, primarily by increasing prostaglandin E2 and vascular endothelial growth factor (VEGF). 

Oral minoxidil acts by opening ATP-sensitive potassium channels in vascular smooth muscle, which increases perifollicular blood flow. It also prolongs the anagen phase of the hair cycle. Unlike topical minoxidil, which requires local sulfotransferase enzyme activity in the scalp for conversion to its active form, oral minoxidil is metabolized systemically via hepatic sulfotransferase, potentially bypassing poor scalp enzyme activity in some individuals.^[2]Kaiser, M., Abdin, R., Gaumond, S.I., Issa, N.T., Jiminez, J.J. (2023). Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs. Clinical, Cosmetic and Investigational Dermatology. 16. … Continue reading 

For hair loss, oral minoxidil is prescribed at significantly reduced dosages compared to antihypertensive therapy – typically:

• 0.25 mg – 1.25 mg for women
• 2.5 mg – 5 mg for men
• Adverse effects are much less frequent at these low doses but may include hypertrichosis (excess unwanted body hair), fluid retention, and, rarely, cardiovascular effects.^[3]Bloch, L.D., Carlos, R.M.D. (2024). Side Effects’ Frequency Assessment of Low Dose Oral Minoxidil in Male Androgenetic Alopecia Patients. Skin Appendage Disorders. 11(1). 14-18. Available at: … Continue reading 

While oral minoxidil is not FDA-approved for hair loss, a number of studies show its efficacy. 

The Evidence

You can see a complete table of oral minoxidil studies here, but we have picked a few to show.

Study One – AGA (Female)

Vahabi-Amlashi et al (2021) conducted a triple-blind, randomized clinical trial in 72 women with female pattern hair loss, comparing oral minoxidil 0.25 mg daily to 2% topical minoxidil twice daily over 36 weeks.^[4]Vahabi-Amlashi, S., Layegh, P., Kiafar, B., Hoseininezhad, M., Abbaspour, M., Khaniki, S.H., Forouzanfar, M., Sabeti, V. (2021). A randomized clinical trial on the therapeutic effects of 0.25 mg oral … Continue reading 

• Measured outcomes included hair shedding, Sinclair scores by three independent evaluators, trichoscopy assessments of hair density and diameter, and safety labs (liver, kidney, electrolytes).
• Both groups showed significant improvement in hair diameter and density:
  • Group 1 (oral): 13% improvement in hair density.
  • Group 2 (topical): 6% improvement in hair density.
• Sinclair and shedding scores decreased significantly in both groups by the end of the study.
• There was no significant difference between groups in any measured endpoint. 
• Oral minoxidil showed slightly better improvement in hair density; topical minoxidil showed slightly better improvement in hair diameter.
• Adverse events:
  • Group 1 (oral): hirsutism (7.7%), gastrointestinal intolerance (7.7%), weight gain (3.8%), hypotension (3.8%), leading to withdrawal.
  • Group 2 (topical): hirsutism (8%).

Study Two – AGA (Male)

Panchaprateep and Lueangarun (2020) conducted an open-label, prospective single-arm study in 30 men with AGA, treated with 5 mg oral minoxidil once daily for 24 weeks.^[5]Panchaprateep, R., Lueangarun, S. (2020). Efficacy and Safety of Oral Minoxidil 5 mg Once Daily in the Treatment of Male Patients with Androgenetic Alopecia: An Open-Label and Global Photographic … Continue reading

• Statistically significant increase in total hair count at 24 weeks (+35.1±18.9 hairs/cm2; p=0.003).
• Hair diameter improved by 15.2% from baseline (p<0.001).
• Global photographic assessment: 43% of patients achieved an “excellent improvement” score by study end.
• High rate of hypertrichosis (93.3% at 24 weeks); pedal edema was reported in 3 patients, resolving after 2-3 months in all cases.
• No serious cardiovascular side effects were observed.

Study Three – AGA and TE (Male and Female)

Feaster et al. (2023) performed a multicenter retrospective study in 210 patients (50 men, 160 women) with AGA and/or telogen effluvium (TE), comparing low-dose oral minoxidil (0.625 – 2.5 mg daily) to a control (no minoxidil or other non-minoxidil treatments) over 52 weeks.^[6]Feaster, B., Onamusi, T., Cooley, J.E., McMichael, A.J. (2023). Oral minoxidil use in androgenetic alopecia and telogen effluvium. Archives of Dermatological Research. 315(2). 201-205. Available at: … Continue reading 

• Group 1 (oral minoxidil): 52.4% of patients showed clinical improvement in hair growth; 41.9% had hair loss stabilization; 5.7% experienced worsening.
• These results were significantly better than the control group (p=0.001). 
• The mean duration of oral minoxidil use was 25.1 months (range 12-54); the most common dose was 1.25 mg daily.
• Adverse effects were uncommon (9.5% of patients), generally mild, and included:
  • Hypertrichosis (4.8%)
  • Edema (1.9%)
  • Hair shedding (1%)
  • Lower extremity cramping (1%)
  • Palpitations (1%)
  • Scalp dysesthesia (1%)
• There were no serious side effects or study withdrawals due to adverse events in the analyzed population.

Overall, these studies demonstrate that oral minoxidil is an effective and generally well-tolerated treatment option for both AGA and TE in men and women. Across the studies, clinical improvements were observed, with similar efficacy to topical minoxidil.

However, the results that people show online are usually more dramatic than what is seen in clinical studies. 

What’s Possible ≠ What’s Probable

When reviewing outcomes, such as oral minoxidil before and after photos, it’s essential to distinguish what can happen from what is likely to happen. Take a look at the example we have created below. The scattered data points represent the full spectrum of possible individual results, while the central trendline shows the average, reflecting the most common or expected response.

These anecdotes (arrows on the graphs) often highlight “hyper-responders”. These are individuals who experience notably dramatic hair regrowth. They may have higher SULT1A1 activity, leading to higher levels of minoxidil activation.

These accounts, although genuine, illustrate results that surpass what most people can achieve. Problems can then arise when people fixate on these exceptional outcomes and assume that their experience will be similar. If their own hair growth is slower or less impressive, they might discontinue treatment early, or wrongly conclude that it isn’t working.

Impressive results are more frequently shared than modest improvements as a result of survivorship bias. This bias happens when only the most impressive successes receive attention, while the many cases with typical or less remarkable outcomes are overlooked or not reported.

Survivorship bias can distort our understanding of how hair loss treatments perform. Online narratives often draw attention to the most extreme cases, either astonishing successes or clear failures, while the more typical moderate outcomes that most people experience are rarely seen or discussed.

Now that we have covered the clinical evidence, strategies, and reasonable expectations for oral minoxidil, let’s now look into 10 firsthand accounts of oral minoxidil before and after photos shared by real users on Reddit.

Oral Minoxidil Success Stories

Keep in mind that the experiences below are purely anecdotal in nature and are not subject to any independent verification. They strictly reflect the individual journeys of each poster and should not be construed as reliable clinical evidence or medical advice.

Case 1: Male (29), Oral minoxidil monotherapy (11 months, 5 mg nightly)

This Redditor began oral minoxidil monotherapy at a dose of 2.5 mg before increasing to 5 mg once nightly. He had switched from topical minoxidil after a year of subpar results. He experienced shedding in the early months of therapy, with visible regrowth by month 3, and a major improvement in hair density by 11 months. Overall, the patient was satisfied with thicker scalp coverage, a fuller beard and brows, and did not report any significant side effects.

Case 2: Male (26), finasteride and oral minoxidil (2 years total; 1 mg finasteride and 2.5 mg oral minoxidil daily)

This 26-year-old used a combination of 1 mg finasteride and 2.5 mg oral minoxidil once daily, having switched from topical to oral minoxidil one year into treatment. He reported notable improvement one year into therapy, with visible regrowth by the 4-month mark. He did not report any shedding or other side effects after switching from topical to oral formulations. After two years of treatment, the patient reported marked hair thickening and cosmetic improvement.

Case 3: Female, oral minoxidil monotherapy (2 years; 2.5 mg daily, titrated up from 1.25 mg)

This user reported one her progress with oral minoxidil monotherapy over 2 years. She started at a daily dose of 1.25 mg, before increasing to 2.5 mg. She had tried vitamins, spironolactone, oils, and Nioxin/Nizoral without benefit for one year prior. Shedding started shortly after beginning the protocol and normalized by the fourth month. She reported visible improvement within one year, and by the end of the second year, she had notable improvement in ponytail thickness and part density. She also reported that her hair looked and felt close to pre-loss baseline. The user did not report any significant side effects.

Case 4: Female (24), Oral and topical minoxidil (9 months topical 5% foam; 6 months oral 0.625 – 1.25 mg nightly)

This 24-year-old began minoxidil monotherapy with 5% foam nightly, before adding oral minoxidil 0.625 mg three months later, and titrating to 1.25 mg nightly the following month. She continued both nightly for six months. She did not note any noticeable shedding on the foam, nor after incorporating 0.625 mg orally. She reported steady baby hairs and a reduction in hair loss at ~6-9 months alongside thickening compared to the baseline, and mentioned that her hair felt and looked much closer to its pre-loss condition overall. She also reported faster growth of facial/body hair (hypertrichosis), water retention, and bloating after salt meals, and occasional stronger heartbeat at night, after incorporating oral minoxidil, though this last symptom did resolve.

Case 5: Male, oral minoxidil (6 weeks shown; 5 mg daily) and weekly microneedling

This male Redditor used oral minoxidil 5 mg once daily in addition to microneedling once weekly with a pen device. The poster also noted no side effects from finasteride, implying that they might have used it alongside the other treatments. He reported an initial shedding phase at around week 3 and rapid visible coverage by week 6 into treatment. In commenting on the progress to date, he noted fuller coverage compared to baseline and said his beard was slightly thicker without any apparent increase in body hair. He did not report any side effects.

Case 6: Female, oral minoxidil + spironolactone (1 year; 1.25 mg oral minoxidil daily, 50 mg spironolactone daily)

The poster took oral minoxidil 1.25 mg once daily, in addition to spironolactone 50 mg once daily (started at 100 mg but reduced the dose due to drowsiness). She noted visible improvement after about 5 months of consistent use, with shedding slowing markedly around weeks 7-8. At the one-year mark, she reported noticeably fuller hair at the part and temples, with ongoing gradual thickening, and “good hair days”. She reported increased body and facial hair from oral minoxidil, which she managed by waxing, and did not report any noticeable weight gain or low-blood-pressure symptoms. 

Case 7: Female, oral minoxidil monotherapy (6 months; 1.25 mg daily, titrated from 0.625 mg)

This female Redditor took oral minoxidil 1.25 mg once daily for six months, having started from the initial dose of 0.625 mg. She supplemented with vitamin B12 injections every two weeks for pernicious anemia, daily shampooing, higher protein intake, and therapy/stress management. She reported steady improvement in hair through month 6, despite a brief “dread shed” in the initial month. Unfortunately, the images don’t show the same hair pulled back, so we can’t see exactly how much improvement was gained. She did report increased facial hair, which she has been managing by shaving/dermaplaning.

Case 8: Female, oral minoxidil monotherapy (1 year; 1.25 mg daily)

This user took oral minoxidil 1.25 mg once daily for one year. She also used Nizoral shampoo on the same timeline. Her hair loss was first diagnosed as telogen effluvium that did not resolve, and she now suspects AGA. She reported modest shedding in the first 2 months, then gradual thickening over the year. The photos showed some improvement, but the patient stated that she is not fully back to baseline. Regarding side effects, she noted increased body hair growth and mild dizziness in the first month that resolved.

Case 9: Male, self-made oral minoxidil (3 months; ingested diluted topical solution)

This male Redditor switched from applying topical minoxidil to drinking a diluted solution mixed with water. He reported taking “a few drops” per dose, having discontinued application of the topical preparation to the scalp. At the three-month mark, the Redditor reported clearly greater overall density and said results were still improving. He did not report any side effects, except for some extra body hair. 

We should mention that we do not recommend ingesting topical minoxidil – if oral therapy is pursued, it is advised to use a prescribed oral dose under medical supervision to control dosing and avoid health risks.

Case 10: Female, oral minoxidil monotherapy (12 months; dose not reported)

This user reported taking oral minoxidil at an unspecified dose for about one year. The photos show modest improvements around the parting. The poster did not report any side effects. Notwithstanding the sparse information provided by this Redditor, multiple commenters observed hair thickening and density gains in the before-and-after photos.

Strategies to Optimize Oral Minoxidil Response

To maximize the benefits of oral minoxidil, consistent use and patience are essential as optimal regrowth often takes 6-8 months to fully manifest. Combining oral minoxidil with other treatments like finasteride or dutasteride, platelet-rich plasma (PRP), or low-level laser therapy (LLLT) can improve results for those who do not respond sufficiently to minoxidil alone. Recent studies support the efficacy of combination regimens, particularly oral minoxidil plus finasteride, with one retrospective study finding significant and clinically meaningful improvements.^[7]Johnson, H., Huang, D., Clift, A.K., Bersch-Ferreira, A., Guimaraes, G.A. (2025). Effectiveness of Combined Oral Minoxidil and Finasteride in Male Androgenetic Alopecia: A Retrospective Service … Continue reading 

People using oral minoxidil, especially at 2.5 mg or more and in combination with other treatments, should keep an eye on potential side effects. This can help catch rare but potentially serious side effects like edema or changes in blood pressure. Regular follow-ups can ensure that any adverse effects are detected early and that the regimen can be safely adjusted to maintain a balance between safety and efficacy. This patient-tailored management increases the likelihood of achieving the best possible outcomes while minimizing health risks.

Probable Regrowth Timeline

Based on the available evidence, the expected regrowth timeline for oral minoxidil is around 8 months.

Months 0-3: Possible increased shedding; no visible gains

• Temporary shedding can occur as follicles transition into a new growth cycle.
• This process often resolves within the first 4-8 weeks and is seen as an early sign that the treatment is starting to take effect.

Months 3-6: First positive density changes for many

• Early visible improvements, such as reduced shedding and appearance of fine new hairs, can be expected.
• Thicker, darker regrowth starts to become apparent for most users during this period.

Months 6-8: Maximal visible benefits

• Cosmetic changes peak, with stronger hair, increased density, and the greatest coverage observed. 
• This is the period of maximum regrowth for most individuals. 

Months 8-12+

• Further gains plateau.
• Continued daily use is needed to maintain improvements.
• Some might consider combination treatment at this point to increase growth outcomes.

Safety and Side Effects

While oral minoxidil can avoid local irritation occurring with the topical formulation, some safety concerns do remain.

Oral minoxidil use does carry a risk of cardiovascular issues like pericardial effusion, especially at the high doses used for blood pressure control. At hair loss doses (0.25 – 5 mg), such events are rare and tend to be individual rather than predictable. 

The majority of side effects, such as excess body hair, mild ankle swelling, lightheadedness, or palpitations, are mild and usually resolve with dose adjustments or stopping the medication. 

Large safety studies have shown that serious side effects are exceedingly rare in otherwise healthy individuals taking low-dose oral minoxidil, with only a small percentage discontinuing treatment due to adverse effects. 

A gradual dose escalation is recommended to minimize side effects with oral minoxidil. Recent studies have shown that a 2.5 mg daily dose is as effective as 5 mg for treating male pattern hair loss, but with a better safety profile, and this supports 2.5 mg as a preferred starting dose for men.^[9]Fonseca, L.P.C., Miot, H.A., Chaves, C.R.P., Ramos, P.M. (2025). Oral Minoxidil 2.5 mg vs 5 mg for Male Androgenetic Alopecia: A Double-Blind Randomized Clinical Trial. Journal of the American … Continue reading 

If you want to use a higher dose, sublingual minoxidil may be beneficial for reducing the risk of cardiovascular side effects.^[10]Gupta, A.K., Bamimore, M.A., Williams, G., Talukder, M. (2025). Comparative Efficacy of Minoxidil and 5-Alpha Reductase Inhibitors Monotherapy for Male Pattern Hair Loss: Network Meta-Analysis Study … Continue reading 

Practical Takeaways

• Oral minoxidil is an effective and generally well-tolerated alternative for people who cannot use topical minoxidil or do not respond to it.
• Clinical trial results typically show stabilization or modest regrowth. Hyper-responder cases seen online are possible but not common. 
• Careful dose selection (0.25 – 2.5 mg daily) minimizes side effects while maintaining efficacy.
• Consistent, long-term use is key; optimal results generally take 6-8 months to appear and require ongoing treatment to maintain gains.
• Combining oral minoxidil with other therapies such as finasteride, dutasteride, PRP, or LLLT may improve outcomes for partial responders.

Final Thoughts

Oral minoxidil use is growing, but should be recognized as an off-label option (albeit backed by a solid body of emerging evidence.. Most users can expect stabilization or noticeable yet modest regrowth rather than dramatic transformation. The best outcomes come with realistic expectations, consistent use over several months, and regular medical supervision to ensure safety. By focusing on average, evidence-based results rather than rare hyper-responder anecdotes, patients can make balanced decisions and maintain long-term adherence to their treatment plan.

Recent years have witnessed a surge of interest in topical dutasteride for hair loss, especially among those who have either not tolerated or seen insufficient results with conventional oral therapies. This growing popularity is fueled by multiple online anecdotes and user testimonials that describe marked improvements in hair density, shedding reduction, and scalp health. 

However, these topical dutasteride before and after photos typically show the very extremes of success or failure, which can give a misleading impression of what average outcomes truly are. This tends to create an environment where typical results are overshadowed by outliers, making it harder to gauge what most people should realistically expect.

Where does topical dutasteride truly fit in the landscape of hair loss treatment? How can one reliably distinguish between what’s achievable and what’s most likely? What’s the best way to interpret anecdotal stories versus the outcomes most users may expect? And, crucially, what kind of regrowth pattern could unfold after years on topical therapy?

This article tackles these questions head-on. Clear expectations will be set for topical dutasteride use, including practical guidance on interpreting online results, examples of standout before-and-after transformations, and insights into what the average treatment journey actually looks like. 

We will also introduce a framework for evaluating topical therapies, helping readers compare dutasteride’s regrowth potential, evidence strength, and long-term safety against other hair loss options.

Interested in Topical Dutasteride?

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What is Topical Dutasteride?

Topical dutasteride is a compounded medication for androgenic alopecia (AGA) that works as a dual 5-alpha reductase inhibitor, reducing dihydrotestosterone (DHT) locally at the scalp. The main distinction from oral dutasteride is that topical delivery is intended to minimize systemic absorption, though some absorption into the bloodstream still occurs, and complete elimination of systemic exposure is not guaranteed. DHT suppression with topical forms is less studied compared to oral; oral dutasteride can lower systemic DHT by 90% or more, but topical formulations do not consistently reach those levels in serum. 

How Topical Dutasteride Works

Dutasteride inhibits both type 1 and type II 5-alpha reductase, the enzymes responsible for converting testosterone to DHT.^[1]Frye, S.V. (2006). Discovery and clinical development of dutasteride, a potent dual 5alpha-reductase inhibitor. Current topics in medicinal chemistry. 6(5). 405-421. Available at: … Continue reading By inhibiting these enzymes, topical dutasteride targets DHT production where hair loss is occurring at the scalp, rather than throughout the body.

Studies show that topical application leads to significantly lower systemic absorption compared with oral forms, which should result in fewer side effects. Absorption data from Franz cell and skin retention studies indicate that only a small fraction of the topically applied dose reaches the circulation.^[2]Noor, N.M., Sheikh, K., Somavarapu, S., Taylor, K.M.G. (2017). Preparation and characterization of dutasteride-loaded nanostructured lipid carriers coated with stearic acid-chitosan oligomer for … Continue reading 

DHT reduction with topical dutasteride is robust in scalp tissue but generally milder in serum compared to oral therapy. 

Common compounded strengths vary widely: for example, Ulo offers concentrations ranging from 0.02% to 0.2%. 

No topical dutasteride product is FDA-approved; all are compounded by pharmacies for individual patients based on prescriptions, with dosing customized to tolerance and response. 

We could find three studies that report significant local efficacy:

Study 1: Nada et al., 2018 (Prospective Randomized; 30 Men; 24 Weeks)

• Design/groups: Compared minoxidil plus topical dutasteride (0.02%) versus minoxidil alone.^[3]Nada, E.A., El-Dawla, R.E., El Maged, W.M.A., Emagd, A. (2018). Topical dutasteride with microneedling in treatment of male androgenetic alopecia. Sohag Medical Journal. 22(1). Available at: … Continue reading
• Outcomes: The dutasteride group showed a significant increase in hair density, hair shaft width, and terminal to vellus hair ratio relative to minoxidil-only controls. Patient-reported satisfaction was higher for the topical dutasteride cohort. 
• Systemic/Serum: A reduction in serum DHT was observed in the topical dutasteride group, confirming some degree of systemic impact but still substantially less than typical oral dosing.

Study 2: Obeid et al, 2024 (Double-Blind RCT; 24 men, 6 women; 16 Weeks)

• Design/groups: Compared minoxidil plus topical dutasteride (0.01%) to minoxidil alone.^[4]Obeid, M.N.A., Fattah, N.S.A., Elfangary, M.M., Husseni, R.M.A. (2024). Comparison between Topical Minoxidil 5% Alone versus Combined with Dutasteride (Topical 0.02% through Microneedling or Oral 0.5 … Continue reading
• Outcomes: The combination group achieved superior overall improvements in hair thickness and density compared to minoxidil monotherapy. Patient satisfaction and photographic evidence suggested enhanced regrowth when dutasteride was added.
• Systemic/Serum: Systemic DHT or hormone changes were not evaluated or reported in this study. 

Study 3: Panuganti et al., 2025 (Phase II Double-Blind; 135 Men; 24 Weeks)

• Design/Groups: Compared three concentrations of topical dutasteride (0.01%, 0.02%, 0.05% w/v), oral finasteride (1 mg), and placebo.^[5]Panuganti, V.K., Madala, P.K., Grandhi, V.R., Alluri, C.V., Mohammad, J., KSSVV, S.R., Dundigalla, M.R. (2025). A Randomized, Double-Blind, Placebo and Active Controlled Phase II Study to Evaluate … Continue reading 
• Outcomes: Dose-dependent improvements in target area hair count (TAHC) were observed. Dutasteride 0.05% was superior at 24 weeks to both topical finasteride and placebo. Mean TAHC increase: 0.015 (12.78), 0.02% (20.03), 0.05% (34.30) vs oral finasteride (12.57). More patients reached global photographic assessment thresholds in the 0.05% group.
• Systemic/Serum: Topical dutasteride produced only modest changes in serum testosterone and DHT compared to moderate suppression seen with oral finasteride. The highest topical strength exhibited a better pharmacokinetic profile (lower systemic absorption) than oral finasteride.

These data provide evidence that topical dutasteride can offer clinically relevant improvement in hair quantity and quality, while keeping systemic risk modest and tolerability high in well-compounded, patient-tailored regimens.

Why Expectation Setting Matters

Setting realistic expectations is important for anyone considering topical dutasteride or other emerging therapies for AGA. Online testimonials and dramatic before-and-after photos can mislead, often emphasizing rare “hyper responders” or downplaying variables like lighting and styling. 

In truth, most users experience gradual, modest improvements, not dramatic transformations, and disappointment is common when hopes are too high. Conversely, setting expectations too low may discourage trials of potentially worthwhile treatments that could deliver meaningful benefits. 

For better outcomes with topical dutasteride:

• Expect gradual change rather than remarkable regrowth.
• Rely on professional advice and published clinical data, not social media images for guidance.

Remember: staying grounded in evidence and expert recommendations will help identify therapies truly worth pursuing on the hair regrowth journey.

Principle #1: What’s Possible ≠ What’s Probable

When looking at treatment outcomes, it’s essential to distinguish between what can happen and what usually happens. Look at the scatterplot below: individual data points are scattered widely, showing what’s possible for one person, while the trendline running through the middle represents the average, or what’s probable.

Online forums tend to showcase the most eye-catching success stories with topical dutasteride, cases where dramatic regrowth happens. 

These anecdotes, while genuine, sit far above the trendline. The problem comes when patients see only these high points and assume the same results are likely for themselves. When their own progress looks slower or less dramatic, they may quit early or wrongly conclude that the treatment doesn’t work.

The key is avoiding unrealistic benchmarks based on outliers. Our Regrowth Potential framework is designed to ground expectations in the probable but not the possible. For most patients, topical dutasteride leads to stabilization plus modest regrowth, with rare cases of strong “hyper responses” that shouldn’t be seen as the norm.

Most people using topical dutasteride experience stabilization of hair loss first, with the earliest cosmetic regrowth occurring at around 3 months. Typical regrowth usually brings hair growth back to where it was between 1-3 years ago, rather than to pre-hair loss density. 

Several factors influence where someone falls on the response spectrum with topical dutasteride. Starting treatment earlier generally leads to better outcomes, as newer thinning areas respond more readily while long-standing bald spots are far less likely to improve. The specific therapy or combination of treatments used also matters, since some approaches are more effective depending on the stage or pattern of hair loss. Consistency is critical; missed applications or stopping too soon can quickly lower results below the expected average.

Principle #2: Poorer Evidence = Greater Variability

Predictability depends heavily on evidence quality. Treatments with a large body of research product outcomes that cluster tightly around the average, while those with fewer studies show more variability between patients.

Finasteride is a good comparison point: with dozens of randomised controlled trials, we can be confident that most users fall close to the mean response, represented by a narrow bell curve. Topical dutasteride, however, is newer and much less studied. While emerging data and user reports suggest potential benefits, even in some cases matching or exceeding oral outcomes, the evidence base is still limited.

In short, the more research that exists, the stronger our confidence in expected results. For topical dutasteride, the smaller body of evidence means higher variability. Some users may beat the average, but others will fall below it. Recognizing this can help you temper expectations and make better-informed decisions.

Evidence quality is the rubric we can use to determine whether the results will be predictable or variable.

10 Topical Dutasteride User Transformations

Now that we’ve covered the mechanisms of topical dutasteride while setting reasonable expectations, let’s look at what the results might actually look like in practice. Below, we’ve curated 10 Reddit case studies of users who saw clear improvement with topical dutasteride. 

The examples below help see what’s possible and do not represent what every user should expect. They are purely anecdotal and not independently verified by us or any qualified third party. 

User Profile #1: 14–15 Months on Topical Dutasteride 0.1% (once weekly; early 1%)

This user started topical dutasteride monotherapy, initially at 1% for the first 3 weeks, then at 0.1%, which he typically applied once weekly at 2 mL. He also used a low-level laser therapy (LLLT) device 3x/week in 15-minute sessions. 

He reported noticeable thickening at month 3 and significant visible improvement with complete recovery of the crown by month 4.5. He also reported that results were maintained at months 14-15 and that gains were stabilized as of a later post. He observed that shedding had reduced to 5 hairs/day from the peak of 100/day. He did not report any systemic side effects on topical dutasteride 0.1%.

User Profile #2: 6 Months on Topical Dutasteride 2%

This user chose topical dutasteride 2% twice per week for 6 months, increasing the frequency to daily application on the hairline only. He previously tried topical minoxidil and weekly microneedling but considered himself a non-responder.

He reported a heavy shedding phase starting from month 2 and lasting for 1-2 months. At the 6-month mark, he reported that shedding is still above pre-treatment levels but is lower than the peak shedding phase. He also reported no regrowth at month 6 and stated that his hair was in worse condition than at baseline. He reported no side effects overall from topical dutasteride. 

User Profile #3: 8 Months on Topical Dutasteride 0.1% Monotherapy

This male chose to use topical dutasteride monoetherapy at the 0.1% concentration with an application frequency of once weekly at months 0-4 and twice weekly at months 5-8. 

At the 8-month mark, the photos showed subtle improvement with the user perceiving a slightly improved appearance. The user stated that his alopecia was aggressive and that a twice-weekly application may still be insufficient. He reported no side effects when asked. 

User Profile #4: 4 Months on Topical Dutasteride 0.1% (with Minoxidil/Tret Mix in Vehicle)

This user started applying topical dutasteride 0.1% every other day, eventually switching to once daily. His compounded lotion also contained minoxidil, plus tretinoin, melatonin, silicon, and biotin. He used a separate AM minoxidil and tretinoin when at home, in addition to once-weekly derma rolling sessions. 

After 4 months on the topical dutasteride-based regimen, he reported the emergence of some baby hairs and some definite regrowth. He exhibited a noticeably better hairline compared to the pre-minoxidil baseline. He reported no side effects.

User Profile #5: 2 Months on Topical Dutasteride (w/ Minoxidil)

This user applied both a topical dutasteride 0.5% solution and topical minoxidil twice daily over the course of 2 months. The user stated that his shedding had dropped noticeably after adding dutasteride to his minoxidil regimen. He reported no side effects with topical dutasteride and acknowledged that twice-daily application at 0.5% may be overkill. 

It should be noted that it is really quite difficult to see improvements in cases where users take photos with different lighting and at different distances. If you are tracking your progress, try to keep as many variables the same as possible so that you can give yourself as accurate a comparison as possible.

User Profile #6: 6 Months on Topical Dutasteride 0.05% + Dutasteride Mesotherapy 0.01%

This user presented with diffuse thinning and was previously on finasteride with no side effects. He is motivated and willing to use medical interventions to achieve recovery. He applied topical dutasteride 0.05% twice weekly and dutasteride mesotherapy 0.01% once weekly via a 0.5 mm dermapen for a total duration of 6 months.  

At the 6-month follow-up, he showed visible thickening, although he acknowledged that the results have not been dramatic. He stated in replies that he attained enough stabilization to later proceed with a crown transplant. The user reported no side effects.

User Profile #7: Male (53), 10 Weeks on Topical Dutasteride 0.3% + Minoxidil 8% (twice daily)

This 53-year-old male applied a topical solution of 0.3% dutasteride and 8% minoxidil twice daily over 10 weeks. He later reduced the frequency to once daily and added intermittent microneedling, rosemary oil, and onion juice for gray hairs. 

He noted a shedding phase starting in week 2, with visible thickening and density improvement by week 10, when he posted the before/after photos. In a later update, the user affirmed his continued improvement with reduced application frequency (once daily) and maintenance of results. He reported no side effects and expressed satisfaction with the early response.

User Profile #8: 4 Months on Topical Dutasteride + Topical Minoxidil

This Redditor’s intervention of choice was topical dutasteride (Anagenica) once daily, topical minoxidil, and dermastamp once weekly. At the 4-month mark, he reported a 90% reduction in hair shedding, the emergence of baby hairs at the crown and temples, and early vellus activation at the crown, which remained slower to respond. 

He reported no side effects to date and did not mention any scalp irritation despite weekly stamping sessions. Notably, he did not state the exact dutasteride concentration in the topical solution, nor whether his dutasteride and minoxidil were contained in separate bottles or were pre-mixed in a single solution. 

User Profile #9: Post-Hair Transplant Patient, 5.5 Months on Topical Dutasteride (Avodart capsules mixed into topical Minoxidil)

This user began using a self-prepared solution by crushing Avodart (dutasteride) capsules and mixing them into a minoxidil PG/alcohol bottle, which he applied twice daily for 5.5 months. He did not report the dutasteride concentration in his homemade solution. He observed significant shedding and thinning, especially at the vulnerable right-sided native zone. After the first month, he also observed many thin, white vellus hairs appearing on top. He reported no systemic side effects.

User Profile #10: Male (NW7) with 18 Months Total Therapy Prior to Full-Dose Oral Dut

This man used topical dutasteride for an unspecified period after 12+ months on minoxidil, before escalating to oral dutasteride 0.5 mg every two weeks, then to twice daily. Additionally, he underwent microneedling monthly at 0.75 mm and used ketoconazole shampoo 1 to 2 times weekly. 

The patient showed visible improvement despite starting therapy from an advanced stage of hair loss (NW7). He reported no significant side effects, but has decreased his microneedling frequency due to scalp soreness.

Since he did not specify the duration of his topical dutasteride use and given that he has used several other formulations at varying doses over the 18 months, it is not possible to reliably estimate the degree to which topical dutasteride is responsible for the regrowth. 

Probable Regrowth Timeline for Topical Dutasteride

We have laid out a likely timeline for topical dutasteride, but this is based on three studies we could find using it.

Months 0-3: Early cosmetic improvements

• Most users won’t see regrowth yet.
• Shedding may occur in the first few weeks (especially if combined with microneedling).
• Early pharmacokinetic studies show scalp DHT reduction with minimal systemic absorption at appropriate doses.

Months 3-6: First cosmetic improvements

• This is the case for both low (0.025%) and higher concentrations (0.1-0.3%) of topical dutasteride.
• Clinical studies found measurable increases in hair density when topical dutasteride was paired with microneedling.
• Improvements are usually more visible in the crown and mid-scalp than at long-standing bald spots.

Months 6-9: Noticeable regrowth in responders

• Hair density and thickness continue to improve.
• Studies reported ~10-15% increases in hair accounts and 15-20% increases in density, especially with microneedling.
• Cosmetic changes (less scalp show-through, fuller appearance) often emerge in this window.
• Data is limited after ~7 months.

Months 9+ 

• Likely that many responders achieve their most visible results by 9-12 months.
• Long-term clinical data are sparse; by 36 months, most hair gains will have occurred.

So, what about all the success stories we see online? This is typically called survivorship bias.

Combining Treatments

If you want to increase the effects of topical dutasteride, combining it with additional therapies can have a beneficial effect.

One study compared topical minoxidil 5% alone vs. in combination with topical dutasteride, showing both approaches to be effective and safe for AGA in men and women.^[7]Obeid, M.N.A., Fattah, N.S.A., Elfangary, M.M., Husseni, R.M.A. (2024). Comparison between Topical Minoxidil 5% Alone versus Combined with Dutasteride (Topical 0.02% through Microneedling or Oral 0.5 … Continue reading 

Another trial evaluated “minoxidil-dutasteride tattooing”, a combined delivery, which led to notable clinical improvement in hair growth for patients with AGA.^[8]Ragi, S.D., Ghanian, S., Rogers, N., Peterson, D.M., Johnson, L.S., Wambier, C.G. (2023). Evaluation of hair regrowth after minoxidil and dutasteride tattooing in men with androgenetic alopecia. JAAD … Continue reading

Microneedling is increasingly used to enhance drug penetration for hair loss therapies. Clinical protocols recommend microneedling (often with 1.5-2.5 mm rollers)before topical dutasteride application for improved efficacy, with studies confirming significant increases in hair density and shaft thickness.^[9]Sanchez-Meza.E., Ocampo-Candiani, J., Gomez-Flores, M., Herz-Ruelas, M.E., Ocampo-Garza, J., Orizaga-Y-Quiroga, T.L., Martinez-Moreno, A., Ocampo-Garza, S.S. (2022). Microneedling plus topical … Continue reading 

Recent reviews discuss rotational therapy for partial responders, switching between topical and oral 5ɑ-reductase inhibitors to individualize regimens and maximize hair regrowth while managing side effects.^[10]Mysore, V., Kumaresan, M., Dashore, S., Venkatram, A. (2023). Combination and Rotational Therapy in Androgenetic Alopecia. Journal of Cutaneous and Aesthetic Surgery. 16(2). 71-80. Available at: … Continue reading

How Can I Maintain Realistic Expectations?

To keep realistic expectations with topical dutasteride, it’s important to remember that most users will see noticeable improvement and stabilization, though individual results can vary. Realistic does not mean pessimistic; most people benefit, but baseline expectations should be guided by typical clinical results rather than extreme cases.

Topical dutasteride may “rewind” hair loss by several months to a couple of years, but full restoration to pre-hair loss density is uncommon. The most likely outcome is gradual improvement in hair density and a slowing of hair loss, rather than dramatic, multi-year regrowth or complete reversal.

Practical Takeaways

• Topical dutasteride is promising, but still considered to be experimental. Early clinical studies show significant efficacy, especially in comparison to finasteride, but more long-term research is needed to confirm its effectiveness and safety in larger populations.
• Systemic side effects appear reduced compared to oral use, but topical dutasteride is not entirely risk-free. Phase II trials report little to no local irritation and only modest changes in serum hormone levels with topical formulations, suggesting an improved systemic safety profile, but ongoing monitoring is recommended.
• Topical dutasteride is best used as part of a multi-therapy regimen. Combination approaches (for example, with minoxidil or microneedling) tend to enhance results and individualize treatment, maximizing regrowth while managing side effects.

Final Thoughts

When evaluating topical dutasteride, it’s essential to apply the framework of Regrowth Potential and Evidence Quality. While initial research and clinical experience suggest topical dutasteride is promising, the clinical data are lacking. Setting realistic expectations is important; focusing on typical results rather than extreme anecdotes helps prevent disappointment and treatment abandonment, encouraging patients to make informed decisions based on both scientific evidence and personal goals.

Topical minoxidil has been a cornerstone of androgenic alopecia (AGA) treatment since its FDA approval in the 1980s. With millions of users worldwide, it stands as one of the most widely adopted therapies for hair loss, supported by decades of clinical evidence, and an enormous body of real-world anecdotes, reviews, and before-and-after photos. 

However, results with minoxidil can be highly variable, and this variability can be traced in part to biological differences, particularly in the activity of the sulfotransferase enzyme (SULT1A1), which is responsible for converting minoxidil into its active form. Not everyone sulfates minoxidil effectively, meaning that while some achieve meaningful regrowth, others see little to no improvement. 

Interested in Topical Minoxidil?

High-strength topical minoxidil available, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

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Adding to this challenge is the influence of online topical minoxidil before and after photos (like you can see below), which can create inflated expectations compared to the more modest, probable outcomes seen in practice. 

This article will break through that noise to answer a critical question: when it comes to minoxidil, what is actually the most probable result, not just possible? 

First, let’s take a look at what topical minoxidil is.

Refresher: What is Topical Minoxidil?

Topical minoxidil was the first therapy ever approved by the FDA for the treatment of AGA, making it a landmark in the medical management of pattern hair loss.^[1]Suchonwanit, P., Thammarucha, S., Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. 13. 2777-2786 Introduced in the 1980s, it has since become one of the most widely available and researched treatments across the globe. Its primary action is as a potassium channel opener, which helps to stimulate blood flow, prolong the hair’s growth phase (anagen), and increase follicle size, mechanisms that together can support thicker, denser hair regrowth over time.^[2]Messenger, A.G., Rundegren, J. (2004). Minoxidil: mechanisms of action on hair growth. British Journal of Dermatology. 150(2). 186-194. Available at: https://doi.org/10.1111/j.1365-2133.2004.05785.x

Minoxidil is known as a “pro-drug”, meaning that it needs to be activated within the body to exert its effect. The enzyme responsible for this is called sulfotransferase or, more specifically, SULT1A1. The level of sulfotransferase activity differs depending on the individual, which means that the effectiveness of treatment also differs depending on who you are.^[3]Pietrauszka, K., Bergler-Czop, B. (2020). Sulfotransferase SULT1A1 activity in hair follicle, a prognostic marker of response to the minoxidil treatment in patients with androgenetic alopecia: a … Continue reading 

Formulations typically come in 2% and 5% strengths. The 2% solution was originally FDA-approved for women, while the 5% concentration was approved for men; however, both are now commonly used off-label across genders. Beyond these standard strengths, compounding pharmacies have made higher concentrations available for patients seeking more individualized treatment approaches, with some online telehealth providers (such as Ulo) offering customized formulations. Standard dose topical minoxidil is available over-the-counter in most countries, ensuring accessibility without the need for a prescription.

The Evidence

Topical minoxidil’s robust efficacy for hair regrowth is supported by dozens of high-quality randomized controlled trials (RCTs) and meta-analyses across men and women, consistently demonstrating average increases in hair count of around 10-20% over 6-12 months. 

We have collated many of these studies into a table, which you can look at here. However, we have summarised some of the most recent topical minoxidil studies.

Liang et al. (2022)

• Prospective, evaluator-blinded RCT with 120 women with female pattern hair loss (FPHL) assigned to three groups: 5% topical minoxidil alone; 5% minoxidil + oral spironolactone (80-100 mg); and 5% minoxidil and microneedling every 2 weeks.^[4]Liang, X., Chang, Y., Wu, H., Liu, Y., Zhao, J., Wang, L., Zhuo, F. (2022). Efficacy and Safety of 5% Minoxidil Alone, Minoxidil Plus Oral Spironolactone, and Minoxidil Plus Microneedling on Female … Continue reading
• Duration: 24 weeks; outcomes measured included dermascope, ultrasound biomicroscopy, physician, and patient assessments.
• Effective rate at week 2:
  • 55.27% (topical minoxidil)
  • 86.49% (topical minoxidil and oral spironolactone)
  • 95% (topical minoxidil and microneedling)
• Combo therapies (Groups 2&3) outperformed topical minoxidil alone for hair density, shaft diameter, scalp/thickness, shedding, and quality of life; Group 3 showed the greatest benefit.
• Adverse effects were reported across all groups; more menstrual disorders were reported in the spironolactone group. Main limitations: small sample, exclusion of severe cases, possible bias from unblinded treatments.

Hassan et al. (2022)

• Comparative study in 60 women with FPHL: 5% minoxidil topical foam and oral vitamin D3, minoxidil foam only, or vitamin D3 for 12 weeks (plus 15 controls for vitamin D comparison).^[5]Hassan, G.F.R., Sadoma, M.E.T., Elbatsh, M.M., Ibrahim, Z.A. (2022). Treatment with oral vitamin D alone, topical minoxidil, or combination of both in patients with female pattern hair loss: A … Continue reading 
• Primary outcomes: reduction in thin hair count and Ludwig stage improvement via clinical and dermoscopic evaluation. 
• Best results from combination therapy (minoxidil foam and vitamin D3), followed by minoxidil foam alone; vitamin D3 monotherapy had minimal effect.
• Vitamin D3 appeared to enhance minoxidil efficacy, though the sample size was small, and adverse events were not reported. 

Bao et al. (2022)

• RCT with 71 men, split into: 5% topical minoxidil twice daily, electrodynamic microneedling every 3 weeks, or topical minoxidil and microneedling combined.^[6]Bao, L., Zong, H., Fang, S., Zheng, L., Li, Y. (2019). Randomized trial of electrodynamic microneedling combined with 5% minoxidil topical solution for treating androgenetic alopecia in Chinese males … Continue reading
• Follow-up: 24 weeks, with an additional 6-month observation period.
• All treatments increased non-vellus hair density; the combined group had the greatest improvements in hair density and diameter. 
• The combination group received additional scalp massages (potential confounder); 12 participants experienced adverse reactions (dermatitis, dandruff, lymph node enlargement), none severe.

Singh et al. (2020)

• Double-blind, placebo-controlled RCT in 80 men: Groups received either 5% topical minoxidil, 5% topical minoxidil and PRP injections, placebo, or PRP alone.^[7]Singh, S.K., Kumar, V., Rai, T. (2020). Comparison of efficacy of platelet-rich plasma therapy with or without topical 5% minoxidil in male-type baldness: A randomized, double-blind placebo control … Continue reading
• 12 weeks’ treatment with 2-month follow-up; outcome: changes in total, terminal, vellus, and non-vellus hair density, pigmentation, and global assessments.
• Highest hair density and satisfaction with topical minoxidil and PRP; both monotherapies are better than placebo, but the combo was most effective.
• Limitations: short-term follow-up, some subjective outcomes; low adverse event rate (mostly mild, e.g., scalp pruritus, facial hair growth).

Overall, when you look across all of the data, consistent benefits are seen with topical minoxidil usage. However, these results are variable. The key reason for this is differences in sulfotransferase activity. As we mentioned before, minoxidil is a pro-drug, and it needs to be enzymatically activated to exert its effect. We will go into more detail about this below.

What’s Possible ≠ What’s Probable

When evaluating treatment outcomes, especially online minoxidil before and after photos, it’s important to separate possibility from probability. The scattered data points below show the full range of what might occur for individuals, while the central trendline reflects the average outcome (i.e., what typically happens).

Online anecdotes often showcase what we would call “hyper-responders” – people who experience dramatic results. These people may also have higher levels of sulfotransferase activity.

These stories, while real, represent outcomes that are well above average. The issue arises when patients focus only on these peak results and expect the same for themselves. If their own progress seems slower or less dramatic, they may stop prematurely or mistakenly believe the treatment is ineffective.

Dramatic results are often showcased more than modest outcomes because of survivorship bias. This bias occurs when only the most striking successes are noticed or shared, while the many average or less impressive results go unreported.

Why Results Are Variable: The SULT1A1 Enzyme

Minoxidil must be converted into minoxidil sulfate by the sulfotransferase enzyme SULT1A1, which is present in the outer root sheath of hair follicles, to become pharmacologically active and stimulate hair growth. 

Several peer-reviewed studies confirm that the level of SULT1A1 activity in scalp follicles is a key determinant of how well a patient responds to minoxidil therapy.^[9]Goren, A., Castano, J.A., McCoy, J., Bermudez, F., Lotti, T. (2014). Novem enzymatic assay predicts minoxidil response in the treatment of androgenetic alopecia. Dermatologic Therapy. 27(3). 171-173. … Continue reading Enhancing SULT1A1 activity, such as by using enzyme-boosting adjuvants, has been shown in recent trials to convert a majority of prior non-responders into responders, further confirming the mechanistic role of this enzyme.^[10]Chandrashekar, B.S., Chandu, M., Shenoy, C., Chander, A., Roopa, M.S. (2024). SULT1A1 enzyme booster to amplify topical minoxidil response in androgenic alopecia: a single-center prospective study. … Continue reading 

This enzyme-based variability explains why two people can apply minoxidil in the same way but see very different outcomes, and why more than half of users may see only limited or no benefit despite consistent application.

Fixing the Enzymatic Problem

A number of evidence-based strategies exist to improve minoxidil response. These include microneeding, retinoic acid co-application, formulation changes, consistency, and combination therapy.

Microneedling

Multiple systematic reviews and clinical trials confirm microneedling significantly improves minoxidil efficacy. A 2023 meta-analysis showed that combining the two led to a significantly greater increase in hair count compared to minoxidil alone, regardless of needle depth or device used. Hair count improvements are notable after 12 to 24 weeks of combined treatment.^[11]Ahmed, K.M.A., Kozaa, Y.A., Abuawwad, M.T., Al-Najdawi, A.I., Mahmoud, Y.W., Ahmed, A.M., Taha, M.J.J., Fadhli, T., Giannopoulou, A. (2025). Evaluating the efficacy and safety of combined … Continue reading 

You can read more about how microneedling improves minoxidil efficacy here.

Retinoic Acid (Tretinoin)

Topical tretinoin has been shown in peer-reviewed studies to upregulate follicular SULT1A1, thereby enhancing the conversion of minoxidil to its active form. In a 2019 study, tretinoin not only improved clinical response in difficult cases but also increased scalp SULT1A1 activity, supporting its role as a mechanistic booster.^[12]Sharma, A., Goren, A., Dhurat, R., Agrawal, S., Sinclair, R., Trueb, R.M., Vano-Galvan, S., Chen, G., Tan, Y., Kovacevic, M. (2019). Tretinoin enhances minoxidil response in androgenetic alopecia … Continue reading

You can see the benefits of adding retinoic acid in our Compare Treatments graph below.

Learn more about retinoic acid and its effects on sulfotransferase here.

Formulation Adjustments (Foam vs. Solution 2% vs. 5%)

Clinical research shows that 5% minoxidil is more effective than 2% for both men and women. Foam is as effective as a solution but better tolerated, with reduced risk of contact dermatitis due to the absence of propylene glycol. Some evidence suggests liquid formulations might yield slightly higher absorption, but both forms are clinically comparable.^[13]Purnak, T., Senel, E., Sahin, C. (2011). Liquid formulation of minoxidil versus its foam formulation. Indian Journal of Dermatology. 56(4). 462. Available at: https://doi.org/10.4103/0019-5154.84714 

Consistency and Adherence

Missed doses can reduce topical minoxidil efficacy. Some clinical guidance suggests that missing minoxidil applications even once per week can diminish results, and consistent, daily use is necessary to achieve and maintain hair regrowth.^[14]Shadi, Z. (2023). Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia. Dermatology and Therapy. 13(5). 1157-1169. Available at: … Continue reading 

Combination Therapy

Combining minoxidil with finasteride/dutasteride, PRP, low-level laser therapy (LLLT), or, in resistant cases, oral minoxidil, provides superior results versus monotherapy. Meta-analyses and randomized trials consistently find greater improvement in hair density, count, and patient satisfaction when using combination regimens.^[15]Xia, Y., Chen, H., Chen, Y., Chen, Z. (2025). Relative efficacy of minoxidil in combination with other treatments for androgenic alopecia: a network meta-analysis based on randomized controlled … Continue reading 

So, what do online topical minoxidil before and after photos look like?

Online Topical Minoxidil Successes

Now that we have discussed how topical minoxidil works, potential regimens, and likely timelines, here are 10 reports published by Reddit users with before and after photos.

Disclaimer: The stories below are unverified anecdotes. Consequently, they illustrate individual outcomes and should not be construed as clinical proof or medical advice.

Case 1: Male (age unknown), 6 months on topical minoxidil monotherapy (5% once daily)

This individual applied 5% topical minoxidil once daily for six months. They chose topical minoxidil out of a general preference for avoiding oral medications. From the before-and-after photos, diffuse thinning can be observed from the center of the crown, and the protocol yielded a noticeable increase in crown density by month six. No side effects or early shedding have been reported.

Case 2: Female (age unknown), about 5 months on topical minoxidil monotherapy (5% once nightly)

This user applied 5% topical minoxidil once nightly for about 5 months, using a liquid solution that she purchased over the counter after a telemedicine consult. She stated that she had AGA and did not note any other treatment. Based on both her comments and photos, she experienced marked improvement in hair density and coverage, stating that minoxidil “saved her hair” and that she wishes she had started earlier. She did not describe any notable early shedding, but noted dry scalp and some dandruff as potential side effects.

Case 3: Male (age unknown), 60 days on topical minoxidil monotherapy (5% foam nightly)

This Redditor applied 5% minoxidil foam once nightly before bed for two months without any concurrent treatment. He reports the typical amount applied daily as “one cap-full”, rinsed out the next morning. The user has Crohn’s disease with prior nutrient absorption issues, and chose to avoid ifnasteride due to side-effect concerns. He had about one year of noticeable thinning before starting. Upon starting minoxidil, shedding increased for the first two weeks, then eased. The first measurable improvement was visible by day 30, with clear density gains at day 60. The crown region improved the fastest, while hairline changes were slower.

Case 4: Female (age unknown), 1 year 5 months on topical minoxidil foam (5% once daily)

This user had AGA with prior telogen effluvium, reporting diffuse thinning along the part and temples and a reportedly high daily shedding. She began therapy with Rogaine Men’s Foam 5% once nightly, supported by Ketoconazole 2% shampoo once weekly. At 2 months of treatment, “peach fuzz”/baby hairs were visible at the hairline and temples. At 6 months, there was a noticeable density across the top with new hairs evident but still short. After 1 year and 5 months of therapy, she notes ongoing thickening and widespread new hair growth. She also reported that her shower shed decreased from ~70 hairs to ~10-15, with visual density improving at the part and temples. She reported a mild scalp itch at the start and subtle peach-fuzz on the upper lip and chin as side effects. 

Case 5: Male (age unknown), 2.5 months on topical minoxidil (5% liquid 1 mL twice daily)

This male user, likely with AGA, reported recession at the hairline and thinning at the crown after 2.5 months of using a Rogaine-style 5% liquid at 2 mL/day, without any concurrent DHT blocker. He experienced an early shedding phase ~1 month into treatment, which stabilized with continued use. He exhibited visible thickening at the hairline and crown by 2.5 months of therapy. He did not report any systemic or local side effects and plans to continue minoxidil while considering adding weekly microneedling and/or topical finasteride if progression resumes. 

Other Redditors have used combination treatments to further improve their hair regrowth. As you can see below, some of the results look dramatic.

Case 6: Male (age unknown), 3 months on topical combo (minoxidil 5% and finasteride 0.1% once nightly)

This user had thinning at the hairline and vertex areas of the scalp and began treatment to improve hair density and maintenance. He applied a single compounded solution (Novegrow) containing minoxidil 5% and finasteride 0.1%, once nightly, for three months before reporting on progress. Additionally, he dermarolled his scalp with a 0.5 mm needle twice weekly and supplemented with daily biotin and a multivitamin. He reported mild shedding in the first two weeks of therapy, and by month 3, he noted visible thickening and improved coverage. He did not report any side effects and added that the once-daily schedule was practical and helped with adherence.

Case 7: Male (25), 11 months on combination therapy (finasteride 1 mg daily and topical minoxidil foam 5% once daily)

This Redditor exhibited typical AGA with frontal recession and diffuse vertex thinning. His core regimen is oral finasteride 1 mg daily and minoxidil 5% foam (Kirkland) once daily. He noted he took regular ice/cold baths, ensured an increased water intake, engaged in exercise, avoided junk food, and did not smoke. He saw noticeable thickening from around 6 months after several shedding cycles. By month 11, he experienced substantial cosmetic improvement, with some commenters even comparing the results to transplant-level density. He did not report any adverse effects from finasteride or minoxidil, and subjectively felt less “brain fog” after starting finasteride.

Case 8: Male (37), 4 months on topical minoxidil 5% and topical finasteride 0.1% (1 mL nightly)

This male had crown-predominant thinning with a stable hairline at baseline. His core regimen is a single combined solution containing minoxidil 5% and finasteride 0.1%, applied to the crown only. He did not report any microneedling or supplementation. He reported that shedding began around week 3 and was “heavy” for approximately 4 weeks. The shedding tapered and largely stopped at the 2.5-month mark. By month 4, he achieved visible crown regrowth and thickening compared to the baseline, despite the application being limited to the crown. He perceived an increase in overall density and did not report any side effects.

Case 9: Male (34), about 12 months on topical finasteride 0.3% and minoxidil 6% (twice daily)

This male reported on his progress after using a combination of topical finasteride 0.3% and minoxidil 6% treatment twice daily for nearly one year. He first experienced hair thinning and hairline recession beginning in his late 20s. Alongside the topical treatments, he also applied a dermastamp at approximately 1.5 mm every 10 days. He reported significant shedding during the first two months of treatment along with mild chest tenderness in the first month, which resolved after temporarily halving the topical dose. He reported month-on-month thickening, with clear improvement by months 7-8 and robust density by the one-year mark.

Case 10: Male (22), 90 days on finasteride 1 mg and minoxidil 5% twice daily plus dermarolling

This user with early temple recession began a combination therapy of finasteride 1 mg oral daily, minoxidil 5% foam twice daily, and dermaoll 1.5 mm weekly. He experienced noticeable shedding at weeks 3-6 of therapy, and at the 90-day progress mark, he reported visible filling in of the temple and general thickening of the hair. He did not report any side effects and noted that pushing through the initial shedding phase was crucial to his progress thus far.

Probable Regrowth Timeline

Based on the available evidence, we have mapped out a likely regrowth timeline (although some may experience results faster or later).

Months 0-3: Initial shedding

• Temporary shedding may occur as follicles shift into a new growth phase.
• This usually resolves within the first 4-8 weeks.

Months 3-6: Early cosmetic improvements

• Early visible improvements, such as reduced shedding and appearance of fine new hairs, can be expected.
• Thicker, darker regrowth starts to become apparent for most users during this period.

Months 6-12: Peak cosmetic changes

• Cosmetic changes peak, with stronger hair, increased density, and the greatest coverage observed.
• This is the period of maximum regrowth for most individuals.

Months 12+: Plateau, maintenance, & slight regression

• Further gains plateau, with 5-year studies showing hair counts remaining above baseline –– but with some loss in “peak” results from year one. Continued daily use is needed to maintain improvements, as stopping treatment leads to a gradual reversal within a few months.

Safety and Side Effects

Local side effects are relatively common with topical minoxidil, especially with the liquid formulations. The principal culprits are propylene glycol and ethanol, which frequently cause redness, itching, dryness, and a dandruff-like scaling of the scalp.^[16]Makhlouf, A., Elnawawy, T. (2023). Hair regrowth boosting via minoxidil cubosomes: Formulation development, in vivo hair regrowth evaluation, histopathological examination and confocal laser … Continue reading Patients with sensitive skin are particularly prone to these adverse reactions and may experience contact dermatitis, which can make long-term use uncomfortable.

The foam formulation is generally better tolerated because it lacks propylene glycol. Most clinical trials and user surveys report fewer cases of scalp irritation, itching, or flaking with foam compared to the liquid version.^[17]Purnak, T., Senel, E., Sahin, C. (2011). Liquid formulation of minoxidil versus its foam formulation. Indian Journal of Dermatology. 56(4). 462. Available at: https://doi.org/10.4103/0019-5154.84714 

While systemic absorption of topical minoxidil is rare, some users may experience unwanted side effects such as dizziness and the growth of facial or body hair away from the application site. These effects are more likely if the medication is used excessively or applied to broken or abraded skin, which can increase absorption. We do not recommend using topical products if you have an inflammatory scalp condition – deal with that problem first, and then take a look at topical hair regrowth products.

Overall, when used as directed, topical minoxidil has a strong safety profile, with most side effects limited to mild local irritation.

Practical Takeaways

• Topical minoxidil is effective and well-established, but clinical results vary between individuals.
• Most patients achieve stabilization of hair loss with modest regrowth, though complete restoration is uncommon.
• Response depends partly on scalp sulfotransferase enzyme activity, which explains why some non-responders see little or no improvement.
• Best results come with consistent, long-term use and may be enhanced by adjuncts such as microneedling or topical retinoids to improve absorption and efficacy.

Final Thoughts

When evaluating minoxidil, it is important to recognize it as the most widely accessible and evidence-backed treatment for androgenetic alopecia. While outcomes can vary, most users see stabilization and modest regrowth rather than dramatic reversal. Success depends on realistic expectations, consistent use, and optimized regimens that may include adjunctive therapies. Applying a framework that emphasizes the likely trendline over anecdotal extremes can help you stay committed, avoid discouragement, and make informed decisions grounded in evidence and personal treatment goals.

Oral finasteride has long been the mainstay for androgenic alopecia (AGA), but many patients and clinicians have turned to dutasteride, a more potent 5ɑ-reductase inhibitor, in pursuit of superior hair growth. 

Oral dutasteride (0.5 mg daily) can reduce dihydrotestosterone (DHT) by 90% or more (compared to ~70% with finasteride), and clinical studies show it grows more hair than finasteride. In fact, a 24-week trial found that oral dutasteride 0.5 mg significantly outperformed finasteride 1 mg in increasing hair counts.^[1]Shanshanwal, S.J.S., Dhurat, R.S. (2017). Superiority of dutasteride over finasteride in hair regrowth and reversal of miniaturization in men with androgenetic alopecia: A randomized controlled … Continue reading

However, dutasteride’s very potency raises concerns: will it also increase side effects like decreased libido or hormonal disturbances? Interestingly, research so far suggests that dutasteride has a similar tolerability profile to finasteride with no clear increase in sexual side effects despite its stronger DHT suppression.^[2]Almudimeegh, A., Almutairi, H., AlTassan, F., AlQuraishi, Y., Nagshabandi, K.N. (2024). Comparison between dutasteride and finasteride in hair regrowth and reversal of miniaturization in male and … Continue reading 

Even so, oral dutasteride’s reputation (it’s approved for prostate enlargement and used off-label for hair loss) makes some men uneasy, especially those who experienced side effects on finasteride. This has led to rising interest in topical dutasteride formulations. By delivering dutasteride directly to the scalp, the goal is to concentrate its DHT-blocking action where it’s needed (hair follicles) while limiting how much enters the bloodstream. The questions we need to answer are:

• Does topical dutasteride work?
• Does it match or even exceed the efficacy of oral treatments?
• Can it maintain these benefits with a more favorable side effect profile?

Ulo offers dutasteride options that range from low to high dose dutasteride – allowing you to be flexible in your treatment choices.

Interested in Topical Dutasteride?

Hair gains bigger than finasteride? Dutasteride makes this possible, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

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*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Oral vs. Topical Dutasteride

Early evidence indicates that topical dutasteride can indeed improve hair growth, in some cases achieving results comparable to oral therapy but with lower systemic DHT reduction. 

Study One

One study tested dutasteride solutions of 0.01%, 0.02%, and 0.05% against a placebo (and an active control) over 24 weeks. All dutasteride groups showed significant increases in hair count versus placebo, and the 0.05% topical solution actually showed more efficacy than oral finasteride (1 mg/day) in promoting regrowth.^[3]Panuganti, V.K., Madala, P.K., Grandhi, V.R., Alluri, C.V., Mohammed, J., Rao, S., Dundigalla, M.R. (2025). A Randomized, Double-Blind, Placebo and Active Controlled Phase II Study to Evaluate the … Continue reading

Study Two

A recent randomized controlled study compared oral dutasteride (0.5 mg daily) to topical dutasteride (0.02% administered via monthly microneedling), both combined with daily topical minoxidil 5%. The trial found that all groups (including minoxidil alone) saw improvement, but the topical dutasteride via microneedling group demonstrated results comparable to the oral dutasteride group in terms of increased hair density and width, with the added advantage of fewer systemic side effects.^[5]Obeid, M.N.A., Fatteh, N.S.A., Elfangary, M.M., Husseni, R.M.A. (2024). Comparison between Topical Minoxidil 5% Alone versus Combined with Dutasteride (Topical 0.02% through Microneedling or Oral 0.5 … Continue reading  

Patient satisfaction and physician assessment favored the microneedling + topical dutasteride group, suggesting that this method may offer similar efficacy to systemic dutasteride, but with reduced risk of systemic adverse effects. The study included both men and women with AGA.

How Does Dutasteride Work?

Dutasteride is a potent inhibitor of the enzyme 5ɑ-reductase, which exists in multiple isoforms in the body. Unlike finasteride (which selectively targets the type II isoenzyme), dutasteride blocks both type I and type II 5ɑ-reductase.^[6]Botto, H., Lan, O., Poulain, J-E., Comenducci, A. (2005). Effect of dutasteride on reduction of plasma DHT following finasteride therapy in patients with benign prostatic hyperplasia. Progrés en … Continue reading 

Type II is abundant in hair follicles and the prostate, while Type I is found in skin, sebaceous glands, and liver. By inhibiting both, dutasteride more completely prevents the conversion of testosterone to DHT.

At a standard oral dose of 0.5 mg/day, dutasteride can drive serum and scalp DHT levels down by ~90% or more.^[7]Ding, Y., Wang, C., Bi, L., Du, Y., Lu, C., Zhao, M., Fan, W. (2024). Dutasteride for the Treatment of Androgenetic Alopecia: An Updated Review. Dermatology. (5-6). 833-843. Available at: … Continue reading This is a more extensive suppression than finasteride achieves at typical doses. This dramatic drop in DHT removes the androgenic stimulus that causes susceptible hair follicles to shrink and enter shorter growth phases, thereby slowing hair loss and allowing follicles to recover over time. 

Topical dutasteride aims to harness this same mechanism locally. When applied on the scalp, dutasteride penetrates into the skin and hair follicle, binding to 5ɑ-reductase enzymes in the dermis and around the follicle bulb. Inhibiting local DHT production creates a scalp environment more conducive to hair growth. 

Pharmacokinetic studies of dutasteride demonstrate parallel linear and nonlinear elimination, with nonlinear (saturable) pathways dominating at low doses. These pathways quickly become saturated, so even small concentrations can lead to substantial enzyme inhibition. As drug concentrations rise and saturate the target enzyme, higher doses yield diminishing increases in effect.^[8]Gisleskog, P.O., Hermann, D., Hammarlund-Udenaes, M., Karlsson, M.O. (1999). The pharmacokinetic modelling of GI198745 (dutasteride), a compound with parallel linear and nonlinear elimination. … Continue reading

Therefore, topical dutasteride at 0.01-0.05% may achieve a large fraction of the DHT reduction that an oral dose would, as long as it reaches the target tissue. This is why even leakage of a small dose into circulation can suppress serum DHT measurably.

Another factor is dutasteride’s long half-life, about 4-5 weeks.^[9]Azzouni, F., Godoy, A., Li, Y., Mohler, J. (2011). The 5 Alpha-Reductase Isozyme Family: A Review of Basic Biology and Their Role in Human Diseases. Advances in Urology. 2012(530121). 1-18. Available … Continue reading This prolonged half-life means that any dutasteride absorbed systemically will accumulate with continued use. From a mechanism standpoint, this is a double-edged sword: 

• It ensures continuous enzyme inhibition (dutasteride remains bound to 5ɑ-reductase).
• But it also means systemic exposure is amplified over time if absorption isn’t minimized. 

What the Science Says

Research on topical dutasteride is not as extensive as that on topical finasteride, but a growing number of trials and case series shed light on its efficacy. Below, we summarize key findings across different concentrations and use cases:

Study	Concentration & Vehicle	Hair Growth-Outcomes	Systemic/Serum Findings
Nada et al, 2018, prospective randomized study, 30 men, 24 weeks.	Group 1: Minoxidil + topical dutasteride (0.02%). Group 2: Minoxidil only.	Group 1 showed a significant increase in hair density, width, and terminal/vellus ratio compared to Group 2. Patient assessment showed higher satisfaction in Group 1 than in Group 2.	Reduction in serum DHT observed.
Sanchez-Meta et al, 2022, double-blind RCT, 34 men, 16 weeks.	Group 1: Minoxidil and topical dutasteride (0.01%). Group 2: Minoxidil only.	Minoxidil and dutasteride produced a superior overall change in hair thickness and density compared to minoxidil alone.	Not evaluated.
Panuganti et al, 2025, phase II randomized, double-blind study, 135 men, 24 weeks.	Group 1: Dutasteride 0.01% w/v topical solution. Group 2: Dutasteride 0.02% w/v. Group 3: Dutasteride 0.05% w/v. Group 4: Oral finasteride 1 mg. Group 5: Placebo.	Dose-dependent increase in target area hair count (TAHC) vs placebo. Dutasteride 0.05% superior to finasteride at week 24. Mean TAHC increase: 0.01% (12.78), 0.02% (20.03), 0.05% (34.30) vs finasteride (12.57). More patients achieved investigator global photography assessment ≥+2 with 0.05% vs finasteride.	Dutasteride caused modest changes in serum testosterone/DHT, while finasteride caused moderate changes. 0.05% dutasteride showed a better pharmacokinetic profile with reduced systemic absorption compared to oral finasteride.

Overall, while there is a lack of peer-reviewed scientific literature, it does support the idea that topical dutasteride is an effective treatment for AGA. Where topical dutasteride does shine is in offering these benefits with reduced systemic involvement, making it a potential option for those who need dutasteride’s effects but are wary of its systemic effects.

Why Formulation and Dose Matter

Not all topical dutasteride products are created equal. Two main factors determine how well topical dutasteride works (and how “safe” it is systemically): formulation (the vehicle and additives) and dosage regimen (concentration and frequency).

• Vehicle and Penetration: Dutasteride is a large lipophilic molecule with poor water solubility.^[10]Kim, N.A., Choi, D.H., Kim, J.Y., Kim, K.H., Lim, D.G., Lee, E., Park, E-S., Jeong, S.H. (2014). Investigation of polymeric excipients for dutasteride solid dispersion and its physicochemical … Continue reading This makes formulation challenging; you need solvents or carriers that keep it stable and help it traverse the skin barrier. Newer vehicles like lipid carriers or cyclodextrin inclusion complexes might improve scalp targeting while limiting diffusion into blood.^[11]Kim, M-S., Ha, E-S., Choo, G-H., Baek, I-H. (2015). Preparation and in vivo evaluation of a dutasteride-loaded solid-supersaturable self-microemulsifying drug delivery system. International Journal … Continue reading,^[12]Min, M-H., Park, J-H., Choi, M-R., Hur, J-H., Ahn, B-N., Kim, D-D. (2018). Formulation of a film-coated dutasteride tablet bioequivalent to a soft gelatin capsule (Avodart): Effect of γ-cyclodextrin … Continue reading 
• Applied Dose vs. Concentration: Users often focus on the percentage (e.g., 0.1% vs 0.02%), but the total amount of drug applied per session is just as important. For example, using 2 mL of a 0.1% solution (which contains 2 mg dutasteride) will deliver four times the dutasteride to your scalp as 1 mL of the same solution. For example, one study using a 0.25% topical used at 4 sprays (around 400 μL) caused a much larger drop in serum DHT than the same solution used at 1-2 sprays (100-200 μL).^[13]Ding, Y., Wang, C., Bi, L., Du, Y., Lu, C., Zhao, M., Fan, W. (2024). Dutasteride for the Treatment of Androgenetic Alopecia: An Updated Review. Dermatology. 240(5-6). 833-843. Available at: … Continue reading 
• Furthermore, volume matters: a seemingly “low” concentration could cause systemic effects if applied in large quantities. Conversely, high concentrations used sparingly might localize better. 
• Dosing Frequency: Dutasteride’s long half-life means you may not need daily application to maintain its effect on the scalp. Ultimately, the goal is to find a regimen that keeps follicles saturated with dutasteride whilst avoiding leakage into the bloodstream.

Minimizing Systemic Absorption

As we have mentioned above, one of the primary motivations for using topical dutasteride is to limit the risk of side effects that come with systemic DHT suppression. There are several strategies you can use to achieve this. 

Vehicle & Penetration Enhancers

As discussed, formulation plays a huge role. Nanoemulsion-based gels and nanoemulgels significantly increase skin permeation and deposition of dutasteride compared to conventional formulations, with optimized nanoemulsions showing up to 1.5-fold enhancement in permeation.^[14]Ali, M.S., Alam, M.S., Alam, N., Siddiqui, M.R. (2014). Preparation, Characterization and Stability Study of Dutasteride-Loaded Nanoemulsion for Treatment of Benign Prostatic Hypertrophy. Iranian … Continue reading If systemic absorption is a concern, you could opt for a slightly less efficient formulation. 

Time On Scalp

The longer the product stays on your scalp, the more the drug can penetrate, increasing efficacy (and potentially systemic absorption). Washing your hair too soon can rinse away some of the medication, potentially reducing efficacy. Many protocols recommend allowing at least 4 hours of contact time (and preferably 6-8 hours) before washing off a topical. 

Application Frequency

Frequency can be adjusted to manage systemic load. Because dutasteride binds 5ɑ-reductase for so long, daily application might not be necessary for full benefit. If you find that daily use lowers your serum DHT more than desired, you could try every other day or even twice-weekly dosing. 

Scalp Condition and Individual Variation

Your skin’s permeability is unique to you..Differences in skin thickness can affect drug permeability (and therefore efficacy).^[15]Noor, N.M., Abudl-Aziz, A., Sheikh, K., Somavarapu, S., Taylor, K.M.G. (2020). In vitro Performance of Dutasteride-Nanostructured Lipid Carriers Coated with Lauric Acid-Chitosan Oligomer for Dermal … Continue reading However, you should be mindful that if you have a scalp condition (like seborrheic dermatitis, etc), you should avoid using any topical hair loss treatments until it has resolved.

Application Area

The larger the area of scalp you treat, the more drug can be absorbed. Treating just the crown vs. the entire scalp could proportionally change systemic exposure. If you have diffuse thinning and apply broadly, you might consider using a lower concentration to compensate for the larger area.

To minimize systemic absorption without compromising results, a practical approach can be:

• Use the lowest effective concentration.
• Use the smallest effective volume.
• Use the least frequent schedule.

This will often require trial and error as you find out what works for you. If you notice side effects like decreased libido, brain fog, or breast tenderness, these could be signs of systemic absorption. In such cases, dial back the frequency or concentration.

How to Maximize Gains and Minimize Risk

If you decide to use topical dutasteride, here are strategies to get the best hair growth results while keeping your risk low:

• Establish a Baseline (Lab Tests): Before starting, it’s wise to get bloodwork for your hormone levels – especially serum DHT and testosterone. This baseline will tell you where you started. Some people also get a full hormone panel (if advised to do so by their doctor). You can then re-test after 4-6 weeks to monitor any significant changes.
• Standardize Your Application Routine: Consistency is key for results. Apply the treatment to a dry scalp. If using a dropper or spray, try to target thinning areas evenly and rub it in gently. Pick a time of day you can stick with. Many prefer nighttime so it can absorb overnight; just be cautious about transferring to pillows (and thereby to partners). If you apply it in the morning, ensure it dries before any activity that might cause sweat (sweating could increase absorption or cause the product). 
• Add Proven Adjuncts (like minoxidil or microneedling): To maximize regrowth, consider combining therapies. Minoxidil can synergize with dutasteride by stimulating follicles directly, while dutasteride tackles the hormonal aspect. As seen above, studies show that dutasteride and minoxidil yield better density than either alone. Microneedling is another option. Weekly or monthly sessions of dermarolling have been shown to boost topical drug delivery and induce growth factors.^[16]Ahmed, K.M.A., Kozaa, Y.A., Abuawwad, M.T., Al-Najdawi, A.I., Mahmoud, Y.W., Ahmed, A.M., Taha, M.J.J., Fadhli, T., Giannopoulou, A. (2025). Evaluating the efficacy and safety of combined … Continue reading 
• Be Patient and Track Progress: Hair growth is a slow process. Do not expect major changes in the first weeks. In fact, you might experience some shedding initially. This can happen with any effective treatment and usually subsides. Give the treatment at least 6 months to a year to judge its effect. To accurately gauge progress, use objective tracking, such as standardized photos, hair counting, or a dermascope. 
• Lifestyle and Supplements: While on treatment, avoid introducing supplements that might complicate treatment. For instance, creatine may increase DHT, and quercetin may decrease it.^[17]van der Merwe, J., Brooke, N.E., Myburgh, K.H. (2009). Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical … Continue reading,^[18]Ma, Z., Nguyen, T.H., Huynh, T.H., Do, P.T., Huynh, H. (2004). Reduction of rat prostate weight by combined quercetin-finasteride treatment is associated with cell cycle deregulation. Journal of … Continue reading 
• Monitor Side Effects: If you notice any difference, then keep a note and let your healthcare provider know. You may be able to adjust the dosage to maintain hair gains and reduce side effects.

Combination Therapies: Enhancing Outcomes

Combination therapy can amplify the benefits of topical dutasteride. We’ve summarized a few of these below:

Dutasteride and Fractional CO2 Laser

One study was conducted in which 30 male AGA patients were randomized to either fractional CO2  laser plus topical dutasteride (0.002%) applied after each session.^[19]Galal, S.A., Ali, M.S., HafizHala, H.S.A. (2025). Comparative study between fractional CO2 laser alone versus fractional CO2 laser combined with topical dutasteride in treatment of male androgenic … Continue reading Each group received 3 sessions, one month apart. The combination group had significantly superior increases in terminal hair count and reductions in vellus hair and hair diameter diversity versus laser alone. Higher patient satisfaction was also reported in the combination group.

Triple Topical Therapy: Dutasteride, Finasteride, and Minoxidil

Fifteen male AGA patients, including both atopic and non-atopic subjects, used a topical compound containing finasteride, dutasteride, and minoxidil (“NuH Hair”), with optional additions of oral finasteride, topical minoxidil foam, and ketoconazole shampoo.^[21]Rafi, A.W., Katz, R.M. (2011). Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN Dermatology. 2011(241953). Available at: … Continue reading

All patients experienced significant new hair growth. Among those using all four components, significant regrowth was seen as early as 30 days, with “major” growth in three patients by day 30 and in all by day 60.  In those using only the triple topical, significant regrowth was observed in all by 3 months, despite some using it less frequently than recommended.  No systemic or local adverse effects were reported.

Topical Dutasteride + Microneedling

A 20-week, randomized, double-blind, placebo-controlled trial of microneedling plus topical 0.01% dutasteride solution (MNSD) vs. microneedling plus saline. The combination group demonstrated significant improvement in hair growth and density compared to the control. No systemic androgen suppression was detected, indicating a favorable safety profile.^[22]Sanchez-Meza, E., Ocampo-Candiani, J., Gomez-Flores, M., Herz-Ruelas, M.E., Ocampo-Garza, J., Orizaga-y-Quiroga, T.L., Martinez-Moreno, A., Ocampo-Garza, S.S. (2022). Microneedling plus topical … Continue reading 

The overarching theme of combinations like the above is synergy. By attacking hair loss from multiple angles, you often get faster, fuller, and more sustained regrowth.

Who Should (or Shouldn’t) Use Topical Dutasteride

Good Candidates

• Men with AGA who need a stronger option.
• Those who experienced side effects from oral finasteride/dutasteride.

Bad Candidates

• Anyone trying to conceive, or with infants, toddlers, or pregnant partners.
• People with non-AGA hair loss.
• Those with severe persistent side effects from 5ɑ-reductase inhibitors.
• People who aren’t able to commit to a consistent routine.

Final Verdict

So, does topical dutasteride work? In short, yes. Clinical trials and real-world use show that topical dutasteride can significantly improve hair growth and reduce shedding in men with androgenetic alopecia. When formulated correctly, it offers comparable scalp DHT suppression and regrowth potential to oral finasteride, and in some cases, it even approaches the efficacy of oral dutasteride, but with lower systemic exposure and fewer side effects.

The key is proper use. Results depend heavily on the right concentration, vehicle, dosage, and frequency. A well-balanced regimen, often guided by a medical provider, offers the best chance of success.

Topical finasteride is gaining traction as a lower-risk alternative to oral finasteride, especially for those concerned about systemic side effects. In the U.S., providers like Ulo and Strut stand out for customization and lab-tested purity. Canadian options include Xyon Health and Essential Clinic, while the UK and EU offer licensed sprays and private compounding through clinics like Hair Repair and Sons. No matter your location, choose sources with strong medical oversight and clear quality standards to ensure you’re getting a safe, effective treatment.

Top Places to Buy Topical Finasteride

• #1 Choice for Quality and Growth: Ulo
• Top Runner-Up in the USA: HappyHead
• Top Pick in Canada: Xyon Health 
• Top Runner-Up in Canada: Jupiter
• Top Pick in the UK: Hair Repair Clinic
• Top Runner-Up in the UK: UsMen

Topical finasteride is a well-known 5ɑ-reductase inhibitor used off-label as a localized treatment for androgenic alopecia (AGA). Finasteride in oral form is an FDA-approved medication for AGA, but its topical formulation is not officially approved in the US. However, compounding pharmacists and telehealth services do prepare it for off-label use.

The goal of using finasteride topically is to deliver the drug to hair follicles in the scalp while minimizing systemic absorption, thereby reducing the risk of side effects commonly associated with the oral pill. Below, we’ll discuss how topical finasteride works and why the source of your topical finasteride matters. Then we’ll explore where to buy topical finasteride in the US and around the world.

Interested in Topical Finasteride?

Low-dose & full-strength finasteride available, if prescribed*

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*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Mechanism of action

Finasteride works by inhibiting the enzyme 5ɑ-reductase (specifically the type II isoenzyme) that converts testosterone into dihydrotestosterone (DHT). DHT is the androgen hormone that binds to hair follicles and causes them to miniaturize in genetically susceptible individuals, leading to thinning hair and eventual hair loss. By blocking DHT production, especially in the scalp, finasteride helps halt this miniaturization process, thereby maintaining or increasing hair density.

Oral finasteride (1 mg daily) is a proven treatment that significantly increases hair counts compared to placebo in men with AGA.^[1]Gupta, K.A., Venkataraman, M., Talukdar, M., Bamimore, M.A. (2021). Finasteride for hair loss: a review. Journal of Dermatological Treatment. 1938-1946. Available at: … Continue reading It’s this effect that topical formulations also aim to achieve, but with a more localized effect.

Advantages of Topical Finasteride

The hope of the topical finasteride formulation is localized delivery of the drug to the scalp, which can minimize systemic exposure. By applying finasteride directly to the balding areas, high drug concentrations can be achieved in the skin and hair follicles where it’s needed, while ideally limiting how much finasteride enters the bloodstream. This targeted approach means the scalp DHT can be lowered substantially (similar to oral finasteride’s effect on scalp DHT) without as large a reduction in blood DHT levels.^[2]Zhou, C., Bin, Y., Huiming, Z., Rushan, X., Ningning, D., Qinping, Y., Chunlei, Z., Guogiang, Z., Aihua, W., Wei, L., Shuxia, Y., Qingchun, D., Yangfeng, D., Liming, W., Lunfei, L., Danyang, J., … Continue reading In other words, topical finasteride can maintain the same inhibitory effect on scalp DHT with significantly less impact on systemic DHT levels. 

While research is ongoing, the suspected outcome of this is that at the right doses, topical finasteride usage will lead to lower side effects than oral. Oral finasteride is well-tolerated by most, but a minority of users experience side effects like reduced libido, erectile dysfunction, or other hormone-related issues. Research shows that these side effects are less common with topical finasteride.^[3]Gupta, A.K., Talukder, M. (2022). Topical finasteride for male and female pattern hair loss: Is it a safe and effective alternative? Journal of Cosmetic Dermatology. 21(5). 1841-1848. Available at: … Continue reading

Clinical trials of a 0.25% finasteride topical spray in men showed significant hair regrowth versus placebo, with good safety and tolerability; no serious adverse effects were reported, and only mild localized side effects (like slight scalp irritation) occurred.^[4]Piraccini, B.M., Blume-Peytavi, U., Scarci, F., Jansat, J.M., Falques, M., Otero, R., Tamarit, M.L., Galvan, J., Tebbs, V., Massana, E. (2021). Efficacy and safety of topical finasteride spray … Continue reading

Other studies similarly report that topical finasteride users experience far fewer sexual side effect reports than oral users, suggesting that keeping finasteride localized to the scalp can indeed mitigate many unwanted systemic effects.^[5]Gupta, A.K., Talukder, M., Keene, S.A., Bamimore, M.A. (2025). Is the Safety of Finasteride Correlated with Its Route of Administration: Topical Versus Oral? A Pharmacovigilance Study with Data from … Continue reading Moreover, by delivering the drug via the skin, it’s possible to use a small total dose of finasteride (since it isn’t undergoing first-phase metabolism in the liver), yet still achieve a therapeutic effect in the hair follicle.

Why Sourcing Matters

Since topical finasteride lacks FDA approval as a commercial hair loss treatment, it relies on compounding pharmacies and specialized telehealth providers for preparation. This creates substantial variation in formulation quality and standards across different sources.

The compounding process introduces multiple variables that can significantly impact the final product. Different providers may use varying preparation techniques, carrier systems, and active ingredient concentrations, resulting in inconsistent efficacy and safety profiles between products.^[6]American Hair Loss Association. (no date). Hair Loss Treatments Online: What to Know About Compounded Medications. Available at: … Continue reading Without the stringent regulatory framework that governs mass-produced pharmaceuticals, these compounded formulations face less oversight regarding quality control and manufacturing standards.

This regulatory gap creates particular concerns around dosing accuracy. Compounded topical finasteride products may contain active ingredient levels that differ from their labeled concentrations, potentially leading to subtherapeutic underdosing or potentially harmful overdosing. The lack of standardized manufacturing processes and quality assurance protocols means patients cannot be certain they are receiving the intended dose or purity level.

These factors underscore why careful selection of telehealth providers and compounding sources becomes essential when considering topical finasteride treatment, as the wide variation in preparation methods and quality standards can directly influence both treatment outcomes and patient safety.

Price and Purity Considerations

The cost of topical finasteride can vary depending on where you get it and what’s included. In general, because these are custom prescriptions, they tend to be more expensive than generic oral finasteride. Prices can fluctuate based on local pharmacy compounding costs, the inclusion of additional active ingredients, and how the product is sold (subscription model vs. one-time purchase).

Ingredient purity represents another consideration, as the quality of raw finasteride used in compounding can fluctuate significantly based on the supplier and sourcing practices. This introduces concerns about both therapeutic effectiveness and the risk of contamination or impurities in the final product. The inconsistency in raw material quality means that patients may receive formulations with compromised potency or unknown adulterants that could affect safety profiles. 

These quality variations highlight the importance of thoroughly evaluating both the provider and their compounding standards when selecting a topical finasteride treatment. Patients and healthcare providers should prioritize sources that demonstrate transparency in their sourcing practices, manufacturing processes, and quality control measures to ensure they receive a safe and effective compounded topical finasteride product.

Now, let’s explore where you can get topical finasteride in various regions (US, Canada, UK/EU, and elsewhere).

Where To Buy Topical Finasteride

United States Providers

In the US, there is no FDA-approved topical finasteride product on the market. Therefore, all topical finasteride is obtained via prescription compounding. The US has a thriving telehealth industry for hair loss, so many patients get topical finasteride by consulting an online healthcare provider who can prescribe a compounded solution shipped to them. 

Ulo – #1 Choice for Quality & Growth

Ulo stands out in the US telehealth market for its high degree of flexibility and rigorous standards:

• Evidence-First Formulations:
  • Offered in both low-dose (0.005%) and full-strength (0.2%) topical finasteride, accurately compounded to mirror the proven effects of oral finasteride on scalp DHT.
  • Every batch undergoes independent GC/MS and HPLC testing with lab reports published online so you know exactly what’s in your bottle.

You can read more about our product lab testing results here.

• Unrivaled Personalization:
  • Add up to five enhancers: 7% minoxidil, 0.01% tretinoin, 0.2% caffeine, 0.01% melatonin, and 1% cetirizine, to tailor your regimen. 
  • Partner physicians collaborate with you to adjust concentrations and ingredients over time, based on your response and tolerance.
  • Treatment regimens can be tailored for once- or twice-daily application, with thoughtfully designed dropper-marked bottles to facilitate accurate dosing.

• Consumer Safety Built-In:
  • No propylene glycol, no corticosteroids, and no ”trending” additives that lack robust safety data (e.g., no latanoprost or copper peptides).
  • Proprietary, low-irritation vehicle ensures deep follicle penetration without the need to mask side effects with steroids.

• Transparent Quality & Pricing:
  • Third-party lab reports accompany every shipment for total transparency.
  • Ulo’s pricing starts at $0.82 per ml (or $0.61 per ml with the discount) for the low-dose finasteride-only formulation, increasing with dose and other ingredients.

• Ongoing Medical Support:
  • Unlimited access to Ulo’s network of licensed physicians via a secure portal, ask questions, report progress, and get real-time guidance anytime.
  • Clear timelines set “possibility vs. probability”, so you know when to expect regrowth, when it might plateau, and how to safely escalate your protocol. 

Ulo was built by advocates who have spent over a decade exposing the hair loss industry’s worst practices and decided to solve them. 

Pros

• Connects patients directly with licensed providers, offering discreet prescriptions and continuous support throughout their hair restoration journey. 
• The customized topical treatments blend finasteride and minoxidil, addressing the underlying drivers of hair loss to deliver more noticeable regrowth.
• Additional ingredients, such as cetirizine, melatonin, caffeine, and retinoic acid, are included to further improve regrowth outcomes.

Cons

• Twice daily usage can be inconvenient.

HappyHead – #1 Runner Up in the USA

HappyHead is a US-based telehealth company specializing in hair growth solutions with a strong focus on medical-grade, customizable topical treatments. HappyHead offers prescription Topical Finasteride, either as monotherapy or in combination with minoxidil and/or retinoic acid, compounded for each patient after an online consultation with a licensed physician. 

Some versions include minoxidil (up to 8%) and tretinoin, aiming to optimize results based on patient needs and tolerance. HappyHead’s platform emphasizes medical guidance, ongoing support, and flexible subscriptions, shipping directly to consumers in most US states. 

Pros

• Offers personalized prescriptions through its telehealth platform, ensuring patients receive discreet access to treatment from licensed providers.
• Its compounded topical solution has the option to combine finasteride with minoxidil and retinoic acid.
• Flexible formulation strengths enable tailoring to patient needs, which can be particularly beneficial for individuals sensitive to the side effects of oral finasteride.

Cons

• Twice-daily application is the standard recommendation, which may feel less convenient compared to simpler once-daily regimens.
• Higher concentrations of finasteride may lead to an increased risk of systemic side effects.
• No dosing flexibility.

Strut Health

Strut Health is an online compounding pharmacy that provides custom formulas for hair loss. Strut allows some customization: their Finasteride Hair Loss Formula can include finasteride 0.25%, minoxidil 0-7.5%, tretinoin 0-0.0125%, fluocinolone 0.01%, and biotin. Corticosteroids are often used to offset the potential irritation that comes with topical use; however, this comes at the risk of long-term skin thinning for customers.

We conducted third-party testing on their custom formula and found that it met the required levels of finasteride, minoxidil, and tretinoin.

Pros

• Strut Health offers tailored hair loss treatments and ongoing support from licensed providers.
• The compounded topical formula combines finasteride with proven agents like minoxidil and tretinoin, both targeting DHT and promoting follicular activity. 
• Custom blends may also include additional ingredients that can strengthen hair, reduce inflammation, and further adapt the treatment to specific requirements.

Cons

• Strut Health includes corticosteroids in its formulation to help with the potential irritation of topical use. However, this comes at the risk of long-term skin thinning for customers.
• Not the cheapest option, costing $1.97 per serving.

Hims

Hims & Hers is a large digital health platform focused on men’s and women’s health. They offer a Topical Finasteride & Minoxidil Spray for hair loss, featuring finasteride 0.1% and minoxidil 6%. A dual-action, pill-free formula is available by prescription after an online consultation. The spray is designed to minimize systemic absorption and side effects compared to oral finasteride, and it’s marketed for its convenient application and personalized telehealth experience.

While we haven’t done third-party testing on their topical formulation, we did on their oral finasteride counterpart – and it met the claimed level of finasteride.

Pros

• Combines finasteride and minoxidil into a single, easy-to-use topical spray, offering a convenient alternative to oral pills.
• Once daily usage is recommended, making the regimen less time-consuming than some alternatives requiring multiple applications daily.

Cons 

• Some users may find sprays less suitable than dropper or foam-based applications, especially if precise targeting of thinning areas is preferred.
• The formulation’s alcohol base could lead to scalp dryness or irritation for sensitive individuals.

Ro (formerly Roman)

Ro is a well-known direct-to-consumer telehealth provider. Their Roman Hair Solution Rx is a 3-in-1 prescription topical spray: finasteride 0.3%, minoxidil 6%, and tretinoin 0.025%. Ro emphasizes convenience with free follow-ups and no required video visits. Customization is not as extensive as with some compounding pharmacies.

Similar to Hims, we haven’t done third-party testing on their topical formulation, but we did on their oral finasteride product – and it met the claimed level of finasteride.

Pros

• Roman Hair Solution Rx blends finasteride, minoxidil, and tretinoin into one topical formula. 
• The solution offers a once-daily, convenient spray application. 

Cons

• No customization offered
• No dosing flexibility
• Some users may experience mild scalp irritation, redness, or dryness due to alcohol-based solutions

Keeps

Keeps is a telehealth brand specializing exclusively in men’s hair loss treatments. Their Topical Finasteride & Minoxidil Gel delivers 0.25% finasteride and 5% minoxidil in a single application. Keeps focuses on ease of use, competitive pricing, and online medical evaluations, shipping treatments directly to most US states. 

As with the above, we haven’t done third-party testing on their topical formulation, but we did on their oral finasteride product – and it met the claimed level of finasteride.

Pros

• Offers a topical gel combining finasteride and minoxidil to target two AGA routes. 
• Gel formula designed to minimize systemic absorption.

Cons

• No customization available.
• No dosing flexibility available.
• Most expensive option (price per serving)

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/Serving	Purity Testing
Ulo	Yes	Minoxidil 7%, Cetirizine 1%, Tretinoin 0.01%, Melatonin 0.01%, and Caffeine 0.2%	Yes, 0.005% or 0.2% finasteride	$0.61	3rd-party lab reports.
HappyHead	No, the doctor customizes the product for you	Finasteride (0.3%), Minoxidil (8%), Retinoic Acid (0.001%), Hydrocortisone (1%)	No	$1.98	3rd-party lab reports of another product were mixed, with some ingredients not meeting the claimed dose.
Strut	Yes	Finasteride 0.25%, Minoxidil 0-7.5%, Tretinoin 0-0.0125%, Fluocinolone 0.01%, and Biotin.	Yes	$1.97	3rd-party lab reports of topical finasteride were good.
Hims	No	Finasteride and Minoxidil	No	$0.65	No 3rd party testing for their topical product, but their oral finasteride product passed lab testing.
Ro	No	Finasteride 0.3%, Minoxidil 6%, and Tretinoin 0.025%	No	$0.65	No 3rd party testing done for topical finasteride
Keeps	No	Finasteride and Minoxidil	No	$2	No 3rd party testing for their topical product, but their oral finasteride product passed lab testing.

Canada Providers

Xyon Health – Top Pick in Canada

Xyon Health is a telehealth brand offering topical hair treatments, including dutasteride and finasteride. For their finasteride options, you can either buy finasteride alone or combined with minoxidil. The platform requires online consultations with specialist physicians and delivers medications in discreet packaging across Canada.

Pros

• Xyon Health uses its patented SiloxysSystem gel technology to deliver its treatment directly to the scalp.
• Offers 92% less systemic absorption than oral finasteride.
• Alcohol-free formula.
• Have a choice of finasteride alone or in combination with minoxidil.
• Convenient once-daily administration.

Cons

• Not the cheapest option ($327 per order for a 3-month supply).

Jupiter – Top Runner-Up in the USA

Jupiter is a telehealth platform offering personalized topical hair loss treatments. Through Jupiter, customers can access a compounded topical that may include finasteride as well as up to four other active ingredients, depending on their needs, including minoxidil, tretinoin, panthenol, and caffeine. 

Unfortunately, they don’t advertise their concentrations or prices, mentioning that you can only view specific medication pricing and options after completing an online assessment. Jupiter provides free shipping Canada-wide, however. 

Pros

• Personalized hair loss treatment, which includes finasteride, minoxidil, tretinoin, panthenol, or caffeine. 
• Convenient once-daily treatments.

Cons

• A lack of freely available data, including whether dosing flexibility is possible and the price per serving.

Essential Clinic

Essential Clinic is a Canadian telehealth platform that specializes in men’s health issues like hair loss and erectile dysfunction. They offer Topical Finasteride + Minoxidil Liposomal Gel that combines finasteride with minoxidil in a liposomal delivery system designed to enhance scalp penetration while minimizing systemic absorption. The platform provides online consultations with licensed Canadian doctors and nurse practitioners. 

Pros

• Treatment is paired with ongoing access to licensed Canadian physicians for follow-up and dose adjustments, plus fast, confidential home delivery of medications.
• The topical finasteride treatment is combined with minoxidil for greater efficacy.

Cons

• The most expensive option that we are able to see prices for.
• No customization. 
• No dosing flexibility.

Beyoung Health

Beyoung Health is another Canadian telehealth clinic (based in Ontario) that offers treatments for men’s health, including hair loss. They prescribe compounded topical finasteride as part of their hair loss program. Beyoung offers finasteride alone or in combination with minoxidil for hair loss therapy. 

Beyoung’s approach is relatively patient-tailored. The doses that they offer are 0.25% finasteride + 5% minoxidil, 0.1% finasteride + 7% minoxidil foam, or finasteride 0.1% + minoxidil 10%.

Pros

• Offers customizable finasteride doses combined with minoxidil. 
• Dosing flexibility.

Cons

• A lack of freely available data, including the price per serving.

Jack Health

Jack Health is a prominent Canadian telehealth platform that offers personalized hair loss treatments, including topical finasteride formulations. Their hair loss program features a product called “Hello Hair”. This program provides custom topical ingredients that may include topical finasteride to assist with hair regrowth.

Pros

• Dosing flexibility offered.

Cons

• A lack of freely available data, including the price per serving.
• No available customization on the site – it is conducted after consultation.

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/Serving	Purity Testing
Xyon Health	Yes	Minoxidil 6%	Yes, Finasteride 0.25% (with 5% minoxidil) or 2.5% (finasteride alone)	$1.21	No
Essential Clinic	No	Finasteride 2.5% and Minoxidil 5%	No	$1.61	No
Jupiter	Yes	Minoxidil, Tretinoin, Panthenol, and Caffeine.	Unknown	Unknown	None
Beyoung Health	Yes	Minoxidil (different strengths)	Yes Finasteride 0.25% (+5% minoxidil) or 0.1% (+7/10% minoxidil)	Unknown	None
Jack Health	No	N/A	Yes	Unknown	None

If you don’t want to buy topical finasteride from a telehealth company, a few dermatology clinics can also prescribe and compound topical finasteride. If you prefer an in-person route, you could ask your dermatologist about a topical finasteride prescription to be made at a local compounding pharmacy. The downside is that compounding costs in Canada can be high, and many dermatologists are still more comfortable with oral finasteride. 

United Kingdom & Europe

In the UK and EU, the situation is a bit different because, unlike the US and Canada, there has been a topical finasteride formulation approved in some markets. In 2021, a finasteride 0.25% topical solution received approval in certain European countries.^[7]Zhou, C., Bin, Y., Huiming, Z., Rushan, X., Ningning, D., Qinping, Y., Chunlei, Z., Guogiang, Z., Aihua, W., Wei, L., Shuxia, Y., Qingchun, D., Yangfeng, D., Liming, W., Lunfei, L., Danyang, J., … Continue reading

Hair Repair Clinic – Top Pick in the UK

Hair Repair Clinic is a UK-based specialist compounding pharmacy offering Finasol, their custom-formulated topical finasteride solution. They use TrichoSol, a proprietary alcohol-light delivery system made from natural mineral salts that’s free of propylene glycol to minimize scalp irritation. Available in concentrations ranging from 0.025% to 0.1% finasteride, with custom strengths available upon request.

Pros

• Products custom-made in the UK by compounding pharmacies, with same-day approval for most orders.
• Uses the TrichoSol base for improved delivery and minimised local irritation.
• Offers customization and dosing flexibility.
• Doesn’t use propylene glycol.
• Convenient once-daily application.

Cons

• Prescription required and needs to be paid for privately; will not be reimbursed by the NHS.

UsMen – Top Runner-Up in the UK

UsMen is a UK telehealth platform specializing in men’s health that offers Topical Finasteride 0.1% and Minoxidil 5% spray. They emphasize competitive pricing and do not require subscriptions. To purchase their prescription products, you must complete a consultation.

Pros

• Cheapest UK offering that we found ($0.51 per serving).
• Topical finasteride is offered combined with minoxidil. 
• Users report easy ordering, low costs, flexible purchase options, and rapid home delivery.

Cons

• No customization or dosing flexibility available. 

Dr Fox

Dr Fox is an established UK online pharmacy that offers Dr. Fox Hair Growth Spray containing finasteride 0.3% and minoxidil 5%. They provide a dual-action topical spray designed to combine the DHT-blocking effects of finasteride with the growth-stimulating properties of minoxidil. 

Pros

• Good pricing: $0.58 per serving.
• Same day approval and discreet UK home delivery.
• The product contains finasteride, minoxidil, and tretinoin for comprehensive treatment.

Cons

• No customization options.
• No dosing flexibility.

Sons

Sons is a major UK telehealth platform offering a Topical Finasteride & Minoxidil Spray, combining finasteride with minoxidil and tretinoin. They claim to be the only UK licence holder for both finasteride and minoxidil treatments. 

Pros

• Convenient, once daily usage.
• Their finasteride product is combined with minoxidil. 

Cons

• A lack of freely available data, including whether dosing flexibility is possible and the price per serving.
• No add-ons available.

Manual

Manual is another leading UK men’s health platform offering an all-in-one spray containing topical finasteride, 10% minoxidil, and 5% azelaic acid. This triple-therapy approach is designed to address multiple aspects of hair loss. Manual provides comprehensive medical support throughout treatment.

Pros

• The “All-in-One Spray” combines prescription-strength topical finasteride, high-dose minoxidil, and azelaic acid into a single formula for male AGA.
• Convenient once-daily application.
• Base formulation designed for efficient absorption.

Cons

• Women and those with non-androgenic hair loss are excluded, with use restricted to adult men who pass clinical screening.
• No customization and no dosing flexibility available.
• A lack of freely available data, including the price per serving.

Hims UK 

Hims UK operates as the British arm of the US company, offering topical finasteride and minoxidil combinations. They provide subscription-based services with online consultations and ongoing medical support. Unfortunately, without going through the consultation, we cannot find out the dosage and price options.

Pros

• Convenient once-daily treatment
• Combination of finasteride and minoxidil. 
• Ongoing medical support available.

Cons

• A lack of freely available data, including customization, dosing flexibility, and price per serving.

Hair Medics UK

This London-based hair clinic also offers compounded topical formulas for sale. They advertise a topical finasteride (0.1%) and dutasteride (0.1%) combination solution (for men only) for £69.99 ($94.72). They also offer a minoxidil (5%) and finasteride (0.25%) combination solution for the same price.

Pros

• Offer a customizable topical finasteride solution that can be combined with either dutasteride or minoxidil.
• Dosing flexibility from 0.1-0.25%.

Cons

• The most expensive option that we have found per serving. 

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/Serving	Purity Testing
Hair Repair Clinic	Yes	Minoxidil	0.025%,0.05%, and 0.1%	$0.81	No
Dr Fox	No	None	No	$0.58	No
UsMen	No	None	No	$0.51	No
Sons	No	None	No	Unknown	No
Manual	No	None	No	Unknown	No
Hims UK	Unknown	Unknown	Unknown	Unknown	No
Hair Medics UK	Yes	Minoxidil, and Dutasteride	0.1% and 0.25%	$2.71	None

If you choose this path, keep in mind that you’re essentially experimenting on yourself with a product of unknown quality. Whenever possible, opt for a reputable telehealth provider or licensed pharmacy. This way, you’ll have professional medical supervision and a much greater assurance that your medication actually contains the right amount of finasteride.

Final Thoughts

Topical finasteride offers a compelling alternative to oral finasteride for individuals seeking effective hair loss treatment with potentially fewer systemic side effects. While the medication is not FDA-approved in topical form in the US, reputable telehealth and compounding options are available throughout the US, Canada, and parts of Europe. Providers like Ulo, Strut, Happy Head, Xyon, and others have stepped in to fill this gap by offering prescription-based, customized topical finasteride, often with additional active ingredients like minoxidil or tretinoin to enhance results.

When choosing a provider, look beyond marketing claims. Consider customization options, pricing transparency, dosing flexibility, and, crucially, whether third-party testing verifies what’s actually in the bottle. A cheap, poorly compounded product may do more harm than good, and skipping medical oversight could leave you exposed to unnecessary risks.

If you’re serious about topical finasteride, make sure you’re sourcing it from a trusted telehealth platform or compounding pharmacy that provides medical consultation and prioritizes formulation quality. Your treatment’s success and your peace of mind depend on it.

When it comes to hair loss treatments, oral dutasteride often emerges as the most powerful option, consistently outperforming FDA-approved alternatives like finasteride in clinical studies. Across the internet, personal stories echo this sentiment: discussion boards and Reddit threads feature dramatic recoveries, with some users claiming transformations from advanced thinning to a full, healthy head of hair.

(You can read more about this one below.)

However, online spaces tend to spotlight the extremes, either remarkable success stories or reports of failure, creating a distorted picture of what typical results look like. 

So, where does dutasteride truly stand? How do we distinguish between what’s possible and what’s probable? How can you weigh anecdotal experiences against the outcomes you’re most likely to see? And importantly, what might your pattern of regrowth look like after 1, 2, 3, or even 10 years of therapy?

This article addresses these questions directly. We’ll set clear expectations for oral dutasteride, explore how to interpret results shared online, highlight some of the most dramatic dutasteride before and after photos, and offer guidance on what an average treatment journey may look like. 

Finally, we’ll introduce a framework you can use to evaluate and compare all hair loss therapies, helping you see dutasteride ranks in terms of regrowth potential, evidence quality, and long-term safety.

Interested in Oral Dutasteride?

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*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Quick Refresher on Androgenic Alopecia (AGA)

Androgenic alopecia (AGA) is the most common form of hair loss affecting both men and women, marked by progressive thinning and miniaturization of hair follicles. This is primarily thought to be a result of genetic predisposition and the influence of androgens, especially dihydrotestosterone (DHT).^[1]Chen, S., Xie, X., Zhang, G., Zhang, Y. (2022). Comorbidities in Androgenetic Alopecia: A Comprehensive Review. Dermatology and Therapy. 12(10). 2233-2247. Available at: … Continue reading 

There is a huge choice of treatment options for AGA, with FDA-approved therapies such as topical minoxidil and oral finasteride. Many other options are either used off-label or under investigation, including low-level laser therapy, platelet-rich plasma injections, hair transplant surgery, herbal compounds, and emerging agents like prostaglandin analogs and caffeine-based solutions.^[2]Bajoria, P.S., Dave, P.A., Rohit, R.K., Tibrewal, C., Modi, N.S., Gandhi, S.K., Patel, P. (2023). Comparing Current Therapeutic Modalities of Androgenic Alopecia: A Literature Review of Clinical … Continue reading This diversity reflects both the complexity of the disease and a significant unmet need in achieving consistent, satisfactory results for patients.

Despite existing for decades, oral dutasteride has recently surged in popularity as an off-label AGA treatment. Like finasteride, it inhibits the conversion of testosterone to DHT. But it blocks both type I and II 5-alpha-reductase enzymes more effectively, potentially offering a more potent effect. 

Dutasteride 101

Dutasteride blocks both type I and type II isoforms of the 5ɑ-reductase enzyme. This enzyme converts testosterone to DHT, a key hormone driving male pattern hair loss and prostate growth. By inhibiting both isoforms, dutasteride causes a near-complete suppression of DHT, reducing its levels in blood by up to 98%, which is higher than finasteride’s reduction of around 65-70%.^[3]Clark, R.V., Hermann, D.J., Cunningham, G.R., Wilson, T.H., Morrill, B.B., Hobbs, S. (2004). Marked Suppression of Dihydrotestosterone in Men with Benign Prostatic Hyperplasia by Dutasteride, a Dual … Continue reading,^[4]Nickel, J.C. (2004). Comparison of Clinical Trials with Finasteride and Dutasteride. Reviews in Urology. 6(Suppl 9). S31-S39. Available at: PMID: 16985923

The standard and most studied dose is 0.5 mg daily. This is the FDA-approved dose for benign prostatic hyperplasia and the most common dose used off-label for hair loss. Lower doses like 0.2 mg daily have been used in one clinical trial, though 0.5 mg remains the norm.^[5]Escamilla-Cruz, M., Magana, M., Escandon-Perez, Bello-Chavolla, O.Y. (2023). Use of 5-Alpha Reductase Inhibitors in Dermatology: A Narrative Review. Dermatology and Therapy. 13(8). 1721-1731. … Continue reading,^[6]Lee, S., Kim, J.E., Lew, B-L., Huh, C.H., Kim, J., Kwon, O., Kim, B.M., Lee, Y.W., Lee, Y., Park, J., Kim, S., Kim, D.Y., Choi, G.S., Kang, S. (2025). Efficacy and Safety of Low-Dose 0.2 mg … Continue reading 

Why “Expectation Setting” Matters

Realistic expectation setting is fundamentally important for anyone starting their AGA treatment journey, particularly with treatments that do not have a large amount of evidence.

Some people may expect dramatic hair regrowth, often influenced by online testimonials or dutasteride before and after photos showing “hyper responders”.

Others may experience disappointment, frustration, and a decline in self-esteem when their own results are modest or average.

On the other hand, those with overly low expectations may forgo potentially beneficial treatments altogether, missing out on improvements that could positively impact their quality of life.

Online before-and after photos and personal anecdotes present another challenge. They are not standardized, can be misleading, and often feature individuals who have responded exceptionally well to a product, rather than the majority who see more moderate effects. These images rarely account for factors like lighting, hair styling, photo angles, or even digital enhancement, all of which can distort perceived efficacy.

To help guide your treatment selections & expectations, here are two key principles that, once understood, will make all the difference in how you approach your hair growth journey.

Principle #1: What’s Possible ≠ What’s Probable

Consider the following chart.

Note the individual datapoints and how scattered they appear. Also note the trendline, which represents the average of all individual datapoints shown in the chart.

The individual datapoints represent what’s possible for any one individual. The trendline represents what’s probable.

 

Resultantly, people see these dutasteride before and after success stories, and think, “This is all I see. And so I’ll probably get the same regrowth, too.” This shifts their expectations for the drug far above the trendline:

Then they try dutasteride and either quit too early to see regrowth (more on that soon)… or they don’t get the same results, and determine (often erroneously) that the drug just isn’t working for them.

The solution: don’t set expectations by what’s possible. Set expectations by what’s probable. Understand the trendlines for oral dutasteride: when results will typically first start to show, when results will peak and/or plateau, and what results will look like 5+ years into the future.

You can do this by using a standardized rubric we created called Regrowth Potential.

Regrowth Potential

As mentioned above, Principle 1 shows us that results tend to scatter across a spectrum: some datapoints high, some low, with a trendline running through the middle. The problem is that online anecdotes usually highlight only the high datapoints, while clinical trial data can feel abstract and hard to translate into lived experience. 

Regrowth Potential is our way of standardizing this landscape. It’s designed to cut through anecdotal extremes and align patients with the trendline, what most people can realistically expect.

So what does the average look like?

Most people see stabilization first, regrowth second, and a slowing of hair loss, with partial reversal layered on top. 

Gains usually peak within 6-12 months, then plateau.^[8]Nestor, S, M., Ablon, G., Gade, A., Han, H., Fischer, D.L. (2021). Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of … Continue reading

Typical regrowth brings hair back to where it was 1-3 years earlier, not to pre-hair-loss density. 

And what influences where you fall on that spectrum?

1. How long you’ve been losing hair: Earlier intervention = higher trendline. Long-standing bald spots rarely respond.^[9]Feldman, P.R., Gentile, P., Piwko, C., Motswaledi, H.M., Gorun, S., Pesachov, J., Markel, M., Silver, M., Brenkel, M., Feldman, O.J., Kamen, C.L., Uleryk, E., Guevara-Aguirre, J., Fiebig, K.M. … Continue reading 
2. Which therapy you use: Some are more effective at certain stages or patterns.
3. How consistent you are: Skipped doses or stopping early push results below the trendline.

Most patients should expect stabilization and modest regrowth. A small minority will experience “hyper-responsiveness,” but these rare outcomes should not set the benchmark. 

Principle #2: Poorly-Studied Treatments = More Variability In Results

When fewer studies exist on a treatment, expectations for hair regrowth become harder to pin down. With limited data, some patients may get spectacular results, while others see very little. But, without enough trials, it’s nearly impossible to know how common each outcome really is.

Take finasteride and oral dutasteride as examples. Finasteride has been tested in dozens of randomized controlled trials, which means we can say with high confidence what the average regrowth looks like and where most patients will land. Oral dutasteride, by contrast, has fewer high-quality studies. 

That doesn’t mean dutasteride is ineffective. In fact, the regrowth gains by dutasteride have often outperformed finasteride users. But it does mean the range of possible outcomes is wider, with more unpredictability between “great responders” and “minimal responders”. 

When it comes to understanding expectations for androgenic alopecia treatments, the normal distribution model helps clarify why individual results can be so different, even when clinical averages sound reassuring. Treatment outcomes typically form a bell-shaped curve rather than a single value, meaning people experience a range of responses. 

• Clinical averages, which are often cited in studies, represent the peak of this curve, not the experience of every patient. Most individuals see results somewhere near this average, but plenty fall above or below it.

• Wide curve (high variability, low evidence): When evidence for a treatment is limited or inconsistent, like with newer therapies, the curve is broad. Some may see fantastic regrowth, others very little, and outcomes are harder to predict. 
• Narrow curve (predictable outcomes, high evidence): For well-researched medications, the curve is tight. Most people’s results cluster close to the average, giving new patients more confidence in knowing what to expect.

Importantly, average never means “everyone”. Treatment outcomes often show a spread, so while clinical trials help set realistic expectations, individual journeys may differ depending on genetics, age, stage of hair loss, and treatment adherence. 

This variability also explains why anecdotes online can feel so misleading. When people share their results in forums, they’re often the outliers, the best or worst cases. On a scatterplot of individual datapoints, these stories sit at the edges. With dutasteride, the scatter is typically above the trendline, meaning a Reddit “success story” may be far removed from what most users should expect.

The rubric we can use to get a sense of whether our results will be predictable or variable is Evidence Quality.

Evidence Quality

Evidence quality answers the question “How reliable is the evidence that this intervention will actually help regrow my hair?” The strength of this evidence is determined not only by the number of studies available but also by their design, especially RCTs, which typically provide the most trustworthy evidence.

The concept of confidence in treatment outcomes can be likened to a game show in which money is hidden behind two doors. Behind door number 1, the amount of money behind it could be anywhere between $0 and $100. You might walk away with nothing, a little, or a lot, and there’s no way to know for sure, because there just isn’t enough evidence to narrow down the possibilities. 

With door number 2, the money behind it ranges tightly between $49 and $51. Because so many high-quality studies exist, you can be confident that your outcome will almost certainly fall within this narrow window, making it much easier to know what to expect.

More evidence means a smaller range and greater predictability; less evidence means more uncertainty and a wider range of possible outcomes.

Relating this back to oral dutasteride, the treatment has fewer published randomized controlled trials compared to finasteride. This means less outcome certainty, so patients considering dutasteride face a wider bell curve of potential results (as shown above), from exceptional regrowth to only minor improvement.

To summarize: 

• More and better studies = tighter confidence around the true average results
• Fewer studies = more uncertainty, a wider range of possible outcomes, and less ability to predict what will happen for any individual. 

Understanding the evidence quality of a treatment empowers patients to interpret clinical claims and anecdotal stories with a critical eye, helping them choose interventions with the best established track record and manage expectations where data is still emerging.  

Anecdotal Successes

In the world of hair loss drugs, Redditors and hair loss forums tend to overshare the best of what’s “possible”. 

Let’s have a look at 10 real-life anecdotal reports shared by Reddit users. 

It goes without saying that the experiences related below, including any before-and-after photos, are anonymously submitted by users and strictly represent their personal experiences. They are not considered medical evidence, nor should they be relied upon as medical advice. 

It should also be noted that some of these individuals used other treatments alongside dutasteride to assist in their hair regrowth journey. With combination treatments, it is not easy to see what’s causing the hair growth, so we need to be even more cautious about the success seen.

Case 1: 14-month course of oral dutasteride 0.5 mg daily

This 25-year-old male reported aggressive hair thinning between ages 19–21, which he reportedly stabilized with dutasteride monotherapy at 0.5mg/day. He had previously tried finasteride for about a year but did not report any visible regrowth. The patient described significant regrowth of previously thin hairs, with increased hair density compared to treatment start. He noted that there were no side effects throughout treatment. Notably, he mentioned that finasteride provided stabilization only, while dutasteride produced visible regrowth after one year of use. Other users also highlighted the greater potency and longer half-life of dutasteride compared to finasteride.

Case 2: 10-month course on dutasteride 0.5 mg and oral minoxidil 0.625 mg daily

A female individual (age unspecified) with diffuse thinning, especially around the parting, reported on her experience using dutasteride 0.5mg/day, along with oral minoxidil 0.625mg/day (which was scaled back from an initial dose of 1.25mg). Further into the treatment, she added topical minoxidil to her treatment stack. At the 10-month mark, she reported a significant increase in hair density compared to baseline, with notable thickening at the part line, as confirmed by the user-submitted photos. The user was delighted with her results and intends to decrease her dutasteride use to a maintenance dose eventually. 

Case 3: 10-month course on dutasteride 0.5 mg and oral minoxidil 5 mg daily

This report was from a 26-year-old male with clearly noticeable balding by age 20 and a family history of male pattern baldness, including his father and both grandfathers. The user’s protocol included oral dutasteride 0.5mg and oral minoxidil 5mg daily. The user noted heavy shedding in the first two months of treatment, with the first noticeable signs of improvement appearing at months 2-3, before achieving a successful outcome by month 10, when they reported marked hair thickening and a renewed sense of confidence and self-esteem. The user did not report any side effects from dutasteride, but linked minoxidil use to a mild increase in arm hair. It’s worth noting that the user’s physician had recommended he switch from his initial finasteride therapy to dutasteride due to their “aggressive” alopecia.

Case 4: 3.5 months on oral dutasteride 0.5 mg and minoxidil 5 mg daily

A 22-year-old male shared his experience using oral dutasteride (0.5mg/daily), oral minoxidil (5mg/daily), plus dermarolling (1.5mm/weekly) for 3.5 months. The user achieved significant increases in hair density and regrowth, a self-reported improvement in self-esteem, and no reported side effects, namely as to his libido and sexual function. He noted his consistent use and starting relatively early in the hair loss process as reasons for his favorable outcome. Additionally, he highlighted that he did not titrate up to his final doses but started the full protocol from day one.

Case 5: 6 months on dutasteride 0.5 mg (ed 1st month – 3x/wk) + microneedling 1.0 mm weekly

This male (23 y/o) used dutasteride at the dose of 0.5mg daily for the first month, then reduced to 0.5mg thrice weekly, along with microneedling 1.0mm once weekly, over the course of six months. The apparent results include hairline and temple regrowth, with the hair improving in thickness and health overall. The user did not report any side effects beyond bleeding associated with microneedling, noting that he began to notice changes within a month. In explaining his results, he also believed himself to be highly responsive to the treatment. 

Case 6: 2+ years on dutasteride 0.5 mg daily and sublingual minoxidil 0.9 mg – 2.7 mg daily

In this report, a 31-year-old male shared his results on a protocol of oral dutasteride (0.5mg daily) and sublingual minoxidil (gradually increased from 0.9mg to 2.7mg daily). While he started treatment with oral finasteride, he switched to dutasteride and sublingual minoxidil at the advice of his dermatologist. The users reported significant improvement after 3–4 months, with darker hair color and thickening of hair at the crown and mid-scalp. He added that most improvements came within 12 months, noting that he did experience any shedding with minimal side effects.

Case 7: 2 months on dutasteride 0.5 mg daily and oral minoxidil 2.5 mg daily

A 31-year-old male detailed his experience taking dutasteride 0.5mg daily alongside oral minoxidil following a series of unsuccessful treatments. He initially began with finasteride 1mg, which slowed hair loss but did not affect major regrowth. He then tried minoxidil and microneedling, before restarting finasteride and topical minoxidil alongside dermarolling. Upon switching to dutasteride, he noted major improvement in just two months, including achieving thicker hair and the disappearance of bald spots. The user reported no major side effects and noted supplementing his protocol with a daily multivitamin (Becadexamin) and a collagen supplement to support skin and hair.

Case 8: 3.5 months on dutasteride 0.5 mg daily and topical minoxidil 2x daily

A 24-year-old male reported significant improvement in hair density and coverage following 3.5 months of oral dutasteride 0.5mg/day and topical minoxidil (Rogaine) applied twice daily. The Redditor reported hair shedding, especially around the hairline, at month one. In the second half of the treatment period (months 2-3.5), however, he experienced accelerated hair regrowth with the appearance of a full head of hair. He was prescribed dutasteride directly (no prior finasteride use) and reported no major side effects as of the 3.5-month mark. 

Case 9: 1 year on dutasteride 0.5 mg daily and 10 years on topical minoxidil

This user (age 31) used daily dutasteride (Avodart 0.5mg) for one year in addition to ten years of consistent topical minoxidil use. He had previously used finasteride for two years with satisfactory results, stating that he could have achieved more regrowth by combining minoxidil with a DHT blocker. Following his switch from finasteride to dutasteride, he noted improvements in hair strength, libido increase, and clearer thinking. Months 3-8 were marked by shedding and brittle, weaker hair, with the patient considering switching back to finasteride. But after month 8, he saw thicker strands and mild regrowth. He also noted longer hair cycles, which now allow him to better maintain hair length. The user planned to continue with treatment and reevaluate at the two-year mark.

Case 10: 8 months on dutasteride 0.5 mg and 10 months on oral minoxidil 2.5 mg

This male user (29 y/o) undertook a protocol of oral dutasteride 0.5mg/day and oral minoxidil 0.5mg/day concurrently for eight months, with strong improvements in hair regrowth and thickness. He reported shedding at months 1-3 followed by regrowth starting at the 3-month mark. He observed increased hair density in the crown and temples from months 3 to 8, and noted major progress by month 10, with the crown nearly full, despite a persistent “M-shaped” hairline. The user reported no major side effects and plans to undergo a hair transplant, notwithstanding the favorable outcome. 

But these anecdotes are often far above the trendline, over “average” expectations.

Probable Regrowth Timeline for Oral Dutasteride

We have laid out a likely timeline for oral dutasteride treatment. However, this is based on four studies that we could find using oral dutasteride for hair loss, including one where it was used for frontal fibrosing alopecia.^[10]Tsunemi, Y., Irisawa, R., Yoshiie, H., Brotherton, B., Ito, H., Tsuboi, R., Kawashima, M., Manyak, M. (2016). Long-term safety and efficacy of dutasteride in the treatment of male patients with … Continue reading,^[11]Pindado-Ortega, C., Saceda-Corralo, D., Moreno-Arrones, O., Rodrigues-Barata, A.R., Hermosa-Gelbard, A., Jaen-Olasolo, P., Vano-Galvan, S. (2020). Effectiveness of Dutasteride in a Large Series of … Continue reading,^[12]Vano Galvan, S., Saceda-Corralo, D., Morena-Arrones, O.M., Rodrigues-Barata, R., Morales, C., Gil-Redondo, R., Bernardez-Guerra. C., Hermosa-Gelbard, A., Jaen-Olasolo, P. (2019). Effectiveness and … Continue reading,^[13]Harcha, W.G., Martinez, J.B., Tsai, T-F., Katsuoka, K., Kawashima, M., Tsuboi, R., Barnes, A., Ferron-Brady, G., Chetty, D. (2014). A randomized, active and placebo-controlled study of the efficacy … Continue reading

Month 0-3: No visible changes:

• Most studies note minimal to no observable regrowth in the first 3 months as dutasteride begins to reduce DHT levels, but hair follicles have not yet responded morphologically. 

Month 3-6: Early results seen:

• Clinical improvements in hair thickness and reduced shedding are often first noted from around month 3 onward.
• Quantitative hair count changes become statistically significant compared with placebo after 12 weeks; global photographic assessments begin to reflect mild positive change (~22-31% of subjects with slight/moderate increase at week 12).

Month 6-9: First cosmetic improvements:

• By 6-9 months, most patients exhibit visible improvement in hair density and coverage, with the peak initial response typically building upon earlier thickening. 
  • In a Japanese study, mean hair count increased significantly at 26 weeks and continued to improve at 52 weeks (68-87 hairs in a 2.54cm area).
  • Panel assessments at month 6 indicated ~75-85% of patients had some improvement in global photographs.

Months 9-15: Peak response period:

• Maximum regrowth and cosmetic benefits are typically observed within the first 12-15 months, based on clinical results.
  • “Marked improvement” rates ranged from 23-25% at 12 months with daily dosing in large cohorts. Median improvement in photographic rating scores and increases in terminal hair count continue through this period.
  • Sustained effects shown to persist up to 1 year in an open-label extension study.

Months 15-24: Maintenance phase: 

• Most patients maintain results with continued therapy, improvements plateau or slightly decline, but remain superior to baseline and other treatments.
  • Longer-term users (mean follow-up up to 17 months) show stabilization and ongoing maintenance with only rare further large gains.
  • Clinical improvement was seen in studies where doses ranged 3-7 capsules/week, with higher doses correlating to better maintenance and slightly higher efficacy.

Months 24-26: Possible plateau, limited data:

• Efficacy plateaus; possible mild regression or fluctuation, but proper adherence maintains gains for most patients. 
  • Real-world data of up to at least 24 months confirm sustainability in appropriately selected patients, especially at higher doses.
  • No long-term studies exceed 36 months, so late-stage trends remain speculative.

But what about all the success stories we see online, users on Reddit or other forums who have experienced dramatic hair regrowth?

Well, this difference usually stems from a phenomenon called survivorship bias. 

What is Survivorship Bias?

• Survivorship bias happens when the accounts you see are not representative of all experiences but are disproportionately skewed toward the most remarkable, positive cases.^[14]Rao, T. (2024). Understanding Survivorship Bias: Implications for Research and Decision-Making. Journal of Emerging Technologies and Innovative Research, 11(6). JETIR2406276
• People with extreme positive results are much more likely to post about their experiences, eager to share their success.
• In contrast, those who experience average or mediocre outcomes (which is the majority) rarely feel motivated to post.
• As a result, the outcomes you typically see online are samples from the tails of the bell curve: exceptional or very poor cases, not the “center” or average results.

Clinical Trial vs. Online Reports

• Clinical trials measure average results across a large, diverse population, using objective metrics.
• Online reports are anecdotal and self-selected. Because impressive transformations are inspiring, these are far more likely to be posted and shared.
• This dynamic can mislead readers into believing that dramatic regrowth is almost guaranteed, when in reality it is just one possibility among many, and not the most probable outcome.

Combining Treatments: Narrowing the Curve

While oral dutasteride is one of the most effective monotherapies for AGA, if you want to increase your odds of good results, combining it with additional therapies can have a dramatic impact. 

Studies have shown that adding minoxidil to dutasteride can further improve regrowth outcomes, leveraging the vasodilatory and follicle-activating effects of minoxidil, alongside DHT suppression from dutasteride.^[15]Obeid, M.N.A., Fattah, N.S. A., Elfangary, M.M., Al Husseni, R.M. (2024). Comparison between topical minoxidil 5% alone versus combined with dutasteride (topical 0.02% through microneedling or oral … Continue reading

Furthermore, adding low-dose dutasteride to ongoing finasteride therapy in patients with suboptimal response resulted in a dramatic increase in hair density, suggesting that combined therapy can be beneficial for those not fully responding to finasteride alone.^[16]Boyapati, A., Sinclair, R. (2013). Combination therapy with finasteride and low-dose dutasteride in the treatment of androgenetic alopecia. Australasian Journal of Dermatology. 54(1). 49-51. … Continue reading 

Going back to the bell curves, more modalities = less variability. By targeting different mechanisms (like minoxidil) or by targeting more types of 5-alpha-reductase (like in the finasteride study), outcomes become less dependent on any single pathway. This leads to more predictable, less variable results across a wider patient group.^[17]Mysore, V., Kumaresan, M., Dashore, S., Venkatram, A. (2023). Combination and rotational therapy in androgenetic alopecia. Journal of Cutaneous and Aesthetic Surgery. 16(2). 71-80. Available at: … Continue reading 

How Can I Maintain “Realistic Expectations”?

To keep realistic expectations on oral dutasteride for hair regrowth, it’s critical to understand both the typical timelines and the nature of outcome variability:

What does “realistic” mean?

• Realistic does not mean pessimistic: Most users will benefit, but responses vary between individuals. A realistic expectation is based on clinical averages, not the best or worst case.
• Don’t expect to be “cured” of your hair regrowth. Most treatments “rewind the clock” a certain amount. Oral dutasteride may reverse hair loss by 6-24 months on average. However, dramatic multi-year regrowth is much less common, possible but not probable for most users.
• Your most probable result is noticeable improvement and stabilization, rather than full reversal of all past hair loss. 

Practical Takeaways

• Be patient: Oral dutasteride takes time – most users don’t see meaningful change until at least 6 months in, with optimal results often peaking around 12-15 months. 

• Track your own progress: Use consistent photos or, ideally, hair counts in a fixed area to monitor changes. Comparing to internet success stories often skews expectations and reflects outliers rather than the norm.

• Define success on your own terms: For some, success means stopping hair loss. For others, it’s regaining density. Know what you’re aiming for and adjust expectations accordingly. 

• Consider combination treatments: Pairing dutasteride with therapies like minoxidil or microneedling may improve outcomes and reduce variability, especially if you’re not seeing early improvements. 

• Use clinical data to ground your expectations: Clinical trials give you an average expectation, not a guarantee. Use online anecdotes as inspiration, not prediction.

Final Thoughts

Your expectations for any hair loss treatment, even oral dutasteride, should rest on two key pillars:  regrowth potential x evidence quality.

Together, they shape your position on the “bell curve” of likely outcomes.

• If you’re early in your hair loss journey, consistently take the medication, and possibly combine it with other therapies, you’re more likely to end up closer to the favorable side of the curve.
• If your hair loss is advanced or you’ve tried many options before, you might fall closer to the average or lower end.

Either way, understanding that most people land somewhere near the middle of the curve, not at the extremes, helps you avoid frustration and stay committed.

Setting expectations isn’t about limiting hope or being overly pessimistic; it’s about anchoring your treatment outcomes to reality, so you can make better, more sustainable decisions about your treatment journey.