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Dutasteride is one of the most powerful pharmacologic treatments for androgenic alopecia (AGA). Initially approved for benign prostatic hyperplasia, dutasteride is now commonly prescribed off-label for hair loss in men and, more recently, has gained attention in topical form to minimize systemic exposure. This has created an important clinical question: how do oral and topical dutasteride compare in terms of effectiveness, safety, and real-world practicality?

This article examines what the current scientific literature reveals about oral versus topical dutasteride, reviewing mechanisms of action, efficacy data, and safety profiles to help you make more informed treatment decisions.

Dutasteride Mechanism of Action and Formulations

AGA is driven by increases in dihydrotestosterone (DHT). DHT binds to androgen receptors in hair follicles, triggering miniaturization that leads to thinner, shorter hairs. Dutasteride works by inhibiting an enzyme called 5α-reductase (5AR), which converts testosterone into DHT. Dutasteride is a dual 5AR inhibitor, meaning it blocks both type I and type II 5AR, leading to decreased DHT levels and ultimately halting the progression of AGA and restoring thicker hair.^[1]Gerst, C., Dalko, M., Pichaud, P., Galey, J. B., Buan, B., & Bernard, B. A. (2002). Type-1 steroid 5α-reductase is functionally active in the hair follicle as evidenced by new selective … Continue reading,^[2]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 … Continue reading

Oral Dutasteride – Mechanism and Formulations

Oral dutasteride is absorbed through the gastrointestinal tract into systemic circulation, leading to significant and sustained reductions in DHT in the blood (serum). This includes reductions in scalp DHT, since less DHT is available systemically to diffuse into hair follicles.^[4]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 … Continue reading,^[5]Olsen, E. A., Hordinsky, M., Whiting, D., Stough, D., Hobbs, S., Ellis, M. L., Wilson, T., Rittmaster, R. S., & Dutasteride Alopecia Research Team. (2006). The importance of dual 5α-reductase … Continue reading

The flip side is that any symptoms tied to systemic DHT suppression, such as sexual side-effects,  are driven by this same mechanism. Given the long half-life and accumulation, systemic exposure persists even if doses are missed or therapy is stopped, and any adverse effects may take weeks to resolve.^[6]Tsai, T.-F., Choi, G. S., Kim, B. J., Kim, M.-B., Ng, C. F., Kochhar, P., Jasper, S., Brotherton, B., Orban, B., & Lulic, Z. (2018). Prospective randomized study of sexual function in men taking … Continue reading

Topical Dutasteride – Mechanism and Formulations

Topical dutasteride treatment might avoid some of these pitfalls: high exposure at the scalp and low exposure elsewhere can target delivery and avoid systemic issues. It is applied directly to the scalp in formulations such as:

• Simple solutions (often alcohol- or glycol-based)
• Gels or lotions
• Liposomal formulations
• Nanoemulsions and nanoemulgels
• Nanocrystalline and other particulate systems

These vehicles are designed to ensure that dutasteride can cross the stratum corneum (the outermost protective layer of the skin) and, ideally, remain localized within the scalp.

What is the Available Evidence for Oral Dutasteride?

The effect of dutasteride on hair loss is well documented: multiple randomized placebo-controlled studies have been conducted over the last 25 years. Dutasteride was first developed as a treatment for benign prostatic hyperplasia and taken as a tablet. Early studies into dutasteride for hair loss therefore used oral formulations, with topical treatments developed later.

Here, we’ll take a look at the evidence supporting the use of oral dutasteride for hair loss. Many studies compare dutasteride with other treatments, most notably finasteride, or use the drug in combination with other therapies. We’ll focus on data showing the effect of dutasteride alone compared to placebo, but will also touch on comparisons with other popular treatments. 

Below is a summary of the findings to date on the safety and efficacy of oral dutasteride:

	Study Design and Population	Treatments and Concentrations (Daily)	Hair Growth Outcomes	Systemic Effects
Study #1[7]Olsen, E. A., Hordinsky, M., Whiting, D., Stough, D., Hobbs, S., Ellis, M. L., Wilson, T., Rittmaster, R. S., & Dutasteride Alopecia Research Team. (2006). The importance of dual 5α-reductase … Continue reading	Randomized, placebo-controlled, double-blinded trial. 415 men with male pattern hair loss aged 21-45 years old; 24 weeks.	0.05, 0.1, 0.5, or 2.5 mg dutasteride; 5 mg finasteride.	Dose-dependent increase in total hair count vs placebo. Improved hair count vs finasteride.	Serum decrease in DHT level (92% at 0.5 mg).
Study #2[8]Stough, D. (2007). Dutasteride improves male pattern hair loss in a randomized study in identical twins. *Journal of Cosmetic Dermatology.* 6(1). 9–13. Available at: … Continue reading	Randomized, placebo-controlled, double-blinded trial. 17 pairs of identical twin males with AGA; 12 months.	0.5 mg dutasteride.	Significant increase in total hair counts in dutasteride-treated twins.	Not assessed.
Study #3[9]Eun, H. C., Kwon, O. S., Yeon, J. H., Shin, H. S., Kim, B. Y., Ro, B. I., Cho, H. K., et al. (2010). Efficacy, safety, and tolerability of dutasteride 0.5 mg once daily in male patients with male … Continue reading	Randomized, placebo-controlled, double-blinded trial. 153 men with male pattern hair loss aged 18-49; 6 months	0.5 mg dutasteride.	Significant increase in total hair count.	Sexual dysfunction was reported in 4.1% of the treatment group and 2.7% of placebo (not statistically significant).
Study #4[10]Harcha, W. G., Barboza Martínez, J., Tsai, T.-F., Katsuoka, K., Kawashima, M., Tsuboi, R., Barnes, A., Ferron-Brady, G., & Chetty, D. (2014). A randomized, active- and placebo-controlled study … Continue reading	Randomized, placebo-controlled, double-blinded trial. 917 men with AGA aged 20-50; 24 weeks.	0.02, 0.1, or 0.5 mg dutasteride; 1 mg  finasteride	Increase in terminal hair count and width vs placebo. Significant increase in hair width vs dutasteride.	No significant changes in reported adverse events.
Study #5[11]Tsunemi, Y., Irisawa, R., Yoshiie, H., Brotherton, B., Ito, H., Tsuboi, R., Kawashima, M., Manyak, M., & ARI114264 Study Group. (2016). Long-term safety and efficacy of dutasteride in the … Continue reading	Open-label, prospective study, no control. 120 men with AGA aged 20-50; 52 weeks.	0.5 mg dutasteride.	Increase in terminal hair count and hair width compared to baseline.	12% of men experienced libido decrease and impotence, of which 50% and 57%, respectively, were not resolved by the end of the study.
Study #6[12]Shanshanwal, S. J., & 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	Open-label, randomized study; no placebo control. 90 men with AGA aged 18-40; 24 weeks.	0.5 mg dutasteride or 1 mg finasteride.	Increase in total hair count and width compared to baseline. Increase in total hair count was significantly higher in dutasteride than finasteride group.	Erectile dysfunction and loss of libido reported in 3 and 4 patients respectively.
Study #7[13]Tsai, T.-F., Choi, G. S., Kim, B. J., Kim, M.-B., Ng, C. F., Kochhar, P., Jasper, S., Brotherton, B., Orban, B., & Lulic, Z. (2018). Prospective randomized study of sexual function in men taking … Continue reading	Randomized, placebo-controlled, double-blinded trial. 117 men with AGA aged 23-50; 24 weeks.	0.5 mg dutasteride.	Not assessed.	Incidence of sexual adverse events was approximately double in the dutasteride group (16% vs 8% in placebo).
Study #8[14]Choi, G.-S., Sim, W.-Y., Kang, H., Huh, C. H., Lee, Y. W., Shantakumar, S., Ho, Y.-F., et al. (2022). Long-term effectiveness and safety of dutasteride versus finasteride in patients with male … Continue reading	Retrospective chart review. 600 men over 18 with AGA.	0.5 mg dutasteride or 1 mg finasteride.	Greater improvements in BASP classifications of AGA compared to baseline were found in dutasteride vs finasteride.	Incidence of adverse events was higher in finasteride group (10.5%) than in dutasteride group (7.6%).

What is the Available Evidence for Topical Dutasteride?

While evidence for the efficacy of oral dutasteride is well established, research into topical dutasteride solutions started relatively recently. Below is an overview of the studies into the efficacy of topical dutasteride:

	Study Design and Population	Treatments and Concentrations (Daily)	Hair Growth Outcomes	Systemic Effects
Study #1[15]Sánchez-Meza, E., Ocampo-Candiani, J., Gómez-Flores, M., Herz-Ruelas, M. E., Ocampo-Garza, J., Orizaga-y-Quiroga, T. L., Martínez-Moreno, A., & Ocampo-Garza, S. S. (2022). Microneedling plus … Continue reading	Randomized, placebo-controlled, double-blinded trial. 34 men with AGA aged 18-65; 20 weeks.	Microneedling with 0.01% dutasteride solution. Placebo was microneedling with saline solution.	Significant improvements in hair thickness, hair density, and vellous: terminal hair ratio.	Not assessed.
Study #2[16]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 … Continue reading	Randomized, placebo-controlled, double-blinded trial. 135 adult males aged 20-60 with AGA; 24 weeks.	0.01%, 0.02%, or 0.05% topical dutasteride; 1mg oral dutasteride	Dose-dependent increase in total hair count and hair width. 0.05% solution showed significant improvement over finasteride in total hair count.	No change in serum DHT levels observed vs placebo.

How Does Oral and Topical Dutasteride Stack Up Against Each Other?

When comparing oral and topical dutasteride, the most important point to note is that there are currently no published clinical trials directly comparing the two formulations alone head-to-head for AGA. All comparisons must be made indirectly, using separate studies with different designs, populations, timelines, and formulations.

What About the Quality of the Available Evidence?

Despite this limitation, the evidence available for each formulation allows us to evaluate its strength and predictability. The current evidence quality for each formulation is as follows:

• Oral dutasteride — 59/100
• Topical dutasteride — 55/100

By our metrics, this means that both treatments have similar evidence quality overall. Longer-term data support oral dutasteride, while topical dutasteride remains less validated, largely due to fewer studies and limited long-term follow-up.

We’ll take a closer look at the strength of the evidence supporting both formulations.

Oral Dutasteride Studies

Oral dutasteride can reduce serum DHT levels by up to 90% and scalp DHT levels by 51-79%.^[17]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 … Continue reading,^[18]Olsen, E. A., Hordinsky, M., Whiting, D., Stough, D., Hobbs, S., Ellis, M. L., Wilson, T., Rittmaster, R. S., & Dutasteride Alopecia Research Team. (2006). The importance of dual 5α-reductase … Continue reading Randomized controlled trials consistently demonstrate that dutasteride, particularly at the standard 0.5 mg daily dose, suppresses serum and scalp DHT and delivers some of the most robust regrowth outcomes documented for AGA. 

A number of the studies outlined above include large sample sizes, often over 100 participants, with the largest including over 900.^[19]Harcha, W. G., Barboza Martínez, J., Tsai, T.-F., Katsuoka, K., Kawashima, M., Tsuboi, R., Barnes, A., Ferron-Brady, G., & Chetty, D. (2014). A randomized, active- and placebo-controlled study … Continue reading Importantly, these cohorts should be large enough to detect changes in the incidence of adverse events, even if they are relatively rare. The replication of results in multiple trials using similar endpoints is a strong indicator of the efficacy of the drug. 

Unfortunately, the longest of these RCTs only lasted 6 months, which may mean that lasting impacts on growth are overlooked. Similarly, side effects associated with long-term use over many years may be missed. 

We can turn to longer studies using finasteride for some indication of how sustained benefits may be, given the similar mechanism of action of the two treatments. A 3-year trials using 1 mg daily doses of finasteride showed sustained improvement in hair growth over the course of the study, while placebo groups saw decreased hair counts.^[20]Price, V. H., Menefee, E., Sanchez, M., & Kaufman, K. D. (2006). Changes in hair weight in men with androgenetic alopecia after treatment with finasteride (1 mg daily): three- and 4-year results. … Continue reading

 A 10-year follow-up study concluded that improvements in hair growth, as determined by expert analysis of hair photographs, from finasteride do not worsen over time, and in 21% of cases, hair growth got even better after 5 years of treatment.^[21]Rossi, A., Cantisani, C., Scarnò, M., Trucchia, A., Fortuna, M. C., & Calvieri, S. (2011). Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year … Continue reading

While we can’t draw any firm conclusions about the long-term efficacy of dutasteride from studies using finasteride, these findings can indicate the impact of long-term inhibition of 5AR, which is also seen in dutasteride treatment.

Topical Dutasteride Studies

Evidence for topical dutasteride is promising but remains less mature. Early clinical research indicates that topical formulations can meaningfully improve hair density, hair shaft diameter, and overall investigator-assessed regrowth, with efficacy in trials approaching that of oral therapy. 

One small study with only 34 participants showed significant improvements in hair growth and thickness when combined with microneedling, compared to microneedling alone. Another study combined dutasteride formulations with minoxidil and also found that topical dutasteride delivered via microneedling produced hair density and thickness improvements similar to oral dutasteride, with fewer systemic side effects.^[22]Sánchez-Meza, E., Ocampo-Candiani, J., Gómez-Flores, M., Herz-Ruelas, M. E., Ocampo-Garza, J., Orizaga-y-Quiroga, T. L., Martínez-Moreno, A., & Ocampo-Garza, S. S. (2022). Microneedling plus … Continue reading,^[23]Abu Obeid, M. N., Abdel Fattah, N. S., Elfangary, M. M., & Al Husseni, R. M. (2024). Comparison between topical minoxidil 5% alone versus combined with dutasteride (topical 0.02% through … Continue reading

A recently published Phase II trial, the first to test topical dutasteride without microneedling, reported that all concentrations improved hair growth versus placebo, produced minimal changes in serum DHT, and that 1 ml daily of 0.05% appeared to outperform oral finasteride. However, concerns about unusually high baseline hair counts and inconsistencies in the placement and size of the 1 cm² target areas used for hair measurements raise questions about the reliability of these results.^[24]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 … Continue reading

Real-world outcomes from low-dose topical dutasteride users (0.01–0.02% applied daily or near-daily) suggest more modest benefits, with good scalp localization and stable serum DHT noted as positives, rather than regrowth exceeding that with oral finasteride.

There have been some concerns raised about the ability of dutasteride to penetrate into the scalp. Dutasteride is a relatively large molecule, with one molecule weighing 528.5 Daltons (Da). There is a commonly cited rule, called the 500 Dalton Rule, that states that molecules should be under 500 Da in order to penetrate the skin. However, dutasteride has been demonstrated to be effective in topical formulations and can measurably lower DHT concentrations. What’s more, a small, unpublished study has also shown that the drug does penetrate into both the scalp and serum, even at low concentrations. As such, in this case, dutasteride does seem to penetrate the skin in the scalp, without the need for microneedling or injection.

How Safe are Dutasteride Formulations?

Because dutasteride produces sustained suppression of DHT, safety considerations, particularly regarding hormonal and sexual side effects, are central to treatment selection. Most clinical trials record adverse events, while some studies are focused specifically on side-effects.^[26]Tsai, T.-F., Choi, G. S., Kim, B. J., Kim, M.-B., Ng, C. F., Kochhar, P., Jasper, S., Brotherton, B., Orban, B., & Lulic, Z. (2018). Prospective randomized study of sexual function in men taking … Continue reading

Oral Dutasteride

Across randomized trials and long-term observational studies, the most consistently reported adverse effects of oral dutasteride involve sexual function, including:

• Decreased libido
• Erectile dysfunction
• Ejaculation disorders
• Gynecomastia and breast tenderness (rare)

Trials report overall total adverse event rates between 4 and 12%, with sexual adverse events such as decreased libido as high as 13%, although this was reported in higher doses (2.5mg daily).^[27]Olsen, E. A., Hordinsky, M., Whiting, D., Stough, D., Hobbs, S., Ellis, M. L., Wilson, T., Rittmaster, R. S., & Dutasteride Alopecia Research Team. (2006). The importance of dual 5α-reductase … Continue reading At the standard 0.5mg daily dose, sexual side effects typically occur at a rate of between 1 and 5%. In the context of other popular treatments, comparisons with finasteride show no consistent increase in sexual side effects with dutasteride, despite dutasteride lowering serum DHT by an additional 20-30% beyond finasteride.^[28]Harcha, W. G., Barboza Martínez, J., Tsai, T.-F., Katsuoka, K., Kawashima, M., Tsuboi, R., Barnes, A., Ferron-Brady, G., & Chetty, D. (2014). A randomized, active- and placebo-controlled study … Continue reading

Most controlled studies show that the majority of sexual side effects resolve either during treatment or after discontinuation. However, due to dutasteride’s long half-life (4-5 weeks) and high tissue binding, systemic effects can persist. At standard 0.5mg daily dosing, serum DHT generally returns to 80% of baseline within 6 months of discontinuation.

Topical Dutasteride

Topical dutasteride is generally well tolerated, and reported adverse events are usually mild and localized, including:

• Scalp irritation
• Erythema
• Contact dermatitis
• Pruritus or dryness

These occur inconsistently and are formulation-dependent, influenced by solvent systems, penetration enhancers, and application volume.

The primary safety advantage of topical dutasteride is reduced systemic exposure. In trials, topical regimens in the 0.01–0.05% range produce minimal or no significant changes in serum DHT or testosterone.^[29]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 … Continue reading When decreases in serum DHT are observed with topical use, they are generally smaller than those seen with oral dosing.^[30]Abu Obeid, M. N., Abdel Fattah, N. S., Elfangary, M. M., & Al Husseni, R. M. (2024). Comparison between topical minoxidil 5% alone versus combined with dutasteride (topical 0.02% through … Continue reading

Adherence and Practical Considerations

Dutasteride, whether oral or topical, is primarily used for AGA in men, though its use for hair loss remains off-label in the United States. Oral dutasteride is formally FDA-approved only for benign prostatic hyperplasia, while topical formulations exist solely through compounding pharmacies.

Adherence and Route of Application

Oral dutasteride offers the simplest adherence burden: one capsule daily (or a modified intermittent schedule). This ease is a major factor behind its consistent outcomes. Topical dutasteride, while potentially safer from a systemic standpoint, requires regular scalp application and attention to dosing volume. 

The effectiveness of topical formulations is heavily influenced by factors such as vehicle, scalp contact time, treated surface area, and individual skin permeability. These practical considerations can meaningfully shape both efficacy and systemic absorption.

Advanced vehicles such as nanoemulsions or nanoemulgels can increase scalp penetration by up to 1.5-fold compared to conventional solutions.^[31]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. … Continue reading However, this may also increase systemic exposure. Application frequency can be adjusted to balance efficacy and hormonal safety. Because dutasteride binds to 5AR for prolonged periods, daily application is not always necessary.

Time on the scalp also matters. The longer a topical formulation remains in contact with the skin, the more dutasteride can penetrate the follicle. Most protocols recommend allowing at least four hours before washing the hair. Rinsing too soon can reduce efficacy, while prolonged contact increases both potency and the possibility of systemic absorption.

The size of the application area affects systemic exposure. Treating a small region, such as the crown, introduces less drug into circulation than applying the same concentration across the entire scalp. Patients with diffuse thinning often benefit from using lower volumes or concentrations to counterbalance the increased surface area.

As we can see, there is a wide range of factors to consider when making a treatment plan with topical dutasteride, which may make consistent application a challenge.

Use in Women

Off-label use of dutasteride in women is limited and generally reserved for postmenopausal women or women with documented hyperandrogenism or a strong family history of AGA. Due to the systemic androgenic impacts of the drug, it’s typically only used in cases where other therapies (minoxidil, spironolactone) are inadequate.

Clinical Interpretation and Decision-Making

The key trade-off between oral and topical formulations is systemic potency versus localized targeting, balanced against differences in side-effect risk, convenience, and cost. Oral therapy is simpler and less variable; topical therapy requires consistent application but offers greater hormonal safety for risk-averse patients.

Combination therapy, most commonly topical dutasteride with minoxidil, can enhance outcomes through complementary mechanisms. Oral dutasteride may also be paired with topical agents in some cases.

Significant research gaps remain, including the absence of direct head-to-head oral-versus-topical trials, limited long-term safety data for topical dutasteride, and the lack of standardized dosing guidelines for topical formulations.

Final Thoughts

Dutasteride, whether oral or topical, represents one of the most powerful tools currently available for treating AGA. Oral dutasteride offers the most consistent and robust regrowth outcomes, supported by the strongest body of clinical evidence, but with predictable systemic hormonal suppression and long persistence after discontinuation.

Topical dutasteride, while still supported by a smaller and newer evidence base, offers a compelling alternative for patients seeking meaningful scalp-level efficacy with reduced systemic exposure. Its ultimate success depends heavily on formulation quality, dosing strategy, and adherence.

There is no universally “best” option: only the best option for specific circumstances. Treatment selection should be guided by hair-loss severity, prior treatment response, risk tolerance, reproductive plans, and long-term adherence capacity. As research continues to evolve, clinical guidance will become more precise. For now, optimal results come from choosing the formulation that best aligns with your goals and comfort with risk.

Minoxidil is a medication that began as a treatment for hypertension (high blood pressure). However, after observing excess hair growth during the testing stages of the drug, minoxidil was repurposed as a treatment for hair loss. Topical minoxidil soon received FDA approval for the treatment of both male and female pattern hair loss, while oral minoxidil is also used as an off-label treatment for hair loss.^[1]Suchonwanit, P., Thammarucha, S., & Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug design, development and therapy. 2777-2786. Available at: … Continue reading

So, if minoxidil is a treatment for hair loss, why does it cause an increase in hair loss when you start using it? Yes, you did read that right – minoxidil can actually cause an increase in hair loss as part of what is often called the ‘dread shed.’ This phenomenon was demonstrated in a retrospective study of 435 patients with androgenic alopecia (AGA) who were prescribed low-dose oral minoxidil [≤5 mg per day] by the same clinic. Self-reported adverse events were recorded for each of the users and, of the 435 patients, 32% experienced increased hair shedding.^[2]Sanabria, B., de Nardo Vanzela, T., Miot, H. A., & Ramos, P. M. (2021). Adverse effects of low-dose oral minoxidil for androgenetic alopecia in 435 patients. Journal of the American Academy of … Continue reading

This is evidently cause for concern – if you have just started minoxidil treatment to prevent hair loss, a sudden increase in hair loss is possibly the last thing you would hope and expect to experience. So what is it about minoxidil that causes this to happen, how long does it usually last, and is it actually a good thing? In this article, we will explore the hair cycle and minoxidil in detail to provide answers to each of these questions.

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The Hair Cycle

To understand why minoxidil can increase hair shedding, let’s first take a refresher on the hair cycle. Our hair is constantly going through a cycle of growing (anagen), regression and transition (catagen), resting (telogen), and shedding (exogen), which it repeats continuously. 

Healthy hairs grow for anywhere between 2 and 8 years, and there is a correlation between the length and strength of a hair and the time spent in anagen. Catagen is the transition from anagen to telogen, a period of approximately 2 weeks during which the follicle regresses from the hair shaft and disconnects it from the blood supply, preventing any further growth. Telogen follows and lasts for 2-3 months, with a new hair shaft beginning to develop at the base of the follicle underneath the now resting hair shaft. Exogen then represents the transition from telogen to anagen, with the growing hair shaft pushing out the old hair shaft.^[3]Natarelli, N., Gahoonia, N., & Sivamani, R. K. (2023). Integrative and mechanistic approach to the hair growth cycle and hair loss. Journal of clinical medicine. 12(3). 893. Available at: … Continue reading 

In the healthy scalp, the percentage of hairs in each of the hair cycle stages is thought to remain fairly consistent. At any one time, evidence suggests that approximately 9% of the hairs on a healthy scalp are in the telogen phase (although there are some suggestions that this figure may actually be too high).^[4]Natarelli, N., Gahoonia, N., & Sivamani, R. K. (2023). Integrative and mechanistic approach to the hair growth cycle and hair loss. Journal of clinical medicine. 12(3). 893. Available at: … Continue reading These hairs exist in a largely asynchronous fashion, with hair follicles progressing through the hair cycle according to their own unique pattern. Hair follicles undergo between 10 and 30 full cycles, and it is normal for up to 150 hairs to fall out per day without there being an underlying hair loss problem, as the hairs are constantly being replaced.^[5]Bergfeld, W. (2009). Diffuse hair loss: its triggers and management. Cleve Clin J Med. 76(6). 361-370. Available at: https://doi.org/10.3949/ccjm.76a.08080 This keeps hair fall relatively consistent, preventing periods of significant hair shedding.

What Happens to the Hair Cycle during AGA?

AGA, the hair loss condition for which topical minoxidil is an approved treatment, is caused by damage to the hair follicle that contributes to its miniaturization. This is when individual strands of hair become smaller and smaller over time, eventually becoming vellus hairs that are shorter, thinner, and more white, which makes them difficult to see. We have a previous article that explores AGA-induced hair loss in great detail, but let’s summarize the key characteristics below:

• Perifollicular fibrosis – collagen deposition in the spaces around the hair follicles restricts the room within which hair shafts are able to grow, acting as a physical barrier to hair growth.
• Increased telogen:anagen ratio – healthy scalps typically have 1 telogen hair for every 12 anagen hairs (1:12 telogen:anagen), but people with AGA may exhibit ratios that are as high as 1:4 or even 2:5. The telogen phase also lengthens, with hairs spending longer in a state of non-growth.
• Shortened anagen phase – as previously mentioned, the length of an anagen phase directly corresponds to the length of the eventual hair shaft, and people with AGA typically exhibit anagen phases that become shorter with every hair cycle.

Although the exact mechanisms underlying AGA are yet to be fully understood, it is evident that AGA is a progressive and cumulative process that occurs due to harmful factors damaging the hair follicle and shortening the anagen phase.

How Minoxidil Works

Minoxidil is also yet to be fully understood, but several mechanisms have been suggested that could explain how it reduces hair loss:

• Vasodilation – Minoxidil started out as a treatment for hypertension, so its function as a vasodilator is well documented. Studies have shown that minoxidil increases blood flow by opening potassium channels, reducing high blood pressure. However, an unintended benefit of this function is increased blood flow to the hair follicles, providing them with nutrients and oxygen that help to prolong the anagen phase.^[7]Messenger, A. G., & Rundegren, J. (2004). Minoxidil: mechanisms of action on hair growth. British journal of dermatology. 150(2). 186-194. Available at: … Continue reading
• Prostaglandin mediation – Minoxidil has been shown to increase the production of prostaglandin E2 (PGE2) in cultured human dermal papilla fibroblasts, the specialized cells that sit at the base of the hair follicle. It is thought that PGE2 may protect hair follicles from damage.^[8]Michelet, J. F., Commo, S., Billoni, N., Mahé, Y. F., & Bernard, B. A. (1997). Activation of cytoprotective prostaglandin synthase-1 by minoxidil as a possible explanation for its hair … Continue reading
• Growth factor mediation – Studies have shown that minoxidil has the potential to upregulate the expression of several growth factors that support hair growth, including vascular endothelial growth factor in human dermal papilla cells.^[9]Lachgar, Charveron, Gall, & Bonafe. (1998). Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells. British Journal of Dermatology. 138(3). … Continue reading

It is likely that minoxidil reduces hair loss through a combination of several mechanisms, including those noted above and perhaps others that are yet to be discovered.

How Might Minoxidil Cause the Dread Shed?

So, we know the basics of the hair cycle, some of the mechanisms that contribute to pattern hair loss, and some of the mechanisms by which minoxidil may reduce hair loss. But what does all this have to do with the ‘dread shed ’? Fortunately, observing the effects of minoxidil is more straightforward than trying to understand how it works, and there is one key effect which is believed to contribute to the increase in shedding: shortening of the telogen phase.

As we previously discussed, a key characteristic of AGA is lengthening of the telogen phase, which causes an abnormal amount of scalp hair to be in a state of arrested growth at the same time. It is widely believed that minoxidil directly addresses this issue by both shortening the telogen phase and accelerating the telogen to anagen transition. In one study,  application of topical minoxidil to rats caused a dramatic shortening of the telogen phase, falling from 20 days to just 1-2 days.^[10]Mori, O., & Uno, H. (1990). The effect of topical minoxidil on hair follicular cycles of rats. The Journal of dermatology. 17(5). 276-281. Available at: … Continue reading In a separate study that was also conducted in rats, topical minoxidil caused a significant switch from the telogen to anagen phase as quickly as 10 days after beginning treatment (Figure 2).^[11]Shatalebi, M. A., & Rafiei, Y. (2014). Preparation and evaluation of minoxidil foamable emu oil emulsion. Research in pharmaceutical sciences. 9(2). 123-133. Available at: … Continue reading

We could only find one clinical study that has investigated the telogen-anagen shift in humans at an early stage after beginning minoxidil use. They conducted a 24-week trial in which men with AGA either applied topical minoxidil [5%] or topical cetirizine for the first 16 weeks, then stopped use for 8 weeks. Although the results were not statistically significant, they showed that minoxidil caused an increase in the percentage of anagen hair and a decrease in the percentage of telogen hair, supporting the idea that minoxidil rapidly induces shortening of the telogen phase.^[13]Mostafa, D. H., Samadi, A., Niknam, S., Nasrollahi, S. A., Guishard, A., & Firooz, A. (2021). Efficacy of cetirizine 1% versus minoxidil 5% topical solution in the treatment of male alopecia: a … Continue reading

In accelerating the telogen to anagen transition, minoxidil also causes “hair follicle synchronization” or synchronization of the hair cycle. As we highlighted earlier, healthy scalps are somewhat ‘protected’ from significant hair shedding events due to the asynchronous nature of the hairs and their individual hair cycles. However, due to the increased density of telogen follicles in the AGA-affected scalp, minoxidil causes a greater-than-normal percentage of hairs to enter anagen at the same time. This syncing of the hair cycles then results in more hairs being pushed out at the same time.

So, to summarize the process that is believed to be the key factor behind the dread shed:

• In AGA, a greater number of hair follicles are in telogen
• Minoxidil treatment accelerates the transition of these hair follicles from telogen to anagen and causes many follicular units to become synchronized
• The transition leads to initiation of the shedding phase (exogen)
• Increased hair shedding occurs

Is The ‘Dread Shed’ Real?

Until very recently, evidence of minoxidil-induced hair shedding was either anecdotal or provided by studies of minoxidil in which increased hair shedding was noted as an adverse event. However, a newly published study sought to investigate the shedding phase in detail.

In this 2025 study, 49 patients with AGA used topical minoxidil [2% or 5%] for 24 weeks. Total hair shedding was quantified daily by the participants, who self-assessed their hair fall after combing, after washing, and on the pillow after sleeping. This was then averaged every 4 weeks and compared to the level of hair shedding prior to starting treatment. They found that the participants who used 5% minoxidil exhibited increased hair shedding (relative to pre-treatment) for 4-8 weeks, while the participants who used 2% minoxidil exhibited increased shedding for 8-12 weeks (Figure 2).^[14]Bi, L., Kan, H., Wang, J., Ding, Y., Huang, Y., Wang, C., Du, Y., Lu, C., Zhao, M., Sun, W. & Su, T. (2025). Whether the transient hair shedding phase exist after minoxidil treatment and does it … Continue reading 

This study provides definitive evidence that minoxidil does cause an initial shedding phase. However, importantly, hair shedding eventually fell below baseline levels in both groups, indicating that the initial shedding phase is temporary and that minoxidil did begin to reduce hair loss.

Is Initial Hair Loss Actually a Good Sign?

The same authors investigating the minoxidil shedding phase also sought to determine whether the amount of shedding had any association with treatment efficacy. They compared peak relative hair shedding (within the first 12 weeks) to changes in AGA severity using the Basic and Specific classification (BASP), which is a universal hair loss classification system that is used to assess the distribution and severity of hair loss in men and women of all races. They also compared peak relative hair shedding to several trichoscopy measurements, including hair density, hair diameter, and terminal hair proportion.^[16]Bi, L., Kan, H., Wang, J., Ding, Y., Huang, Y., Wang, C., Du, Y., Lu, C., Zhao, M., Sun, W. & Su, T. (2025). Whether the transient hair shedding phase exist after minoxidil treatment and does it … Continue reading

Interestingly, in the 5% minoxidil group, a significant association was found between the amount of initial hair shedding and hair density, hair diameter, and the proportion of terminal hairs. In other words, people who lost more hair in the ‘dread shed’ actually experienced greater outcomes from minoxidil treatment. Furthermore, participants who initially shed the most hair in both the 2% and 5% minoxidil groups demonstrated the greatest improvements in AGA severity by week 24.^[17]Bi, L., Kan, H., Wang, J., Ding, Y., Huang, Y., Wang, C., Du, Y., Lu, C., Zhao, M., Sun, W. & Su, T. (2025). Whether the transient hair shedding phase exist after minoxidil treatment and does it … Continue reading 

These results are very interesting – not only does the initial shedding phase indicate that the minoxidil is working, but more shedding may even predict better treatment outcomes! So, if you’ve just started treatment, don’t fear the shed!

Final Thoughts

Minoxidil is an FDA-approved treatment for AGA but, in some cases, it can cause increased hair shedding in the early stages of use. Known as the ‘dread shed,’ this phase is believed to be caused by minoxidil shortening the telogen phase of the hair cycle, causing old hairs to fall out. This shedding is even more pronounced due to the increased density of telogen hairs present in the scalps of people with AGA. However, this shedding is only temporary, typically lasting between 4 and 8 weeks. Moreover, people who experience more shedding in this initial phase may actually experience greater overall outcomes from their minoxidil treatment. So, if you have just started minoxidil and are noticing increased shedding, don’t panic – it is most likely a sign that the minoxidil is working.

Caffeine & Hair Growth: A Scientific Deep-Dive

In recent years, there’s been an explosion of interest in caffeine shampoos / topicals and their potential to improve pattern hair loss (androgenic alopecia). The hope: that applying caffeine to our scalps might stimulate growth factors, improve blood flow, and maybe even reverse hair follicle miniaturization.

At first glance, caffeine use might look like a viable, natural intervention. But what does the research actually say?

In other words, does caffeine work? Is it a viable alternative to minoxidil? Is caffeine better if ingested, applied topically, or used as a shampoo? How much hair regrowth can we expect? And are there any longterm side effects?

This article dives in the science (and answers).

We’ll dispel a lot of common knowledge about caffeine’s efficacy for hair growth. We’ll also comb through the evidence, set realistic expectations, and reveal how to best use caffeine to maximize your chances of hair recovery.

Long-story short: caffeine isn’t a miracle cure. But it might not be completely useless, either.

Topical caffeine: highlights

• Effort. Low – daily topical application, shampoo use, or ingestion are all easy to implement
• Expectations. According to studies, hair improvements are typically observed by 6+ months
• Response rate: 75%
• Regrowth rate: 0-5%
• Cost. $10-25 per month
• Problems. Low-grade clinical evidence; studies measure outcomes like shedding rates and anagen:telogen ratios, not hair counts; lacking impressive before-after photosets; likely less effective than minoxidil; must be combined with other treatments or ingredients like azaleic acid for maximized benefit.

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Key takeaways

Topical caffeine is clinically shown to reduce hair shedding rates and improve anagen:telogen ratios in men with androgenic alopecia. Unfortunately, it’s still unclear just how effective caffeine-based topicals and shampoos are for improving pattern hair loss.

Caffeine shampoos/topicals fall under an intervention umbrella of “low risk, low reward”. In other words, caffeine’s risk of significant side effects is minimal, as is the amount of hair growth it may initiate.

Having said that, not all caffeine is created equally. While topical caffeine products have been shown to improve shedding rates and anagen:telogen ratios, oral caffeine might actually increase hair loss in those who have insulin resistance or are hypothyroid.

Of all clinical studies on topical caffeine for pattern hair loss, the best results seem to occur when topical caffeine is combined with ingredients like azelaic acid or drugs like minoxidil.

In any case, a 0.2% caffeine dilution for topical solutions and a 1% caffeine dilution for shampoo formulations seem to be the best studied (and most promising), so look for brands that meet these criteria.

If you’re going to use caffeine as a potential hair loss intervention, please understand that this stimulant is only clinically tested on androgenic alopecia, and that it’s likely not effective as a standalone treatment.

More information on the science behind caffeine – its mechanisms, as well as the optimal delivery methods, dilution, and more for hair recovery – can be found below.

What is caffeine?

Caffeine is a stimulant derived from plants – namely, coffee and tea. It’s the most popular stimulant on the planet.

Caffeine structure

As a stimulant, caffeine has a variety of effects on the human body – from better focus to improvements in endurance. But interestingly, the magnitude of these effect often vary per person, and as a result of differences in our genetic constitution, food consumption, and even past caffeine exposure.

What popularized caffeine as a potential hair loss treatment?

In general, caffeine has been studied for its effects on:

• The cardiovascular system – i.e., increased heart rate and possible vasodilation and/or vasoconstriction
• Longevity – i.e., muscular development, cellular metabolism
• Hormones – i.e., cortisol and thyroid hormones (these may play a role in caffeine’s “energizing” effects)

And interestingly, vasodilation, cellular metabolism, cortisol, and thyroid hormones have all been studied as potential treatments to different hair loss disorders.

For instance, hair loss drugs like minoxidil improve hair growth by increasing vasodilation; thyroid drugs like levothyroxine help to improve hypothyroid-related hair loss by restoring thyroid functionality.

This begs the question: what sort of impact might caffeine have on our hair follicles?

Can caffeine – ingested orally or applied topically – mimic the mechanisms of hair loss interventions? And if so, are the effects of caffeine strong enough to actually improve hair loss outcomes?

These connective points are what prompted scientists to start studying caffeine as a potential hair loss intervention. And taking a deeper look, there is some mechanistic overlap in how this stimulant might improve hair loss outcomes.

Caffeine is one of the most popular stimulants. It’s well-studied in terms of its effects on vasodilation, cellular metabolism, and hormonal health. And interestingly, these research avenues have left scientists wondering if caffeine can also be reoriented as a hair loss solution.

How might caffeine help with hair regrowth?

It’s hard to say. On the one hand, caffeine does have some hair-promoting effects. On the other hand, caffeine also has some issues that may actually contribute to hair loss. All in all, the way it will effect you will boil down to (1) the dose and (2) the ingestion type (oral or topical), and (3) your genetic constitution.

Here are a few effects that caffeine has – both positive and negative – in regard to hair health.

1. Topical caffeine may improve vasodilation (good)

Caffeine’s effects on blood flow vary depending on the mode of ingestion (i.e., topical versus oral) and the actual tissue being measured. Just see this chart demonstrating how oral caffeine impacts blood flow across body tissues.

Caffeine’s location-dependent effects on blood flow

(source)

Interestingly, both topical caffeine and oral caffeine seem to improve blood flow in microcapillary networks – the blood vessel networks that supply our peripheral tissues (i.e., skin) – and the same blood vessel networks that help support the growth of our hair follicles.

This is because in vascular smooth muscle cells, caffeine acts as a phosphodiesterase inhibitor. In other words, caffeine helps to block the enzyme phosphodiesterase.

This enzyme helps inactivate a molecule called cyclic adenosine monophosphate – a biological messenger molecule that regulates vasolidation (i.e., blood flow) in smooth muscle cells. In the absence of phosphodiesterase, more cyclic adenosine monophosphate accumulates, thus expanding vasodilation in smooth muscle tissues.

This is also why phosphodiesterase inhibitors are often prescribed for a variety of blood flow-related health conditions – i.e., erectile dysfunction, hypertension, and even vascular disease. They all help promote blood flow.

Caffeine happens to be one of these phosphodiesterase inhibitors. And while it’s a weak inhibitor, it still has an effect on these capillary networks.

But, there’s one caveat here. While it’s true that a defining characteristic of androgenic alopecia (AGA) is reduced blood flow, it’s still debated whether blood flow is a cause or consequence to hair follicle miniaturization. So, we don’t yet know if caffeine’s vasodilation effects will really have any impact to our hair.

2. Caffeine may increase cellular metabolism (good)

Caffeine doesn’t just inhibit phosphodiesterase. It also inhibits adenosine receptors – a type of neural receptor that helps to regulate cellular metabolism and our own sense of “wakefulness”.

In the absence of caffeine, a molecule called adenosine normally binds to an adenosine receptor in our brain. When adenosine binds to an adenosine receptor, our brain’s neural activity begins to quiet. The end-result: we feel a bit sleepier.

Caffeine is an adenosine receptor antagonist. That means that when it’s ingested, caffeine blocks adenosine receptors so that adenosine cannot bind to them. This prevents the “quieting” of neural activity – and thus promotes longer periods of wakefulness.

Interestingly, there’s also evidence that caffeine’s inhibition of both phosphodiesterase and adenosine receptors may promote cellular metabolism. To put it more bluntly, caffeine ingestion might help to improve (1) energy utilization in the body, and (2) the mobilization of free fatty acids for energy usage.

This may have pro-hair effects, as many genes that are upregulating in balding scalp tissues tend to have an association with impaired cellular metabolism. But again, we just don’t know for sure.

3. High-dose oral caffeine may increase insulin resistance (bad)

Unfortunately, not all effects from caffeine are pro-hair. While improving cellular metabolism may help support the growth stage of our hair follicles, there are also consequences to the way in which caffeine improves cellular metabolism that may negatively impact our hair.

For instance, one study found that oral caffeine consumption decreased insulin sensitivity by 15% in healthy adults. That’s not good – especially for young men and women who are balding, as insulin resistance is almost always a commonly confounding factor in early-onset AGA.

Moreover, there’s also evidence that at high dosages, oral caffeine’s “liberation” of free fatty acids also promotes hyperglycemia and insulin resistance in peripheral tissues (i.e., our skin) – possibly as a result of increased stress hormones like cortisol. Which brings us to our second concern…

4. Oral caffeine increases cortisol levels, and may impair thyroid function and skin quality.

Evidence strongly implicates oral caffeine consumption and an increase in cortisol levels. Unfortunately, the hormone cortisol, when chronically elevated, can negatively impact hair-related bodily functions and in two major ways:

• It can lead to skin degradation around the follicle and disrupt the hair cycle
• It can reduce thyroid functionality, which can increase hair loss for those susceptible to hypothyroidism.

Another noteworthy mention is that coffee can also impair the absorption of thyroxine. So, if you are taking this medication for a thyroid disorder, it’s likely in your best interest to avoid consuming coffee around the same time. But, it’s unclear whether this effect is a result of the caffeine content or other compounds found in coffee.

Again, we don’t yet have any data correlating oral caffeine consumption to pattern hair loss. But these concerns are worth noting for anyone who’s balding and has had a history of hyperglycemia, insulin resistance, hypothyroidism, or adrenal dysregulation.

What about topical caffeine?

In contrast to high dose oral caffeine, it doesn’t seem like topical caffeine elicits the exact same anti-hair effects. Rather, topical caffeine (as a lotion or shampoo) might have some therapeutic benefit to our scalp hair.

For reference, in vitro studies in humans and in vivo studies in mice suggest that caffeine’s effects on (1) phosphodiesterase inhibition and (2) adenosine receptor binding probably will improve hair growth, and through a variety of means.

Specifically, topical caffeine might…

• Prolong the growth phase of the hair cycle (i.e., the anagen phase)
• Stimulate matrix keratinocyte proliferation – or encourage the growth of new hair fibers
• Increase IGF-1 – a signaling protein that helps regulate hair growth
• Inhibit apoptosis – or the “death” of cells responsible for regulating hair growth
• Promote blood flow – which is historically much lower in balding versus non-balding scalps

So, overall, it seems like mechanistic evidence supports at least the use of topical caffeine as a potential hair loss intervention. And this conclusion is why so many researchers have bothered studying caffeine lotions and shampoos for the improvement of AGA.

Caffeine is a (1) phosphodiesterase inhibitor and (2) an adenosine receptor antagonist. While its effects vary on a tissue-by-tissue basis, oral and topical caffeine seem to improve microcapillary networks in periphery tissues (where our hair follicles reside). Moreover, caffeine can help improve cellular metabolism by liberating free fatty acids for energy use. Improvements to both (1) vasodilation and (2) cellular metabolism should theoretically benefit our hair.

At the same time, oral caffeine seems to also increase insulin resistance in peripheral tissues. This is problematic – as reduced insulin sensitivity may interfere with the growth cycles of our hair follicles. Moreover, oral caffeine consumption can increase cortisol levels and decrease thyroid functionality – which may also negatively impact hair growth cycles.

Despite concerns of oral caffeine use for hair, evidence does support the use of topical caffeine for hair growth – at least from a mechanistic standpoint. In vitro research suggests that, in human hair follicles, topical caffeine helps to prolong anagen duration, increase IGF-1, inhibit cell death, and improve blood flow. While this doesn’t mean that these effects will translate in vivo, it does give credence to the idea that topical caffeine is worth testing as a hair loss intervention.

This all brings us to our next question: what does the clinical data say about topical caffeine and its use as a hair growth stimulant?

Is topical caffeine effective for hair loss?

This is harder to answer than it may seem.

At face-value, the answer is yes. This is because there are a lot of studies showing that caffeine in a topical or shampoo (or caffeine in conjunction with minoxidil and/or azelaic acid) can improve hair loss outcomes.

For instance, this recent literature review on topical caffeine dives into over a dozen clinical studies, many of which report:

• “…Statistically significantly better results” when used in conjunction with minoxidil versus minoxidil alone
• Higher patient satisfaction when used with minoxidil compared to minoxidil alone
• Decrease in hair loss after washing when using caffeine + minoxidil + azelaic acid, with similar results to a minoxidil solution after 36 weeks
• Decrease in hairs lost in a hair pull test after 6 months of using a caffeine shampoo (no placebo) and 4 months of using a caffeine-containing lotion.

Reading these conclusions, it’s no wonder why caffeine topical sales have spiked in the last few years.

However, taking a closer look, these studies might not be as encouraging as their conclusions imply. Here’s why.

Quality analysis: how do caffeine-hair loss studies stack up?

When it comes to research, not all peer-reviewed papers are created equally.

Some studies are published in predatory journals that circumvent the peer review process; others are published in low-ranking journals; others simply have major methodological concerns that draw the findings of those studies into question.

When it comes to the studies on caffeine and hair regrowth, it’s that last issue that’s most prevalent. That’s not to say that we should dismiss caffeine’s effects entirely. But, there are several concerns worth highlighting.

1. Methodological concerns

In the above literature review, most of the feature studies don’t measure hair count increases. Rather, they measure endpoints like patient self-satisfaction surveys, changes to anagen:telogen ratios, and a reduction in hair fall during “wash tests” or “tug tests”.

These measurements are difficult to standardize and are notoriously unreliable, meaning it can be hard to determine the true effectiveness of caffeine from any study designed this way.

In fact, it’s my belief that a lot of industry-funded research purposefully chooses these measurement endpoints because of their unreliability. For reference, these types of endpoints are why so many low-level laser therapy studies will report almost unbelievable hair improvement – i.e., “200% hair diameter increases” or “80% hair density improvements” in their clinical trials – while paradoxically, having no visual improvements to show subjects’ photographic assessments.

The bottom line: these measurement endpoints aren’t very strong, and some investigators who choose these endpoints may be doing so to deliberately skew caffeine’s perception of efficacy. But no matter what, the weaker the hair measurement endpoints, the less reliable the results.

2. Topical caffeine is rarely measured as a standalone treatment

Most of these studies measure topical caffeine alongside enhancer ingredients – like azelaic acid, minoxidil, or both – and not caffeine as a standalone treatment. This makes it hard to evaluate whether caffeine by itself is very effective.

In fact, there’s just one study that we could find that measured topical caffeine as a standalone treatment. Unfortunately, it measures topical caffeine versus minoxidil, not a placebo. That study’s takeaway? That topical caffeine is similarly effective to 5% minoxidil… at least when we compare weak measurement endpoints (see #1).

3. Conflicts of interest

Of all the clinical research done on caffeine and hair growth, most of it is industry-funded.

At face-value, this isn’t necessarily a problem. After all, a significant portion of hair loss studies comes from industry-funded research teams. Where there’s financial incentive for a treatment, there will be attempts at peer-reviewed research to prove efficacy.

Having said that, this does become a problem when the studies are typically designed with poor measurement outcomes – such that the odds of achieving “favorable” results increases dramatically. Nearly all of the topical caffeine studies on AGA have this very problem. Compile that with the issue of almost never measuring caffeine alone, and you have even more problems (see #1 and #2).

4. Manufacturers publish research on topical caffeine, but sell you shampoo-based caffeine

One of the most frustrating aspects of hair loss products are that manufacturers will publish a study showing their product demonstrating benefit, but then sell you a product that’s different from the one studied.

This happens all the time with LLLT devices, and it seemingly also happens with caffeine products for hair loss.

Case in point: Alpecin’s study on a topical caffeine solution. The findings showed that this topical did improve hair loss outcomes. But ironically, Alpecin doesn’t sell this topical; it sells a caffeine shampoo. Topicals are leave-in for hours, whereas shampoos may only come into contact with the scalp for 60 seconds. It was this issue in addition to #1-#3 that got Alpecin banned in certain countries from saying their “shampoos” could reduce hair loss.

It was a combination of these issues that led researchers in the above literature review to conclude that while caffeine might help improve aspects of our hair, there isn’t yet enough evidence to support most claims being made by manufacturers.

Topical caffeine does have clinical research supporting its use for hair loss. However, in literature reviews of the dozen or so studies on topical caffeine, concerns of endpoint measurements, lacking study as a standalone treatment, conflicts of interest, and discrepancies in what’s studied versus sold to consumers raises red flags as to caffeine being a truly viable long-term solution.

Despite all of this, there is evidence that topical caffeine might help our hair

Circling back to that literature review, there is accumulating evidence that caffeine can help reduce hair shedding from androgenic alopecia and even improve anagen:telogen ratios. It’s just that if we’re going to use it, we shouldn’t set our expectations at regrowth; we should set our expectations at a slowing of hair loss.

This leaves us with an interesting dilemma: if we want to leverage caffeine as a hair growth promoter, we need to do so in topical or shampoo form. And that means we need to know:

1. What’s the best caffeine formulation: topical or shampoo?
2. Is there a difference in regrowth reported between 0.2% and 1% caffeine dilutions?
3. What’s the optimal frequency of application? Once a week, once a day, etc.?
4. Does the effectiveness of caffeine wane over time – like minoxidil and other hair loss drugs?

Sifting through the literature review, there are studies that answer these questions. But again, they’re all subject to significant bias.

Even still, we can use these studies to guide some caffeine best practices – at least for those who want to make the investment and try it out.

Using caffeine for hair growth: best practices

The best caffeine formulation is likely within a shampoo or topical

Oral caffeine likely doesn’t accumulate in the scalp at a high enough degree to elicit adverse or beneficial effects. However, it may have peripheral action through increased cortisol levels, and this may indirectly impede hair growth for those with insulin resistance and/or hypothyroidism.

Knowing this, the safest and most effective way to use caffeine for hair growth is through topical means, either through some sort of lotion or shampoo.

Considering one study found that caffeine solutions penetrate the hair follicle after 2 minutes and peak at 2 hours, a leave-on caffeine solution may be optimal over a shampoo formulation.

The best caffeine dilution is 0.2% for topicals and 1% for shampoos (as far as we can tell)

But to be clear: the answer likely depends on whatever other ingredients are also in the topical (i.e., azelaic acid, minoxidil, etc.). Here’s why.

• This study, the only study measuring the efficacy of caffeine alone, found that a 0.2% caffeine topical (Alpecin) was just as effective as 5% minoxidil at improving anagen hair percentages.
  • Problems: does not measure total hair count changes, thus improvements to anagen:telogen ratio can also be achieved by simply just shedding more telogen hairs for either treatment group; study only went for 6 months and results (i.e., improvements to anagen:telogen ratio for both caffeine topical and minoxidil) are within range for what we’d expect from seasonality
• Pazoki-Toroudi et al. (2013) assessed the combination of caffeine 1%, minoxidil 5%, and azelaic acid 1.5% versus minoxidil 5%. The combination therapy was more effective than minoxidil alone.
  • Problems: does not measure caffeine alone, so we can’t really say.
• Bussoletti et al. (2010, 2011) found that a 1% caffeine shampoo alone and caffeine lotion alone both resulted in less hair lost to a pull test after 6 and 4 months, respectively.
  • Problems: no concentration specified for the lotion; no control group used to assess true efficacy.
• Golpur et al. (2013) found that caffeine + 2.5% minoxidil was more effective than 2.5% minoxidil alone.
  • Problems: no percentage of caffeine was indicated.
• Sisto et al. (2013) analyzed the effects of a caffeine-containing shampoo vs a caffeine-free shampoo and found that the active treatment was superior to the placebo.
  • Problems: no concentration specified.

So, from what we can garner from the limited studies available, a 0.2% solution for topical application seems to be somewhat effective. However, keep in mind that this is only for a leave-on treatment, not a shampoo.

We don’t really have much information on optimal shampoo dilution. A 1% dilution was the only concentration reported for caffeine shampoo alone, but this treatment wasn’t compared against a placebo and, so, results aren’t super applicable. Even still, 1% seems to be comparably effective to minoxidil.

A 1% caffeine, minoxidil 5%, and 1.5% azelaic acid topical was considered more effective than minoxidil alone, but we can’t extrapolate this 1% dilution to a caffeine-only shampoo.

0.2% for topical solutions and 1% for shampoo formulations is all we can really extract from the current body of evidence, but it should be noted that these recommendations aren’t necessarily reliable given the minimal evidence.

What is the optimal frequency of use?

Like concentration, data on the frequency of use is also sparse. In the highest quality study, subjects used a 0.2% caffeine topical twice a day, every day. Another study instructed subjects to apply a caffeine lotion (unspecified concentration) once daily.

Other studies likely using shampoos most likely involved subjects using the treatment product however often they would normally shampoo their hair. So, it can be difficult to quantify just how often is optimal because use wasn’t standardized, as far as we can see.

With the knowledge we have, daily use of a topical seems to be optimal. Conversely, using a shampoo daily may be drying to the hair and the scalp, so it’s safe to say that using a caffeine-containing shampoo however often you would normally shampoo is probably best.

Does caffeine’s efficacy wane over time?

While no studies measure caffeine’s effectiveness for long enough to see if regrowth is sustained, we can assume – like nearly all topicals – that its hair-promoting effects will likely lessen over time.

The reasons why will be explained in a future article – one comparing the long-term outcomes of antiandrogenic versus non-antiandrogenic hair loss interventions. But the short answer is that we can liken any sort of topical formulation for hair loss – even minoxidil – as a bandaid that won’t necessarily fully address the underlying roots of the problem.

Summary

Topical caffeine may help to elongate the anagen phase of the hair cycle, improve anagen:telogen ratios, decrease hair shedding, and slow the progression of androgenic alopecia (AGA). But it’s by no means a miracle cure, and evidence so far suggests that this topical isn’t any better than 5% minoxidil.

The limited evidence we do have on topical caffeine is relatively biased, poorly designed, and has only been studied for androgenic alopecia. Until studies with better designs are published, it’s hard to say with certainty just how much of an effect topical caffeine will have on our hair.

Nevertheless, topical caffeine leave-on treatments have more quality evidence to support their use (as opposed to shampoos). 0.2% dilutions for topicals and 1% dilutions for shampoos seem to be the most promising. Moreover, the best way to utilize caffeine seems to be in conjunction with minoxidil and, possibly, azelaic acid.

Paradoxically, oral caffeine consumption may have an adverse effect on hair growth through increased cortisol release, increased hyperglycemia in periphery tissues, and potentially decreased thyroid functionality. For these reasons, anyone with a history of insulin resistance or hypothyroidism is probably better off avoiding oral caffeine altogether – particularly for hair health.

If you do decide to implement caffeine into your regrowth regimen, the first thing you’ll notice is how difficult it is to field the market. Almost all companies that have any merit in this space don’t quantify the caffeine dilution in their products. Considering most caffeine treatments are upwards of $35 USD, you may want to call around and see if their customer service representatives can give you more information.

Let us know if you have personal experience or testament in using (or excluding) caffeine. If you start using caffeine, report your progress here for others to see! Any questions or comments? Please reach out in the comments section.

The Ultimate Guide To Platelet-Rich Plasma Therapy (PRP)

In the last decade, thousands of dermatologists have started offering platelet-rich plasma (PRP) therapy as a treatment for hair loss. At first glance, PRP seems like an enticing therapy: a hands-free, drug-free approach to improve our hair thinning…

…but with a $1,000+ price tag, is the therapy worth it? Is PRP right for all hair loss sufferers? And if platelet-rich plasma therapy does work, how much hair can we expect to regrow?

This ultimate guide to platelet-rich plasma therapy uncovers the answers. Here we’ll reveal how platelet-rich plasma therapy works, how it compares to similar therapies, and what most dermatologists don’t tell you about their PRP “before-after” photos.

We’ll also reveal how hair regrowth from PRP depends largely on your form of hair loss, whether you combine PRP with other treatments, and the type of PRP your dermatologist provides (Acell, etc.).

If you’re considering PRP as a hair loss treatment, this guide will help you determine if the costs make sense for your situation and, if so, how to select the right provider.

PRP Therapy: Highlights

• Effort. Medium (requires a few dermatology appointments, but is otherwise a hands-free therapy)
• Expectations. According to studies, regrowth can occur in as little as 3 months.
• Response rate: 80%+
• Regrowth rate: this varies depending on if PRP is done alone or alongside other therapies.
  • PRP (alone): 25-30%
    • PRP + finasteride: +1%
    • PRP + microneedling: +5%
    • PRP + minoxidil: +5%
    • PRP + microneedling + minoxidil: +5-10%
    • PRP + ACell: no studies (yet), but anecdotes suggest better results than PRP alone
• Cost. $1,000-$4,000+
• Problems. Expensive; real-world results often don’t match those of studies; similar mechanisms targeted with massaging and microneedling; results vary wildly depending on the clinic; results contingent upon continued sessions

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Key takeaways

PRP is effective for androgenic alopecia and alopecia areata, but it’s expensive and requires ongoing injections to maintain results. It works best as an adjunct treatment alongside other hair loss therapies, and while it has helped both men and women, evidence suggests that it’s less effective for females overall. If you’re going to try PRP, don’t just go to any clinic; rather, vet your cosmetic surgeon by asking them a list of questions we’ve suggested (below).

What is platelet-rich plasma therapy (PRP)?

Platelet-rich plasma therapy (PRP) is an injection-based therapy. It’s the injection of a modified version of our own blood into a tissue site – with the goal to accelerate healing, reduce scarring, and improve injury outcomes.

PRP has been used for dentistry, facial reconstruction surgery, orthopedics, sports injuries, acne scarring, and fat grafting. But in the last decade, it’s been given serious attention as a potential treatment for thinning hair.

How does PRP work?

PRP therapy is a multi-step process that involves drawing a sample of our blood, separating out its platelets, concentrating those platelets, and then re-injecting those platelets into a targeted location (like our scalp).

If you’re considering PRP, the procedure usually takes around an 30-90 minutes, and the process looks something like this:

1. Obtain blood from the patient
2. Centrifuge once – under a low speed – to separate out platelet-rich plasma from the blood
3. Remove anything that isn’t plasma
4. Centrifuge again
5. Repeat step 3
6. Mix the solution to make it uniform

Why focus on platelets?

Our blood volume contains roughly 55% plasma, 40-45% red blood cells, 6% platelets, and 1% white blood cells. Whenever our tissues incur a wound – for example, a paper cut – an inflammatory reaction begins, and our bodies will send blood to our injury site to initiate repair.

Interestingly, our platelets – which constitute just 6% of our blood volume – are responsible for a huge part of the entire repair process. Specifically, platelets do two things:

1. Platelets help clot a wound to prevent excessive bleeding
2. Platelets carry with them dozens of growth factors, all of which help to coordinate the entire healing process.

This begs the question: what if we could concentrate our platelets so that instead of sending only 6% of platelets to a wound tissue, we could send a much higher percentage? Would we see better injury outcomes? Would we see less scarring?

Well, this is exactly what platelet-rich plasma therapy does. In fact, recent advents in “centrifugation” – or the swirling, mixing, and separation of platelets from our blood – have enabled dermatologists to achieve blood platelet concentrations higher than 94%+. That’s a huge jump from the 6% typically carried within our normal blood volume.

And as of today, it seems like platelet concentrations do improve injury outcomes and scarring. Decades of studies show that, on average, if we concentrate high levels of plasma and send that plasma to an injury site, we can improve injuries, reduce scar tissue, and in doing so, maybe even regrow some hair.

How, exactly, does PRP improve hair loss?

There are several growth factors carried within plasma linked to hair growth, most notably:

• Platelet-derived growth factor
• Transforming growth factor
• Vascular endothelial growth factor
• Epidermal growth factor
• Fibroblast growth factor
• Connective tissue growth factor
• Insulin-like growth factor (IGF-1)

And when injected into balding scalp tissues, the arrival of these growth factors can do a few things:

1. They reactivate dormant hair follicles and encourage them to reenter the anagen phase, thus increasing hair counts.
2. They prevent hair follicles from entering the catagen phase or undergoing cell apoptosis (programmed cell death).
3. They help to resolve longstanding inflammation and reduce scar tissue surrounding miniaturizing hair follicles, thereby increasing the hair thickness of miniaturized hairs.
4. The promote blood vessel growth around the hair follicles to aid in hair regeneration.

Isn’t this similar to how massaging and microneedling work?

Yes. PRP’s mechanisms overlap with one of the ways by which massaging and microneedling improve hair loss: they both increase the number of growth factors in balding scalp regions. But, they do it in slightly different ways.

Massaging and microneedling first generate acute inflammation (i.e., micro-wounding), which then increases growth factors, which then helps to promote hair recovery. The order of operations is as follows:

Massaging / microneedling >> evokes micro-inflammation >> evokes platelets / growth factors >> decreases scarring proteins / increases angiogenesis >> reduces perifollicular fibrosis >> improves blood flow to miniaturizing hair follicles / increases follicle growth space >> increases hair growth

But there’s a key difference between PRP and these two therapies. With massaging and microneedling, you need to first evoke inflammation to increase growth factors to a wound site. With platelet-rich plasma, you essentially skip that first step, and instead, you simply inject platelets directly into the tissue of your choosing.

When it comes to balding scalp tissues, we can think of the mechanistic difference between these therapies as this:

Now, there is some wounding involved in PRP procedures. But that wounding / acute inflammation is a consequence to the injection of the platelets. In this way, PRP is sort of like a supercharged microneedling or massage session – only with many more platelets present.

Is platelet-rich plasma therapy effective?

This is a tricky question to answer.

If forced to give a one-word answer, then yes. Most studies on PRP show positive outcomes for hair loss. But if you’re going to invest thousands of dollars into the therapy, there are caveats of which you should be made aware.

The reality is that PRP’s effectiveness for regrowth depends on the study you reference and how you define the term, “effective”. Moreover, PRP efficacy varies greatly by:

• Hair loss type (i.e., androgenic alopecia, alopecia areata, etc.)
• Whether we combine PRP with other treatments (i.e., minoxidil, finasteride, microneedling)
• The type of PRP procedure (i.e., PRP alone, PRP + Acell, etc.).

We’ll cover all of this below.  First, we’ll start with PRP’s issues. Then, we’ll dive into PRP’s benefits (and its effects on our hair).

Cons

Problem #1: most PRP studies have a high risk of bias

Most PRP studies are conducted by dermatologists who offer PRP procedures at their clinics. That creates an incentive to achieve positive results – because those positive results might encourage patients to do the procedure at their specific clinic.

However, this problem isn’t necessarily game-ending. In fact, nearly all hair loss research contains some level of bias. For instance, despite our efforts to control for bias in our own study on the massages, technically you could argue that because this site conducted it, our results are at risk of bias, too.

In any case, there are plenty of well-controlled studies on platelet-rich plasma and hair loss. We’ve filtered for these. But if you go digging through the literature and find a PRP study with crazy results, just know that if it wasn’t included in our analysis, there’s probably a good reason why.

Problem #2: most platelet-rich plasma studies aren’t standardized

Nearly every PRP study has a different patient profile (i.e., ages and hair loss severities), methodology (i.e., injection methods, rounds, treatment regions), trial duration (i.e., three months versus two years), and hair assessment method.

For instance, here are just a few ways PRP studies have measured hair loss “improvements” (ranked from worst to best).

1. Hair tug tests (i.e., when an investigator yanks at a subject’s hair before and after treatment, then counts the number of hairs that fell out)
2. Reduction in hair fall (i.e., hair shedding collected in the shower, by patients, pre- and post- treatment)
3. Patient satisfaction scores (i.e., when a patient fills out a survey saying whether they’re happy with the treatment)
4. Independent visual assessments (i.e., when a dermatologist eyeballs photos to give their input on hair improvements)
5. Follical unit survival rates (for PRP + hair transplant studies) (i.e., how many transplanted hairs survived the transfer)
6. Hair thickness (i.e., the change in the diameter of hair shafts in a specific scalp region)
7. Terminal/vellus hair ratio (i.e., the number of thick and healthy versus thin and wispy hairs in a specific region)
8. Hair counts (i.e., when a region is marked – usually with a temporary tattoo – to count hairs before and after treatment)

To be fair, this isn’t just a problem with PRP; it’s a problem with all of hair loss research. It’s why literature reviews have a hard time drawing conclusions about most treatments – because there are rarely apples-to-apples comparisons.

But again, we’ve sorted through all the PRP studies we could find to standardize the research (as best we can) and give you ballpark assessments of regrowth rates (i.e., increases to hair count in balding regions).

Problem #3: platelet-rich plasma therapy likely requires ongoing treatments

When you look into the research on minoxidil or finasteride, studies show that within 3-12 months of quitting either drug, your hair loss will return to what it was prior to the intervention. So, how long will results hold for platelet-rich plasma after quitting?

Well, it’s unclear how long results will last after you stop doing PRP treatments, but evidence suggests that a percentage of people will start seeing their hair return to baseline after a year.

Out of all PRP studies, the one with the longest follow-up period (two years) included 20 patients. Interestingly, four of them experienced a relapse in hair loss one-year post-PRP. In fact, their androgenic alopecia progressed beyond their pre-trial hair counts by the 16-month mark. This suggests that for about 20% of people, PRP’s effects start to wane 12-18 months after the treatment.

This wouldn’t be such an issue if the procedure were cheap, but it isn’t: several therapeutic rounds of PRP cost $1,000-$4,000+. So, if you’re going to give this procedure a try, make sure you’re financially comfortable with the investment.

Problem #4: PRP might not work for every person with hair loss

Out of all the research on PRP, only two studies found that PRP was an ineffective treatment option. One study was on females with androgenic alopecia. The other study was on men with advanced androgenic alopecia (Norwood gradients 4+).

If you were to ask me why the first study failed to produce results, I would say that it was probably because (like most women with hair loss) the females in that study likely had other undiagnosed hair loss types (like telogen effluvium / hair loss related to a chronic condition).

And as far as the study on men with advanced androgenic alopecia (AGA) – we need to keep in mind that the investigation team only did two rounds of PRP injections. For what it’s worth, in all of the PRP studies which saw improvement, a minimum of three PRP injection rounds were performed. So, it’s likely that either this study didn’t do enough injections to see results, or that men with advanced AGA needed several more injections before PRP begins to repeat significant benefit.

Problem #5: most PRP studies don’t measure PRP by itself

In fact, the overwhelming majority of studies measure PRP alongside other hair loss treatments – like minoxidil, finasteride, or even a hair transplant. So, it’s important to delineate between the studies you reference when evaluating whether PRP is right for you (we’ve done this below).

This also brings up another problem: dermatologists showcasing their PRP results online often don’t tell you something important: that they’re showing you PRP results alongside drugs like minoxidil and finasteride.

This is incredibly disingenuous, and I suggest that if you’re shopping around for a PRP clinic, you call ahead and ask the doctor if the results they showcase on their website are from PRP alone. If they are, great. If they’re not, but they’re labeled to make it seem as such, then that means these dermatologists are intentionally misleading prospective patients, and they should lose your business (and their license to practice).

Pros

While we might’ve just painted a problematic picture for PRP, this isn’t the whole story. In fact, PRP is an incredibly effective treatment for hair loss under the right circumstances. This is all covered below.

Alopecia areata

PRP has shown great promise for the hair loss disorder alopecia areata. This is an autoimmune condition that leads to hair loss in patchy spots throughout the head. In some cases, it can advance to complete baldness (alopecia universalis).

In fact, studies show that PRP is very effective in treating at least 70% of alopecia areata cases. Here are some of the really promising photos (source):

Androgenic alopecia

PRP alone (no other treatments)

When looking at PRP as a standalone treatment, most studies measuring hair counts suggest that the average patient will regrow 15 hairs per square centimeter (i.e., half the size of a penny). That’s about a 25-30% regrowth rate at 3-6 month follow-ups.

Quantitatively, that’s pretty impressive. For a benchmark, most studies on finasteride show just a 10% increase in hair count over two years.

Across studies, some of the less quantitative outcomes for PRP alone (at least at the 3-6 month mark) are:

• Patients report about a 75% increase in hair quality and thickness, and a decrease in the rate of hair loss.
• Patients usually perform better on the hair pull test, meaning that when they pull on a clump of the patient’s hair, fewer hairs came out compared to control groups.
• Patients report somewhat high satisfaction with the procedure at month three of follow up

Finally, a common trend mentioned among researchers is that PRP treatment seems to be more effective for patients with less severe forms of AGA. So, if you’re in the early stages of hair loss, PRP might be a great option for you.

PRP + hair transplantation

In one study examining hair transplantation, two areas with 50 grafts each(not a lot to measure, especially for hair transplantation) were compared with or without PRP injections. The area with PRP had, on average, 46.75 units that survived compared to the non-PRP which had, on average, 41 units that survived.

While this isn’t that drastic of an increase – we have to keep in mind that transplant procedures are incredibly costly… and that means that every hair follicle unit counts.

So, if you’re considering a hair transplant, you’ve spent the finances to secure a skilled surgeon, and you still have some extra spending money you’d like to throw into improving your results – do it alongside PRP. Chances are your hair transplant survival rates will improve, as will your overall hair count.

PRP + microneedling

In this study, 30 male participants received 6 PRP injections following microneedling sessions. At the six month follow-up, the average patient had a hair density increase of about 30%. This study also noted that the most significant improvement was seen in patients with less severe AGA.

PRP + minoxidil or PRP + finasteride

In this study comparing the efficacy of PRP + minoxidil and PRP + finasteride, while both outcomes were deemed effective, the PRP + minoxidil treatment actually achieved significantly better results than the PRP + finasteride group. In fact, the PRP + minoxidil group showed five-fold better hair increases versus the PRP + finasteride group.

Now, you might read these results and think that makes no sense. Finasteride is clinically more effective than minoxidil. So, why would PRP + minoxidil outperform PRP + finasteride?

Well, the devil is in the details. For one, the sample size of each PRP subgroup was less than 15 people. So, it’s possible these differences might’ve been due to statistical noise which would’ve canceled itself out with subgroups of 150+ people.

And secondly, while a five-fold improvement might sound drastic, we’re actually dealing with the law of small numbers here. Yes, PRP + finasteride saw an additional hair count lift of 1% versus 5% for the PRP + minoxidil group. And yes, that is technically a five-fold improvement. But in all reality, that’s just a few percentage points better.

PRP + minoxidil + microneedling

In this study comparing PRP + minoxidil + microneedling versus minoxidil alone, the earlier treatment proved to be much more effective than the latter, although exact numbers were not given in this study to show this. However, we can assume that PRP + minoxidil + microneedling is probably better than PRP + minoxidil, and that PRP + minoxidil is probably better than PRP alone.

PRP + Acell

PRP + Acell is a relatively new procedure that a lot of PRP practitioners are offering now. Acell is a protein matrix derived from pig bladder (you read that right) that creates a “scaffold” for new hairs. Acell essentially offers a platform by which all of our growth factors (and hair) can cling to. It also helps to stimulate stem cell activity.

[Note: since ACell is made from pig, people allergic to pig products should notify their physicians about their allergy prior to the treatment.]

There doesn’t seem to be any studies measuring the results of PRP + Acell compared to PRP alone, so it’s hard to objectively say whether it increases the effectiveness of PRP.

Are there any risks to PRP?

At least so far, there haven’t been any severe risks reported. However, some milder symptoms have been noted during and shortly after the procedure:

• Headaches
• Pain
• Itching
• Drowsiness
• Infection (rarer)
• Scarring or calcification of the injection site (for those with a propensity toward keloid scarring) (rarer)
• Blood vessel or nerve injury (rarer)

Who’s a good candidate for PRP? Who’s a bad candidate?

Androgenic alopecia treatments vary depending on your (1) finances, (2) willingness to invest time into a therapy, and (3) comfortability with FDA-approved drugs. Compared to some of the other AGA specific treatments, like standardized scalp massages and microneedling, PRP is a pricey option. At the same time, PRP is a lot less time consuming than microneedling or massaging because you may only go into a clinic for a handful of injection rounds before you start seeing results.

You are a great candidate for PRP if you…

• Are comfortable with the financial investment and ongoing treatments
• Want to stack PRP alongside other treatments in your hair loss regimen – like microneedling, massaging, minoxidil, or finasteride
• Are going to get a hair transplant and want to optimize your outcome of the procedure
• Have early-stage to mild AGA (and relatively small areas of hair loss)
• Have alopecia areata
• Are a poor candidate / do not want to try traditional hair loss medications
• Are physically healthy in general

You are not a great candidate for PRP if you…

• Do not want to spend thousands of dollars on the procedure
• Have advanced AGA and aren’t willing to commit to several rounds (and months-to-years) of injections
• Are a female with androgenic alopecia alongside conditions like hypothyroidism (treat that first!)
• Do not want to keep reinvesting money into a procedure that might not prove effective after a year.
• Have a bleeding disorder with clotting factor deficiencies or low platelet counts
• Use blood thinners
• Have a liver disorder
• Have a recent cancer history or sepsis (blood infection)
• Are a heavy smoker, alcoholic, or illicit drug user
• Have low blood pressure or chronic user of steroids

Do PRP study results hold true in the real world?

When evaluating any hair loss therapy, it’s important to note that, sometimes, study results don’t match up to real-world results. On hair loss blogs and forums, there’s sometimes an inkling that this might be the case with PRP.

For starters, while there are positive patient stories with PRP, there are also many anecdotes of patients who tried PRP without success. This video is a perfect example. And if you dig deeper, you’ll probably find more negative than positive anecdotes.

This can be confusing – as most of the literature tends to describe PRP as seemingly beneficial. And even more troublesome, it’s also worth noting that I’ve spoken with dozens of readers who’ve tried PRP… and most of them have also reported negligible improvements.

This begs the question: is PRP that effective? And regardless of the answer, why might there be a discrepancy between studies’ results and patient reports?

What could explain the discrepancies between PRP studies and real-world results?

For starters, it’s actually unclear if there are clinical versus real-world discrepancies for PRP. For instance, it’s possible that PRP treatments might just suffer from the “Yelp effect”. This is when someone with a negative experience is far more likely to leave a public review versus someone with a positive experience.

So, PRP might just be one of those treatments that have collected negative reviews over a period of years – much like finasteride and its reports of sexual side effects.

Secondly (and this is the more important point to make), clinical research does not always depict reality. For instance, while a 25-40% increase in hair count from PRP looks great on paper, it doesn’t always translate to cosmetic results.

This tends to be a problem with even the “best” FDA-approved treatments. Just take a look at these five men who did combination treatments of minoxidil, finasteride, laser combs, and even hair transplants – and their results after one year.

I’ll save you the suspense: their final “after” photos are darkened to obscure just how minimal their hair changes are. And, for the hundreds (to thousands) of dollars each of the men spent, their hair seems more-or-less cosmetically unchanged.

(Note: that video is just one of the reasons why, for most AGA sufferers, I recommend approaches like massaging / microneedling as a baseline for any regimen. Not only do these therapies enhance other hair loss treatments, but also without their inclusion, you’re statistically likely to see no cosmetic improvements from your other treatments).

Thirdly, we just learned that without follow-up sessions, PRP results will fade for 20% of patients starting 12-18 months after their last round of injections. So, if you’re reading a review of someone who got PRP once four years ago and never saw results (or is experiencing continued hair loss) – you’ll know that it’s probably because they didn’t do enough injection rounds and they didn’t keep up with the therapy.

In any case, it’s worth noting that of the readers with whom I’ve communicated, the ones who tried PRP + Acell all reported positive results. While there aren’t yet studies validating this combination therapy, it seems to be the most promising from an anecdotal standpoint (if that means anything to you).

How to choose the right PRP practitioner

If you’re going to invest $1,000+ into platelet-rich plasma, don’t give your money to the first PRP clinic you find.

Instead, find a few clinics near you that offer the procedure and make sure they have a proven track record. That means they should have a website with PRP before-after photos.

Make a list of these clinics. Then, call each clinic and ask if their online photos are of PRP alone or of PRP + finasteride / minoxidil.

If the photos are of PRP alone, great! If they’re of PRP + multi-therapies but advertised to represent only PRP… then hang up, cross them off your list, and consider reporting them the clinic to the Better Business Bureau.

Doing this should eliminate 60-70% of providers.

Next, call the remaining providers and ask about their PRP techniques. You’ll want to find a clinic that offers 1-4+ months between injection rounds. If someone offers you a package of 10 PRP sessions spaced out as one injection round per week, that goes against the literature’s recommendations (and our understanding of wound-healing timelines) – and you should probably find another provider.

Moreover, the actual PRP product that a clinic uses will vary by volume, number of injection rounds, color, platelet count, leukocyte count, and protein content. The best PRP providers will offer double-spin centrifugation preparation with an activator like thrombin or calcium chloride. While some evidence suggests that “platelet activators” are not necessary, they also don’t seem to hurt the procedure. In any case, it’ll be good to speak with your provider about all of this – so you can get a feel of whether they can actually answer these questions. If they can’t, then cross them off your list.

Lastly, ask your remaining clinics if they offer PRP + Acell. If they do (and the costs aren’t prohibitive), then this might be a better option versus PRP alone. If they don’t, it’s not the end of the world – and chances are you’ll still see benefit from the procedure.

Following this process should leave you a few great PRP clinic options. And, as long as you’re willing to commit to injections every 4-6 months, you should see a considerable lift in hair count… especially if you’re combining platelet-rich plasma with other therapies.

Summary

Platelet-rich plasma therapy is effective for both androgenic alopecia and alopecia areata, but the procedure is cost-prohibitive and requires repeated clinic visits to see sustained results. These factors are big turnoffs for most hair loss sufferers considering PRP as a treatment option.

PRP works best as an adjunct treatment alongside other hair loss therapies. So, don’t just try PRP as the only thing to help your hair. We recommend combining it with massaging and/or microneedling, and (if you’re comfortable), FDA-approved drugs (especially minoxidil) to maximize results. And, if you can, try to find a clinic that provides PRP + Acell.

While PRP can help both male and female hair loss sufferers, preliminary evidence suggests that it’s just not as effective for females. However, this might be because of the added complexities of female AGA – and the fact that women are so frequently misdiagnosed with AGA but instead actually have hair shedding disorders related to underlying chronic conditions.

Be careful about clinic selection for PRP. For instance, the photos you’ll see on most dermatology websites offering PRP are from patients doing PRP + finasteride / minoxidil (rather than PRP alone). The equivalent would be if I advertised a before-after photo of someone doing massaging + finasteride, but decided to position the photo as if the results were only from massaging. It’s just bad business. So, be aware of this. Call all clinics to confirm the regimens of their highlighted patients.

If you’re seeing improvements from PRP, chances are you’ve already navigated through this mess to find a good provider. So, steer the course and keep us posted with your progress!

Saw palmetto for hair growth: does it stack up to finasteride?

Saw palmetto is often touted as nature’s finasteride. This herbal extract reduces levels of the hormone dihydrotestosterone (DHT). For this reason, it’s clinically demonstrated to improve hair growth in men with androgenic alopecia (AGA).

But is saw palmetto as effective as finasteride?

Not quite. In fact, a closer look into the research on saw palmetto reveals that taking this supplement also comes with risks.

That’s not to say that saw palmetto is ineffective. But if you’re going to opt for saw palmetto over finasteride, you’re going to want to weigh its benefits and risks. Specifically, you’re going to want to know how saw palmetto compares to finasteride in terms of its (1) ability to reduce DHT, (2) ability to regrow hair, and (3) reported side effects.

This Quick Win dives into the details (and answers). The bottom line: saw palmetto isn’t as powerful as finasteride, but it also comes with some upsides that may make it a better option, at leaast for certain hair loss sufferers.

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 research, start with our long-form articles.

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What is saw palmetto?

Saw palmetto is a palm plant native to warm humid climates (Florida).

Saw palmetto plant

Thirty years ago, researchers discovered that certain polyphenol and lipid extracts of saw palmetto could reduce the activity of type II 5-alpha reductase – an enzyme our bodies use to make the hormone dihydrotestosterone (DHT).

DHT is the main hormone implicated in pattern hair loss, also called androgenic alopecia (AGA). And interestingly, the popular hair loss drug finasteride (Propecia®) reduces that same enzyme – type II 5-alpha reductase – to lower DHT levels and improve pattern hair loss outcomes in ~80% of men trying the drug.

Unfortunately, finasteride use is also associated with sexual side effects. This scares a lot of men away from trying the drug. It also leads many of them to wonder…

“If I use saw palmetto instead of finasteride, can I still regrow hair while also reducing my risk of side effects? After all, saw palmetto is natural, and natural often means safer.”

For starters, anything branded as “natural” isn’t always safer. Many natural supplements sold through Amazon and tested by third parties have been found to contain dangerous levels of heavy metals. Moreover, many popular natural extracts – i.e., green tea extract – have been associated with hepatic failure due to the metabolic demands these extracts can place on our livers. (For more information, see my master class).

In any case, if we’re to answer the question, “Is saw palmetto as effective as finasteride?”, we’ll need to evaluate saw palmetto versus finasteride in terms of its (1) expected hair regrowth, and (2) risk of side effects.

The rest of this Quick Win does just this.

Saw palmetto vs finasteride: hair regrowth

“Hair regrowth” is a non-specific term, and most clinical studies on pattern hair loss define this term differently:

• Reductions to hair shedding
• Improvements to anagen:telogen ratios
• Increases in non-vellus hair counts
• Global photography assessments

…the list goes on.

That’s why, whenever we’re diving in studies on hair loss, we standardize the term “hair regrowth” into two categories:

1. Response Rate. This is the percentage of people receiving treatment who see a slowing, stopping, or reversal in their hair loss. After all, simply slowing down the progression of AGA is a win for most hair loss sufferers.
2. Regrowth Rate. This is the percent change in terminal (i.e., non-vellus) hair counts before and after treatment. We use this metric because it’s best out there in terms of translation to visual improvements. Increases to vellus hair counts (i.e., small, wispy, white hairs) just don’t show up in photographs, so we don’t count those.

So, if we summarize the data on saw palmetto versus finasteride, how do these two interventions compare? (1) (2)

	Saw Palmetto (320mg)	Finasteride (1mg)
Response Rate	60%; dependent on the dose and delivery (supplement or topical)	80-90%
Regrowth Rate	0-10%; potentially higher if used alongside other therapies	10%, alongside thickening of miniaturizing hair

The key takeaway: compared to finasteride, saw palmetto has a lower response rate and regrowth rate. And when we look at the individual studies that constitute these aggregated estimations, things look a little bleak.

To date, there’s only one clinical study directly comparing saw palmetto versus finasteride for the treatment of androgenic alopecia. The investigation team randomized 100 men with androgenic alopecia into two groups. They gave one group 320mg of saw palmetto and the other group 1mg of finasteride – every day, for two years. (3)

The results? After 24 months, 68% of finasteride users saw hair regrowth, while only 38% of men taking saw palmetto saw hair regrowth. Moreover, investigators noted that in the saw palmetto group, hair regrowth only occurred in the crown (i.e., vertex), and that the magnitude of regrowth was significantly less than finasteride.

In other words, saw palmetto achieves half the response rate of finasteride, and that if regrowth does occur, it’s not nearly as impressive as what finasteride achieves.

Having said that, it’s not all bad news. That same study also demonstrated that 45/50 men in the saw palmetto group saw a stop in hair loss over the two years that they took it. So, in this one study, saw palmetto showed a response rate of 90%.

This means it’s not a complete stretch to say that most men taking 320mg of saw palmetto daily should see an improvement in their pattern hair loss. It’s just that this improvement won’t be anywhere near on-par what is achievable with finasteride.

Why isn’t saw palmetto as effective as finasteride?

This likely has to do with the ways in which saw palmetto reduces DHT, and the amount of DHT that saw palmetto reduces.

Finasteride is a synthetic azosteroid. It reduces DHT by competing with (and binding to) a coenzyme that our bodies use to make type II 5-alpha reductase – the enzyme that converts free testosterone into DHT.

Conversely, saw palmetto competitively and non-competitively inhibiting type II 5-alpha reductase, reducing the binding of DHT to androgen receptors, and increasing the conversion of DHT to a weaker metabolite called androstanediol (4).

The long-story short is that these factors, along with differences in the half lives of both finasteride and saw palmetto, lead to differences in their abilities to lower DHT.

For reference, see this graph on the DHT-reducing capabilities of both saw palmetto and finasteride, as organized by different tissue sites.

The bottom line: saw palmetto is about half as effective as finasteride because it just doesn’t reduce as much DHT.

What about side effects?

At this point, we’ve really only evaluated half of the question: is saw palmetto as effective as finasteride?

In terms of response rates and regrowth rates, the answer is no. But can saw palmetto make up for its lower efficacy by being a safer long-term supplement for hair loss sufferers?

Maybe.

Saw palmetto: risk of adverse events

Long-term clinical studies show that saw palmetto’s overall rate of side effects is just 2%. Moreover, if side effects do occur, they’re relegated more so to gastrointestinal distress than to sexual dysfunction. Even better, many studies on saw palmetto show no change in libido; some studies show improvement to sexual health (at least for men with enlarged prostates). (5) (6) (7)

Finasteride: risk of adverse events

The “Yelp effect” is a phenomenon where patrons of a business are far more likely to leave a review if their experience was negative rather than positive. Finasteride is a drug that suffers from the Yelp effect, meaning that its sexual side effects are often overstated and amplified online.

Having said that, side effects do occur. Moreover, the self-assessment questionnaires filled out by participants in large-scale clinical trials for finasteride were worded in such a way where under-reporting certain side effects were more likely than not (but that’s for another article).

In any case, finasteride use does come with a heightened risk of side effects. Depending on which study you cite, between 1% and 25% of finasteride users will report issues ranging from brain fog to depression to sexual dysfunction. (8) (9) Moreover, when side effects are reported, they seem to be of higher magnitude versus saw palmetto.

The bottom line:

• Finasteride’s side effects are likely overstated online and understated in the literature
• Compared to saw palmetto, finasteride likely leads to side effects that are (1) of higher incidence, and (2) more severe

Saw palmetto or finasteride: which one is right for you?

It depends on your risk tolerance for side effects, and whether you plan on combining saw palmetto with other treatments, therapies, or procedures to make up for its lower response rates and regrowth rates.

There’s evidence that supplemental + topical saw palmetto, alongside other ingredients, might lead to better hair loss outcomes than just supplemental saw palmetto. Moreover, combining saw palmetto with massaging, microneedling, platelet-rich plasma therapy, or other interventions might help mitigate its lower efficacy.

Having said that, making these choices will depend entirely on someone’s needs, preferences, and unique hair loss situation.

Anything else to know?

Unlike finasteride, saw palmetto isn’t standardized. Serenoa repens growing conditions, extraction methods, and manufacturing practices can all impact the composition, bioavailability, and absorption of each saw palmetto supplement. In fact, these differences might explain the variances in response rates and regrowth rates seen across saw palmetto studies.

So, if you’re looking for a more comprehensive guide on how to use saw palmetto – including recommendations for dosages, extraction practices, and combinations therapies – see our saw palmetto ultimate guide here.

The bottom line

In order to evaluate whether saw palmetto is as effective as finasteride, we need to understand how the supplement compares in terms of (1) response rates, (2) regrowth rates, and (3) risk of side effects.

Saw palmetto isn’t as effective as finasteride in terms of its response rates or regrowth rates, but it also seems to cause fewer (and less severe) side effects. Because of this, making the choice to use saw palmetto over finasteride depends entirely on someone’s risk tolerance for side effects, as well as whether they plan on combining the supplement with other treatments, therapies, or procedures to make up for its less-impressive efficacy.

	Saw Palmetto (320 mg)	Finasteride (1 mg)
Response Rate	60%; dependent on the dose and delivery (supplement or topical)	80-90%
Regrowth Rate	0-10%; potentially higher if used alongside other therapies	10%, alongside thickening of miniaturizing hair
Side Effects	2%; more relegated to gastrointestinal distress than sexual side effects	1-25%; partly psychosomatic, but more severe than saw palmetto

Otherwise, if you have any questions, please feel free to leave them in the comments section.

 

Latanoprost is a medication that was originally developed to treat glaucoma. Over the last two decades, research groups have also started testing it as a treatment for hair loss – including alopecia areata, androgenic alopecia, and telogen effluvium.

Introduction

Finasteride is one of the most commonly-prescribed medications for treatment of male pattern hair loss—also known as androgenic alopecia (AGA). But it’s also used as an off-label treatment for female pattern hair loss. Evidence suggests this medication can help regrow hair in both sexes.

But what’s the best dose of finasteride for women with AGA? Unfortunately, it’s complicated. This article sets out to evaluate the data, uncover the answers, and provide recommendations based on the current landscape of clinical research.

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What Is Finasteride?

Finasteride is a drug developed to inhibit type II 5-alpha reductase. This is an enzyme in the body that converts free testosterone in dihydrotesterone (DHT).

Essentially, finasteride lowers DHT levels by reducing the amount of type II 5-alpha reductase circulating throughout our bodies. And by taking finasteride at 0.2 to 5.0 mg daily dosages, we can often reduce total DHT levels by 70%. ^[1]https://www.ncbi.nlm.nih.gov/books/NBK513329/

Why Use a Drug To Reduce DHT?

DHT is not just a metabolite of testosterone; it’s also the primary male hormone causally associated with androgenic alopecia.

We know this because studies have shown that men who cannot produce DHT are nearly fully-protected from going bald throughout a lifetime. Furthermore, clinical studies on DHT-lowering drugs – such as finasteride – show that if DHT levels are suppressed enough, 80-90% of men can arrest the progression of their pattern hair loss and even regrow 10-20% of their lost hair. ^[2]https://pubmed.ncbi.nlm.nih.gov/29407002/ ^[3]https://www.ncbi.nlm.nih.gov/books/NBK430924/

Similarly, studies on females with androgenic alopecia have shown that finasteride can also improve their hair loss outcomes. The evidence is less robust than for men, but finasteride is something many women should consider trying in order to improve their pattern hair loss.

Finasteride for Women: What’s the Perfect Dose?

In men, the FDA has approved the use of 1mg of finasteride for pattern hair loss. However, male and female hair loss cases are not always the same. Reducing DHT levels is often of therapeutic interest to fighting AGA – and for both sexes – but some clinical evidence suggests that females might need a different dose of finasteride versus males.

How Much DHT Does Finasteride Reduce?

Finasteride has what is known as a dose-dependent, logarithmic response curve for DHT reduction. In other words: a little bit of finasteride reduces nearly as much DHT as a lot of finasteride. For an example, see this chart:

Clinical studies have demonstrated that 0.2 mg and 5.0 mg reduce nearly the same amount of finasteride: 69% versus 72%, respectively.

Because of this, a lot of people actually prefer to use lower dosages of finasteride than what is generally prescribed. This practice is also supported by clinical data. For instance, in men, 0.2mg of finasteride AGA at a statistically similar level as 1.0 mg of finasteride over the course of a year. ^[4]https://europepmc.org/article/med/15319158

But is the same true with females? Unfortunately, the data is less clear.

Finasteride for Female Pattern Hair Loss: the Clinical Evidence

The FDA approves the use of 1 mg of finasteride for male pattern hair loss.^[5]https://www.fda.gov/drugs/information-drug-class/5-alpha-reductase-inhibitor-information But the underlying causes of male and female pattern hair loss cases (androgens such as DHT) are not always the same. Furthermore, while reducing DHT levels is of therapeutic relevance in treating AGA in men and women, some clinical evidence suggests that females might need a different dose of finasteride versus males. 

What does the available research tell us? Here are a few of the key studies on finasteride for women, and their main findings (summarized in the table below).

Finasteride for Women: Key Studies

Finasteride for Women: Key Studies Takeaway

There is conflicting data regarding the efficacy of finasteride for female pattern hair loss. Some studies report improvements while others do not.

There are some key variables to consider when weighing the available evidence:

• The dose of finasteride used
• The length and frequency of treatment
• Oral administration versus a topical treatment
• Whether finasteride was used in conjunction with other drugs or therapies
• The type of hair loss in the patient groups (e.g., female pattern hair loss versus age-related thinning – and was this accurately determined?)
• Patient age, history, and status (e.g., pre-, or post-menopausal, or abnormal androgen levels)
• How the treatment was assessed (e.g., quantitative hair counting versus patient self-assessment)
• Whether the study contained appropriate controls (i.e., placebo-receiving patients, ideally matched for age, weight and medical history)
• The number of patients in the study (which affects the statistical power; was the study a case report of one patient, or a larger study with a control group?).

Interpreting research data can be difficult and confusing. such as different studies using different dosages of finasteride and for varying lengths of time, measuring different hair loss outcomes, and using different numbers and ages of patients.

The specific type of hair loss is also a crucial variable.^[19]https://pubmed.ncbi.nlm.nih.gov/30604525/  Often, studies reporting positive outcomes are based on patient self-reporting, which can be suspect and not meaningfully objective or quantitative in measuring true prevention or reversal of hair loss.

What is the best dose? Explaining the conflicting results.

Given the dose-response relationship between finasteride and DHT levels, shouldn’t 1 mg be as effective as 5 mg? Why aren’t women getting consistent regrowth across doses within these ranges?

Other discrepancies are the time for which finasteride was given. In men, 1 mg of finasteride can be effective in 6-12 months, but it is possible that women require more long-term treatment regimens.^[20]https://pubmed.ncbi.nlm.nih.gov/30604525/ Generally, success with finasteride in women has been reported in both the short- and long-term.^[21]https://pubmed.ncbi.nlm.nih.gov/12399766/

Alternatively, the difference in observed efficacies between studies may be due to patient background and the type of hair loss. Hair loss in patients suffering from PCOS or adrenarche (i.e., high levels of adrenal gland activity) likely has a clear causal link to abnormal androgen signaling (and therefore suitable for finasteride), where hair loss in post-menopausal women may be more akin to age-related hair ‘thinning’, and not linked to testosterone or DHT, which may explain why some studies find no effect with finasteride.^[22]https://pubmed.ncbi.nlm.nih.gov/10674382/^[23]https://pubmed.ncbi.nlm.nih.gov/11050579/^[24]https://pubmed.ncbi.nlm.nih.gov/12399766/

That said, finasteride is also reportedly effective in patients that are androgen-normal.20 Therefore, there needs to be more careful classification of the type of hair loss and the likely underlying mechanisms, as well as clear standardization of treatment outcome measurements. 

Conclusions

Does finasteride work for women suffering from hair loss? If so, what is the ideal dosage? 

Finasteride is most beneficial for women when their hair loss occurs alongside elevated androgen levels—much like hair loss in men.

It is likely that DHT is a major factor in a proportion of female hair loss cases. Finasteride is likely to be a beneficial part of a successful hair loss regimen in these cases. However, it is not clear that male and female pattern hair loss universally share the same underlying cause.

Finasteride may be less suitable in contexts of age-related hair thinning. Hair follicles are sensitive to all manner of different hormones and chemical signals, not just androgens such as testosterone and DHT.^[25]https://pubmed.ncbi.nlm.nih.gov/32731328/

The best dose is one that maximizes the desired benefits (prevention and reversion of hair loss) while minimizing any undesirable side effects.

Finasteride can be effective at reducing DHT even in small doses. Because of this, experimentation with low levels of finasteride may lead to results with far less exposure to chemicals. Topical treatments may also be considered to further reduce systemic side effects.

Therefore, the best dose will be patient-subjective. Prior consideration of your history, goals regarding hair loss, and experimentation with dosages is needed before you will find the ideal routine for your hair health.

Topical finasteride has emerged to meet demand for hair loss treatments that promise strong results with fewer systemic side effects than oral finasteride by concentrating action at the scalp while reducing overall drug exposure. Early studies suggest it can improve hair growth and lower scalp dihydrotestosterone (DHT) with less systemic absorption, but side effects are not eliminated, and long-term head-to-head data versus oral finasteride remain limited.

This article will cut through the “same results, fewer side effects” marketing narrative and set realistic expectations by focusing on what current clinical evidence and real-world user patterns actually support.

How Does Finasteride Work?

Finasteride is a 5-alpha reductase inhibitor, meaning that it blocks this enzyme from converting testosterone into DHT, the more potent androgen that drives miniaturization of sensitive scalp follicles in androgenic alopecia (AGA). The enzyme catalyzes this conversion in the scalp, skin, liver, and prostate. By inhibiting it, finasteride lowers both local (scalp/prostate) and circulating DHT.^[1]Zito PM, Bistas KG, Patel P, et al. Finasteride. [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: … Continue reading

Why Oral Finasteride is Systemic

A standard 1 mg oral dose reduces DHT by roughly 60-70%, with some studies reporting around 70% suppression at steady state, and intraprostatic DHT falls by about 90%.^[2]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,^[3]Smith, A.B., Carson, C.C. (2009). Finasteride in the treatment of patients with benign prostatic hyperplasia: a review. Therapeutics and Clinical Risk Management. 5. 535-545. Available at: … Continue reading Because 5 alpha-reductase is expressed in multiple organs, this systemic inhibition affects DHT signaling throughout the body, not only in the scalp.  

Why Side Effects Occur

Sexual and mood-related side effects are not purely “in the mind”; they reflect altered androgen physiology in a subset of men whose tissues are more sensitive to a DHT drop, even though testosterone usually stays within the normal range or rises modestly. Reduced DHT can influence libido, erectile function, ejaculate volume, and, in some individuals, mood or energy, consistent with the hormone’s broader role beyond hair follicles.^[4]Traish, A.M. (2017). Negative Impact of Testosterone Deficiency and 5ɑ-Reductase Inhibitors Therapy on Metabolic and Sexual Function in Men. Advances in experimental medicine and biology. 1043. … Continue reading

Topical Targeting vs. Spillover

Topical finasteride aims to concentrate drug action in the scalp by delivering finasteride directly to hair follicles, potentially lowering local DHT while limiting how much drug reaches the bloodstream. However, percutaneous absorption still occurs, and pharmacokinetic studies do show measurable reductions in serum DHT with topical formulations, meaning systemic exposure is reduced compared to oral dosing, but not eliminated.^[5]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 

What the Research Says About Topical Finasteride Side Effects

The evidence on topical finasteride’s side effect profile shows a nuanced picture – measurable systemic exposure, lower but not zero adverse event rates, and substantial variability between formulations and individuals.

Systemic Absorption

The 2021 Piraccini trial, one of the largest randomized double-blind topical finasteride studies to date, tested a 0.25% finasteride spray applied once daily over 24 weeks in 458 men.^[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., Topical Finasteride Study Group. (2022). Efficacy and safety … Continue reading Plasma finasteride concentrations were over 100-fold lower than with oral finasteride. Serum DHT fell by 34.5% with topical use compared to 55.6% with a 1 mg oral tablet.

Caserini found that lower volumes (100-200 μL of 0.25% solution) reduced serum DHT by 24-26%, while higher volumes (300-400 μL) dropped it by 44-48%.^[7]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 Even at the lowest tested doses, scalp DHT declined by roughly 47-52%, demonstrating effective local action with more limited systemic spillover.

Other studies report a range of serum DHT suppression with topical formulations, but all confirm that absorption is lower than oral administration, not absent. One hydroxyl-propyl chitosan formulation was designed specifically to retain finasteride in the reticular dermis near hair bulbs; repeated-dose rat experiments showed no detectable plasma finasteride and no accumulation in skin, although human data remain sparse.^[8]Monti. D., Tampucci, S., Burgalassi, S., Chetoni, P., Lenzi, C., Pirone, A., Mailland, F. (2014). Topical formulations containing finasteride. Part I: in vitro permeation/penetration study and in … Continue reading 

So to summarize, topical finasteride’s systemic exposure is markedly reduced compared to oral dosing, yet reductions in circulating DHT do still occur across most formulations (in human studies), meaning that some degree of systemic exposure is virtually unavoidable.

Reported Side Effect Rates in Studies

Clinical trials have monitored sexual dysfunction, dermatological reactions, and less common systemic complaints, though sample sizes and durations limit the ability to detect rare or delayed adverse events.

Sexual Side Effects

In the 2021 Piraccini study, 2.8% of topical finasteride users reported sexual adverse events (decreased libido, erectile dysfunction, and ejaculatory dysfunction) versus 4.8% on oral finasteride and 3.3% on placebo. 

The similarity between the topical and placebo groups led some investigators to suggest that many reports may not be causally linked to the drug. However, a 2025 FDA pharmacovigilance analysis of adverse event reports (2019-2024) identified 32 cases involving topical finasteride formulations, most of which were compounded products, with complaints of erectile dysfunction, anxiety, brain fog, depression, fatigue, insomnia, decreased libido, and testicular pain.^[9]US Food and Drug Administration. (2025). FDA alerts health care providers, compounders and consumers of potential risks associated with compounded topical finasteride products. FDA. Available at: … Continue reading   What’s more, many of these symptoms reportedly persisted after discontinuation.

A separate analysis found that topical finasteride generated fewer signals for post-finasteride syndrome (PFS) – like events than oral finasteride, but erectile dysfunction remained the most consistently reported adverse event for both routes.^[10]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 

Scalp Irritation and Contact Dermatitis

Local reactions are the most common topical-specific side effects. A 2018 systematic review noted reports of erythema, contact dermatitis, and scalp irritation in several studies, though serious cutaneous adverse events were absent.^[12]Lee, S.W., Juhasz, M., Mobasher, P., Ekelem, C., Mesinkovska, N.A. (2018). A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. Journal of Drugs in … Continue reading 

Rates of contact dermatitis ranged from 12-24% in some combination formulations (finasteride + minoxidil), though these were generally mild and did not lead to treatment discontinuation. The irritation effect likely derives from vehicle components (alcohol, propylene glycol) as well as the active drug.

Headaches, Fatigue, and Other Systemic Complaints

Less frequently, trials have documented headaches, feeling about to faint, testicular pain, increased liver enzymes, and even bed-wetting in isolated cases. The 2025 FDA alert highlighted fatigue and insomnia among the systemic complaints associated with topical formulations, reinforcing that absorption can produce effects beyond the scalp.

Trial Limitations: Duration and Sample Size

Most published trials run 12-24 weeks with cohorts of 30-135 participants per arm, which may under-detect rare events (incidence <1%) or adverse effects that emerge only after prolonged exposure. Only a handful of studies have extended beyond six months, and none approach the multi-year observation periods needed to assess phenomena such as PFS.^[13]Pereira, A.F.J.R., Coehlo, T, O. de A. (2020). Post-finasteride syndrome. Anais Brasileiros de Dermatologia. 95(3). 271-277. Available at: https://doi.org/10.1016/j.abd.2020.02.001 Recruitment through specialist dermatology centres may also select for patients more tolerant of medication, introducing survivorship bias.

How do the Side Effects Compare with Oral Finasteride?

Head-to-head data have shown that topical finasteride has a numerically lower, but not zero, incidence of systemic adverse events. In Piraccini’s trial, sexual side effects occurred in 2.8% of topical users versus 4.8% of oral users, representing an approximate halving of risk.

There are two important points often overlooked in clinical summaries, however:

• Population averages do not predict individual susceptibility: Even if 97% of topical finasteride users report no sexual side effects in a 24-week trial, that statistic offers little reassurance to someone who is biochemically sensitive to modest DHT reductions. Genetic polymorphisms in 5ɑ-reductase isoforms, androgen receptor sensitivity, and neurosteroid metabolism all vary widely, meaning that a 25% serum DHT drop can be innocuous for one man and symptomatic for another.^[14]Pereira, A.F.J.R., Coehlo, T, O. de A. (2020). Post-finasteride syndrome. Anais Brasileiros de Dermatologia. 95(3). 271-277. Available at: https://doi.org/10.1016/j.abd.2020.02.001
• Short trials may miss long-latency or persistent events: Most published studies conclude at 6 months, yet reports to the FDA and patient registries describe symptoms that onset gradually or persist long after stopping treatment. The cases flagged in the FDA alert involved adverse events that continued to persist after product discontinuation, suggesting that systemic absorption, however modest, can trigger durable changes in a subset of users. However, the exact cause of symptom persistence is not yet known.

Why Do Some People Still Get Side Effects From Topical Finasteride?

Despite the reduced systemic exposure, some people still experience sexual, mood, and systemic adverse effects. Let’s take a look at the mechanisms why.

Skin Permeability Varies Significantly Between Individuals

Human skin is not a uniform barrier. Stratum corneum thickness, lipid composition, hydration status, pH, and blood flow differ among individuals and even within scalp regions of a single person. 

In vitro permeation studies using human cadaver scalp skin show that finasteride flux ranges of 1.1-20.1 μg/cm2/h, depending on vehicle choice, a roughly 18-fold variation. Live scalp skin likely exhibits even greater heterogeneity due to sebum content, follicle density, and individual differences in dermal blood flow, all of which influence how much drug reaches the bloodstream versus remaining confined to follicular tissue.^[15]Farah, A.H., Brown, M.B., McAuley, W.J. (2020). Enhanced Follicular Delivery of Finasteride to Human Scalp Skin Using Heat and Chemical Penetration Enhancers. Pharmaceutical Research. 37(6). 112. … Continue reading

For topical finasteride to minimize systemic exposure, it needs to stay within the area of the hair follicle. Variability in penetration means some individuals absorb more systemically than others, despite using the same concentration and volume.

Vehicle Formulation Dramatically Alters Absorption

The formulation of a topical finasteride product isn’t just a minor detail; it’s one of the biggest determinants of how much of the medication actually enters the bloodstream. Not all vehicles behave the same way, and the differences can be dramatic. For example, in vitro research comparing common topical solvents on human scalp skin shows that propylene glycol (PG) and isopropyl alcohol (IPA) formulations allow far more drug to pass through the skin: roughly 62–81 µg/cm² over 24 hours. In contrast, dimethyl isosorbide (DMI), often marketed as a “low-penetration” carrier, delivered just 17.8 µg/cm² in the same timeframe.^[16]Farah, A.H., Brown, M.B., McAuley, W.J. (2020). Enhanced Follicular Delivery of Finasteride to Human Scalp Skin Using Heat and Chemical Penetration Enhancers. Pharmaceutical Research. 37(6). 112. … Continue reading That’s a 4.5-fold reduction in systemic permeation, purely from changing the solvent.

More sophisticated delivery systems behave differently still. Liposomal and niosomal gels, for example, are designed to deposit the medication deeper into hair follicles while limiting diffusion into the bloodstream. And in controlled experiments, these vesicular carriers did exactly that: liquid-state liposomes delivered 2.1–2.3% of the applied dose into the skin, compared to only 0.76% from a standard hydroalcoholic solution.^[17]Tabbakhian, M., Tavakoli, N., Jaafari, M.R., Daneshamouz, S. (2006). Enhancement of follicular delivery of finasteride by liposomes and niosomes: 1. In vitro permeation and in vivo deposition studies … Continue reading 

In other words, depending on the vehicle, the same dose of finasteride can behave like a local scalp medication or something much closer to an oral drug.

At the opposite end of the spectrum are ethosomes, ethanol-rich vesicles that dramatically increase drug penetration. In one study, finasteride ethosomes produced 7.4-times higher transdermal flux than the same drug in an aqueous solution, reaching all the way into the dermis.^[18]Rao, Y., Zheng, F., Zhang, X., Gao, J., Liang, W. (2008). In vitro Percutaneous Permeation and Skin Accumulation of Finasteride Using Vesicular Ethosomal Carriers. 9(3). 860-865. Available at: … Continue reading

This is the kind of penetration behavior that significantly raises the likelihood of systemic absorption.

The bottom line: two topical finasteride products with the same concentration can have completely different side-effect profiles, simply because the vehicles modulate how much drug gets through the skin. Hydroalcoholic sprays tend to penetrate more aggressively; liposomal or niosomal gels are usually more conservative; and individual biology, skin barrier integrity, inflammation, and sebaceous output add yet another layer of variability. This is why real-world responses to topical finasteride are so mixed, and why formulation needs to be taken as seriously as the dose itself.

Concentration and Application Volume Compounds Absorption

Higher concentrations and larger volumes increase both local scalp DHT reduction and systemic spillover. As mentioned above, Caserini’s dose-response study found that applying 100-200 μL of 0.25% finasteride reduced serum DHT by 24-26%, whereas 300-400 μL volumes reduced it by 44-48%, approaching the efficacy of oral dosing at the higher end.^[19]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 

Users who apply larger volumes, cover a wider scalp area, or use higher-concentration formulations absorb more drug systemically, shifting the risk-benefit profile toward greater potential for side effects.

Finasteride’s Half-Life Enables Accumulation

Finasteride has a terminal half-life of 5-6 hours in young men and 8 hours in older men.^[20]Mysore, V. (2012). Finasteride and sexual side effects. Indian Dermatology Online Journal. 3(1). 62-65. Available at: https://doi.org/10.4103/2229-5178.93496 Although short, daily topical application leads to steady-state accumulation in plasma and skin tissues.

With topical dosing, measurable finasteride concentrations appear in plasma within hours and remain detectable for a full day; repeated daily application amplifies cumulative levels, particularly if absorption is higher than intended due to vehicle choice or individual skin permeability.^[21]Tai, Z., Cui, Z., Shi, X., Li, H., Chai, R., Huang, Y., Fang, Y., Jia, D., Zhu, Q., Chen, Z. (2025). The Pharmacokinetics of Topical Finasteride 0.25% Spray in Chinese Adult Male Volunteers with … Continue reading 

DHT Sensitivity Varies Widely Between Individuals

Even when two people experience the same level of DHT reduction, their bodies may not respond the same way. This is where individual biology plays a much bigger role than most clinical studies acknowledge. Variations in genes tied to 5α-reductase activity, androgen receptor sensitivity (including CAG repeat length), and enzymes involved in neurosteroid production, such as 3α-HSD, can all influence how strongly someone reacts to changes in DHT.^[22]Cecchin, E., De Mattia, E., Toffoli, G.,  Mazzon, G., Cauci, S., Trombetta, C. (2014). A Pharmacogenetic Survey of Androgen Receptor (CAG)N and (GGN)N Polymorphisms in Patients Experiencing … Continue reading,^[23]Rahimi-Ardabili, B., Pourandarjani, R., Habibollahi, P., Mualeki, A. (2006). Finasteride-induced depression: a prospective study. BMC Clinical Pharmacology. 6(7). Available at: … Continue reading 

For one man, a 30% drop in circulating DHT might feel completely benign. For another, that exact same reduction might coincide with noticeable changes in libido, erectile quality, or overall sexual function.

Layered on top of genetics are factors like baseline hormone levels, underlying hypogonadism, and even a person’s psychophysiological sensitivity to small hormonal shifts. Together, these variables help explain why side effects remain so individualized and difficult to predict, and why two people using an identical topical finasteride formulation can walk away with very different experiences. This isn’t meant to alarm anyone, only to highlight that DHT suppression is not a one-size-fits-all phenomenon, and that understanding your own sensitivity is often just as important as choosing the right dose or vehicle.

How Can I Minimize the Risk of Topical Finasteride Side Effects?

Target the Lowest Effective Exposure

• Understand exposure = concentration × volume. The systemic finasteride dose delivered through the scalp depends on both how strong the solution is and how much is applied. A low-concentration solution applied in large volume can expose the body to as much finasteride as a small volume of a stronger solution. Both variables must be considered together when aiming to reduce side effects.
• Start with the minimum viable dose. Evidence suggests that daily exposure to around 0.1 mg (for example, 0.005% solution applied at 2 mL per day) can still achieve measurable scalp DHT reduction with negligible systemic suppression.
• 0.25% remains the most studied concentration. Clinical trials show that 0.25% topical finasteride effectively treats androgenetic alopecia with hair density gains similar to oral finasteride yet significantly lower serum DHT reduction. For most users, starting at or below this level helps balance efficacy and safety.
• Higher isn’t always better. Increasing concentration or volume each raises systemic absorption, but hair-growth benefits tend to plateau. Pushing beyond the optimal concentration can shift the risk-to-benefit ratio unfavorably.
• Consider titrating upward. If highly sensitive to hormonal side effects, begin at lower exposure (e.g., 0.025–0.1% at 1 mL daily), then increase concentration or frequency only if well-tolerated and results plateau. Serum DHT measurements can help assess systemic exposure over time.

Adjust Volume and Frequency to Limit Systemic Load

• Keep volume conservative. Systemic absorption scales with total dose applied. Around 1 mL per application is a common clinical standard; using more typically provides diminishing returns for hair outcomes but notably raises systemic uptake.
• Use the lowest frequency that maintains results. Because twice-daily 0.25% use can suppress serum DHT by up to 70%—similar to oral dosing—while once-daily reduces it by only 20–35%, finding a balance between efficacy and exposure is key. For many users, once-daily application of a lower-strength solution achieves a good safety–efficacy trade-off.

Choose Vehicles Carefully

• Hydroalcoholic vs. liposomal: Standard hydroalcoholic (alcohol-based) solutions enhance drug penetration, which can lead to greater systemic absorption. In contrast, advanced vehicles like liposomal or other nanoparticle-based formulations are designed to target drug delivery to the hair follicle and reduce transdermal flux into the bloodstream.

Implement Smart Application Strategies

• Apply to a dry scalp: Applying topicals to wet skin can enhance absorption. Ensure the scalp is completely dry to create a more robust barrier.
• Target affected areas only: Use the applicator to apply the solution precisely to the areas of thinning hair, not the entire scalp, to limit the total surface area of absorption. 
• Avoid compromised barriers: Do not apply the solution immediately after microneedling, on sunburnt skin, or on a scalp with cuts, inflammation, or dermatitis, as a compromised skin barrier significantly increases uptake.
• Wash hands thoroughly: Always wash hands with soap and water after application to prevent accidental transfer to other body parts or individuals.

Important: If you experience any side effects, we recommend first stopping and speaking to your primary care physician.

Who Should Avoid or Be Cautious with Topical Finasteride?

While topical finasteride carries a lower risk profile than its oral counterpart, some people may still need to exercise caution or avoid the drug entirely. 

Groups That Should Exercise Caution

• Those with a prior history of persistent sexual dysfunction from oral finasteride. 
• People with underlying endocrine disorders or baseline sexual dysfunction. 
• Those sensitive to propylene glycol or alcohol-based carrier agents.

It should be mentioned that a history of side effects from oral finasteride does not mean that topical finasteride won’t work well for you; however, it does warrant a personalized, cautious approach. This approach might include starting with lower doses, extended monitoring, and communication with the prescribing physician about any potential symptoms.

Groups That Should Avoid Topical Finasteride

• Women who are pregnant or attempting to conceive. 
• People with severe scalp dermatitis or barrier dysfunction.
• Individuals with known allergy/hypersensitivity to finasteride or formulation components.

If I Can’t Tolerate Topical Finasteride, What Should I Do?

For users unable to tolerate topical finasteride due to side effects or scalp irritation, several evidence-based alternatives exist.

Pharmacological Alternatives

Low Dose Oral Minoxidil 

Oral minoxidil is a hair growth stimulant that bypasses the hormonal pathway entirely. Studies show high efficacy (e.g., 43% of men achieving excellent results with 5 mg), but it carries systemic risks such as hypertrichosis (excess body hair), fluid retention, and cardiovascular effects like tachycardia.^[24]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

Alternative Topical Anti-Androgens

Fluridil is a topical anti-androgen designed to degrade in water (i.e., blood), minimizing systemic exposure. Clinical data are limited but suggest efficacy without affecting serum testosterone or sexual function.^[25]Sovak, M., Seligson, A.L., Kucerova, R., Bienova, M., Hajduch, M., Bucek, M. (2002). Fluridil, a rationally designed topical agent for androgenetic alopecia: first clinical experience. Dermatologic … Continue reading

Clascoterone (17ɑ-proprionate) is an androgen receptor antagonist that competes with DHT at the follicle rather than reducing DHT production. It offers a different mechanism but is still under investigation for hair loss.^[26]Devjani, S., Ezemma, O., Kelley, K.J., Stratton, S., Senna, M. (2023). Androgenetic Alopecia: Therapy Update. Drugs. 83(8). 701-715. Available at: PMID: 37166619

Pyrilutamide is a non-steroidal anti-androgen that binds to the androgen receptor with high affinity. Like fluridil, it is designed to metabolize into an inactive form upon entering systemic circulation, theoretically offering a safety advantage over finasteride.^[27]Biospace. (2023). Kintor Pharma’s KX-826 and GT20029 for Treatment of Androgenetic Alopecia (AGA) and Acne Presented at AAD 2023. Biospace. Available at: … Continue reading

Non-Pharmaceutical Options

Microneedling creates micro-injuries in the scalp and stimulates growth factors (PDGF, VEGF) and activates Wnt/ꞵ-catening signaling, promoting hair regeneration even without concurrent drug use.^[28]Dhurat, R., Sukesh, M.S., Ayhad, G., Dandale, A., Pal, A., Pund, P. (2013). A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study. International … Continue reading 

Low-level laser therapy (LLLT) devices use red light (650-655 nm) to stimulate mitochondrial activity in hair follicles, prolonging anagen and improving density with an excellent safety profile.^[29]Egger, A., Resnik, S.R., Aickara, D., Maranda, E., Kaiser, M., Wikramanayake, T.C. (2020).  Examining the Safety and Efficacy of Low-Level Laser Therapy for Male and Female Pattern Hair Loss: A … Continue reading 

Some botanical supplements have some 5ɑ-reductase inhibitory properties. Saw palmetto and pumpkin seed oil have been shown to have mild  5ɑ-reductase inhibition.^[30]Cho, Y.H., Lee, S.Y., Jeong, D.W., Choi, E.J., Kim, Y.J., Lee, J.G., Yi, H.Y., Cha, H.S. (2014). Effect of Pumpkin Seed Oil on Hair Growth in Men with Androgenetic Alopecia: A Randomized, … Continue reading,^[31]Pilar, P., 2010. Potency of a novel saw palmetto ethanol extract, SPET-085, for inhibition of 5alpha-reductase II. Advances in Therapy. 27(8). 555-563. Available at: … Continue reading  While less potent than finasteride (reducing DHT by ~30-40% vs. >60%), they may provide a viable “middle ground” for those seeking modest stabilization.

Final Thoughts

Topical finasteride offers a compelling middle path for those seeking the hair-growth benefits of 5-α-reductase inhibition with a lower likelihood of systemic side effects. But “lower” does not mean “none,” and responses vary widely depending on formulation, dose, skin permeability, and individual DHT sensitivity. The current research, while promising, remains short-term, and real-world patterns remind us that systemic exposure is still possible.

For many people, topical finasteride can be a safe, effective component of a broader hair-loss program. The key is approaching it strategically: start low, personalize dosing, choose the right vehicle, and monitor closely for changes. For others, especially those prone to hormonal side effects, alternatives ranging from anti-androgen topicals to non-pharmaceutical options may offer a better balance of efficacy and tolerability.

As with any AGA therapy, the best results come from matching the treatment to the individual, not the other way around.

After years of anticipation, we finally have the first-ever study testing topical dutasteride as a standalone treatment for androgenic alopecia (AGA). No microneedling, no formulations mixed with other ingredients, just topical dutasteride itself.

And the results?

Frankly, they are shocking.

According to the study, low-dose topical dutasteride outperformed oral finasteride for hair regrowth. 

On the face of it, this is so surprising that it borders on unbelievable, especially given the 5+ years of real-world data we’ve collected from our members. 

So, in this article, we’ll break down:

• What we previously knew about topical dutasteride.
• How real-world user experiences compare to clinical findings.
• What this new study claims.
• And why two major methodological problems force us to seriously question the results.

What We Knew About Low-Dose Topical Dutasteride Before This Study

Until now, only two small clinical studies have evaluated low-dose topical dutasteride. Both used it alongside microneedling and applied it just once every 1-4 weeks.

1. Nada et al. (2018): Microneedling + Topical Dutasteride vs. Microneedling Alone

Nada et al. reported that adding low-dose topical dutasteride to a structured microneedling regimen improved hair density and shaft thickness more than microneedling alone, while only slightly reducing serum DHT, likely without meaningful systemic hormonal impact.^[1]Nada, E.A., El-Dawla, R.E., El-Maged, W.M.A., Elmaged, M.A.A. (2018). Topical dutasteride with microneedling in treatment of male androgenetic alopecia. Sohag Medical Journal. 22(1). Available at: … Continue reading

30 men with AGA were randomized to either microneedling plus topical dutasteride 0.02% or microneedling alone for six months. Both groups received 13 microneedling sessions with a 1.5 mm Dermapen (12-needle cartridge) on a staggered schedule: weekly during the first 8 weeks, then gradually reduced to once every 2-4 weeks through month six. In the combination arm, up to 2 mL of 0.02% dutasteride 

1. Sanchez-Meza et al. (2022): Microneedling + Topical Dutasteride vs. Microneedling Alone

Sanchez-Meza et al. found that adding very low-dose topical dutasteride to microneedling produced greater clinical and trichoscopic improvement than microneedling with placebo, without reported sexual side effects and with much lower total dutasteride exposure than earlier work.^[2]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

34 men with AGA were randomized to microneedling plus 1 mL of 0.01% topical dutasteride (~0.1 mg) or microneedling plus 1 mL of saline as a placebo. Both groups received three treatment sessions spaced 4 weeks apart using a Dr. Pen Ultima A6 device set to a 2.5 mm needle depth, and outcomes were assessed over a 16-20 week period.

While both these studies showed mild hair regrowth, the effect is not from topical dutasteride alone, nor from daily use. 

Furthermore, low-dose topical dutasteride showed almost no systemic dihydrotestosterone (DHT) suppression. 

Across these studies, bloodwork suggested:

• Little to no measurable DHT suppression
• Meaning minimal systemic absorption
• And therefore lower risk of systemic side effects

This makes sense. Dutasteride is a large, lipophilic molecule. At low concentrations, it tends to stay localized to the scalp unless dosing or penetration enhancers are significant.

What Did Real-World Users Experience?

Because early studies were promising, some of our members tried 0.01-0.02% topical dutasteride in the years that followed.

A dozen users also tracked blood DHT levels before and after treatment. 

The results? Strong localization with minimal regrowth.

• No meaningful changes in serum DHT (just normal daily variation of 10-15%). 
• Even among users applying up to 2 mL daily.
• Meaning: absorption remained low – as expected.
• But…users also reported very little growth.

Instead, most people saw hair maintenance, not cosmetic improvement. 

This aligns with the published studies: low-dose topical dutasteride appears to stabilize hair loss, with minimal systemic impact, but not drive substantial growth.

You can get more information about this and comparisons to topical finasteride here: 

• Topical Dutasteride Vs. Topical Dutasteride: The Dose Decides Everything (2025)
• Topical Finasteride: Where Do We Stand Today? (2025 Update)
• Topical Finasteride: Same Results, No Side Effects? (2022)

What Happened in the August 2025 Study?

This new randomized, double-blind, placebo-controlled study appeared to be the gold standard of topical dutasteride research.^[3]Panuganti, V.K., Mandala, P.K., Grandhi, V.R., Alluri, C.V., Mohammad, J., Rao, S., Dundigalla. (2025). A Randomized, Double-Blind, Placebo and Active Controlled Phase II Study to Evaluate the Safety … Continue reading  

It was the first study to test topical dutasteride:

• By itself (no microneedling).
• With daily use.
• Across multiple doses (0.01%, 0.02%, and 0.05%).
• Against both a placebo and oral finasteride.

On paper, this looked like the definitive study that we have long needed.

Study Design

135 men aged 20-60 with Norwood III vertex, IV, or V AGA were randomized across five treatment arms in a 2:2:2:2:1 ratio:

• 0.01% topical dutasteride (n=30)
• 0.02% topical dutasteride (n=30)
• 0.05% topical dutasteride (n=30)
• Oral finasteride 1 mg + placebo topical (n=30)
• Placebo topical + placebo oral (n=15).

All participants were Asian men, average age of ~38 years. Baseline hair loss severity was balanced across groups. 

Each 1 mL dose contained:

• 0.01% = 0.1 mg dutasteride
• 0.02% = 0.2 mg dutasteride
• 0.05% = 0.5 mg dutasteride 

Importantly, the solution was nearly 30% dehydrated alcohol, a known penetration enhancer. This choice may have implications for systemic absorption and hair-count interpretation, though the authors claim systemic exposure remained minimal. 

The researchers measured hair counts (total area hair counts) and hair widths (total area hair widths). Using a Dino-Lite microscope, researchers identified a 1.9 cm2 circular region at the vertex, clipped hairs to 0.5 – 1 mm, marked the center of the circle, and captured macrophotographs at baseline, week 12, and week 24.

The authors do not mention tattooing, ink permanence, or the use of a positioning device, which becomes critically important later.

The Study’s Reported Results

Here’s where the shock factor begins.

At 24 weeks, the study reported:

• 0.01% dutasteride: +32.32 hairs/cm2
• 0.02% dutasteride: +27.48 hairs/cm2
• 0.05% dutasteride: +75.52 hairs/cm2
• Oral finasteride: +41.21 hairs/cm2
• Placebo: 0.07 hairs/cm2

The headline claim: “0.05% topical dutasteride significantly outperformed oral finasteride (p=0.0083)”

This is a remarkable result, and one that contradicts every known real-world case we’ve observed at similar dosing. 

Hair-Width Improvements

All active groups increased hair thickness, with results very close to oral finasteride:

• 0.01% +6.68 μm.
• 0.02% +9.15 μm.
• 0.05% +11.59 μm.
• Finasteride: +10.68 μm.
• Placebo: +4.00 μm.

Only the 0.05% topical and finasteride groups significantly beat placebo. The 0.05% topical did not significantly outperform finasteride in hair-width metrics.

Global Photography Assessment (Investigator-Rated)

At 24 weeks, the percentage of participants rated as having “moderate improvement” or better (GPA ≥ +2) was:

• 0.05% topical: 68.97%.
• Finasteride: 21.43%.
• Placebo: 13.33%.

These numbers suggest a level of regrowth from 0.5 mg/week of topical dutasteride that we’ve simply never witnessed, not in our community, not in the medical literature, and not among clinicians who routinely prescribe topical dutasteride. 

Patient-Reported Outcomes (MHGQ)

By week 24, 96.55% of 0.05% topical users were satisfied with the hair on top of their heads. This is far above the finasteride group (71.43%) and far above the placebo (33.33%).

Again, the magnitude of the difference warrants scrutiny.

Serum Hormone Changes

This is where things do align with real-world experiences of low-dose topical users.

DHT Reductions

• Finasteride: 11% to -27%.
• 0.05% topical dutasteride: around -9% to -11%.

Testosterone Increases

• Finasteride: +20%.
• Topical dutasteride: modest, non-significant changes.

The authors emphasize that topical dutasteride caused minimal systemic effects.

This is consistent with our members’ lab data – but inconsistent with the hair-growth magnitude reported.

Pharmacokinetics (How Much Enters the Bloodstream)

According to the PK data: 

• Plasma dutasteride levels were near or below quantification limits.
• A few values spiked as high as 2555 pg/mL, suggesting occasional high absorption events.
• Dutasteride remained detectable at day 168, implying accumulation over time.

The authors interpret this as “low systemic exposure”. But variability this large raises questions.

Safety Findings

Across the entire study, no serious adverse events were reported, no withdrawals due to safety, minimal skin irritation, and all groups showed mild effects like “glazing” at similar rates.

This matches expectations for low-dose topicals.

So, Why Don’t the Results Match Real-World Experience?

For more than five years, we’ve tracked user outcomes from low-dose topical dutasteride at comparable or even higher weekly doses than used in this study.

Not once have we seen:

• Regrowth exceeding oral finasteride.
• Cosmetic transformation from 0.05% topical alone.
• Hair-count improvements anywhere near +75 hairs/cm2.

Even in dermatology clinics across the world, this simply isn’t observed. So, why would this study find such dramatically different results?

It comes down to two major methodological problems – both related to hair counts.

Problem #1: Baseline Hair Counts That Defy Biology

The average baseline hair density reported in the study was 305-330 hairs/cm2. 

For context: 

• A healthy adult without hair loss typically has 100-250 hairs/cm2. 
• Men with Norwood III-V AGA typically have 25-100 hairs/cm2 in the vertex.
• Yet this study reports 300+ hairs/cm2 in balding men.

This would mean that severely balding scalps had triple the hair density of a normal, non-balding scalp, and that hair counts exceeded what is physiologically plausible.

Why might this happen?

Possible Explanations

Vellus hairs were counted.

• The study never defines a diameter cutoff.
• Best practice is to exclude hairs ≤40 µm.
• Counting vellus hairs inflates numbers dramatically. 

The measurement area was bigger than stated.

• The paper claims 1 cm2.
• Even a small mismeasurement could triple hair counts.

Manual counting errors.

• The study doesn’t specify software use. 
• Manual hair counting is outdated and error-prone.

None of these possibilities inspires confidence in the baseline data.

Problem #2: The Measurement Circle Moves Between Photos

This is the more serious problem, and the one most likely to invalidate the findings entirely.

When examining the study’s published before-and-after images, the measurement circles:

• Change location.
• Change size.
• Change shape.
• Appear hand-drawn.
• Clearly do not track the same exact scalp area over time.

Take a close look at these images; the center point marks do not appear to be consistent (at least from these photos). This means that you really can’t compare the improvements over time, as the follow-up hair counts would have been conducted in slightly different areas of the scalp!

This is an enormous methodological flaw.

A shift of just 1-2 millimetres in circle placement can change hair counts by 50% or more, something we demonstrated in our 2021 publication.^[5]Jnr, R.E., Ruiz, S. (2021). Conflicting Reports Regarding the Histopathological Features of Androgenic Alopecia: Are Biopsy Location, Hair Diameter Diversity, and Relative Hair Follicle … Continue reading

Yet the improvements reported in this study were around 10-30%.

Meaning: These “improvements” could be fully explained by inconsistent circle placement, not actual regrowth. 

This alone is enough to call the validity of the hair-count data into question. 

Final Thoughts

This is one situation where we at PHH trust the real-world experiences of our members over a randomized, controlled clinical trial, because while the study appears rigorous on the surface, its hair-counting methods reveal inconsistencies significant enough to undermine its conclusions. 

All available evidence still supports the following: low-dose topical dutasteride (0.01-0.05%) localizes well to the scalp, minimally suppresses serum DHT, effectively slows or stops hair loss, and rarely produces meaningful regrowth, whereas high-strength topical dutasteride (≥0.1%) is more likely to leak systemically, carry a greater risk of side effects, and generate visible regrowth approaching the results of oral finasteride.

Female hair loss remains a widely misunderstood and often under-treated condition, affecting nearly one-third of all women at some point in their lives and up to two-thirds after menopause. Unlike male pattern hair loss, research and treatment options for women have historically lagged, resulting in limited specialized solutions and significant emotional distress for those afflicted.

Minoxidil stands as the only FDA-approved medication for female pattern hair loss. Its efficacy is supported by robust data, particularly at the 2 and 5% concentrations for women. In this guide, we will showcase the six best minoxidil products for women, including the best overall, best value, and top specialized choices. 

Quick Look: Top 6 Minoxidil Brands for Women 2025

Product	Strength	Format	Customization	Price	Best
Ulo Women’s Rx Minoxidil	7%	Solution	High	$41.65	Overall
Musely	8%	Solution	High	$99	Strength
Rogaine Women’s Foam	5%	Foam	None	$49.97	Sensitivity
Hers	2%-5%	Solution/Foam	None	$30	Value
Happy Head (Women’s Formula)	6%	Solution	High	$79	Alternative
Winona	7%	Solution	None	$150	Woman-centered care

Before we get into our list, let’s first take a look at what female pattern hair loss is and how minoxidil works for women.

Interested in Topical Minoxidil?

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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 Female Pattern Hair Loss?

Female pattern hair loss (FPHL) is a chronic, non-scarring alopecia where genetically susceptible follicles on the central scalp progressively minaturize, leading to reduced hair density over time. Clinically, women usually show diffuse thinning over the crown and midline part with relative preservation of the frontal hairline rather than “bald patches”.^[1]Bhat, Y.J., Saqib, N-U., Latif, I., Hassan, I. (2020). Female Pattern Hair Loss – An Update. Indian Dermatology Online Journal. 11(4). 493-501. Available at: … Continue reading 

The Ludwig scale grades this pattern from I-III: mild central thinning (I), moderate widening of the part and density loss (II), and advanced, see-through vertex thinning (III). Trichoscopy and histology show increased hair shaft diameter variability and replacement of terminal hairs by finer, vellus-like hairs.^[2]Kothari, C.R., Shivakumar, P. (2024). Trichoscopic Features in Female Pattern Hair Loss: 1-Year Hospital-Based Cross-Sectional Study. Clinical Dermatology Review. 8(2). 95-101. Available at: … Continue reading 

FPHL arises from a mix of genetics, hormones, low-grade inflammation, oxidative stress, and microvascular and aging-related changes around the follicle. Unlike classic male pattern hair loss, many women have normal serum androgens, suggesting that local androgen sensitivity and non-androgen mechanisms both contribute.^[3]Ramos, P.M., Miot, H.A. (2015). Female Pattern Hair Loss: a clinical and pathophysiological review. Anais Brasileiros de Dermatologia. 90(4). 529-543. Available at: … Continue reading 

How Minoxidil Works

Minoxidil functions as a potassium channel opener that promotes vasodilation, increasing blood flow and improving microcirculation around hair follicles.^[4]Hussein, R.S., Dayel, S.B., Abahussein, O., El-Sherbiny, A.A. (2024). Applications and efficacy of minoxidil in dermatology. Skin Health and Disease. 4(6). E472. Available at: … Continue reading

 It is also a prodrug that must be converted by the sulfotransferase enzyme into its active form, minoxidil sulfate. This conversion helps extend the anagen (growth) phase while shortening the telogen (resting) phase, thereby shifting a greater number of follicles into active growth cycles.^[5]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

Additional evidence indicates that minoxidil stimulates the expression of growth-promoting factors, such as vascular endothelial growth factor (VEGF), and activates the Wnt/β-catenin signaling pathway, both of which further support hair regrowth.^[6]Gupta, A.K., Talukder, M., Shemer, A., Piraccini, B.M., Tosti, A. (2023). Low-Dose Oral Minoxidil for Alopecia: A Comprehensive Review. Skin Appendage Disorders. 9(6). 423-437. Available at: … Continue reading

While minoxidil does not directly address dihydrotestosterone (DHT), it can enhance the effectiveness of other therapies by targeting different biological pathways involved in hair loss. When used alongside anti-DHT treatments such as finasteride, which reduces the underlying hormonal driver of androgenic alopecia, minoxidil offers a complementary, non-hormonal mechanism of action. Clinical research demonstrates that the combined use of topical finasteride and minoxidil produces greater improvements in hair density in men compared to minoxidil alone.^[7]Asad, N., Naseer, M., Ghafoor, R. (2024). Efficacy of Topical Finasteride 0.25% with Minoxidil 5% versus Topical Minoxidil 5% Alone in Treatment of Male Pattern Androgenic Alopecia. Journal of Drugs … Continue reading

Why Women Respond Differently

In women, pattern hair loss is generally less strictly DHT-driven than in men, so microcirculation, oxidative stress, and local inflammatory pathways play a proportionately greater role.^[8]Fabbrocini, G., Cantelli, M., Masara, A., Annunziata, M.C., Marasca, C., Cacciapuoti, S. (2018). Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. International Journal … Continue reading This helps explain why a vasodilatory, pro-anagen agent like minoxidil is often effective even when anti-androgens alone are insufficient.

Hormonal transitions like perimenopause/menopause, thyroid dysfunction, and polycystic ovary syndrome (PCOS) commonly unmask or accelerate FPHL by altering estrogen-androgen balance and cycling dynamics.^[9]Aksenenko, M., Palkina, N., Komina, A., Ruksha, T. (2019). MiR-92a-1-5p and miR-328-3p Are Up-Regulated in Skin of Female Pattern Hair Loss Patients. Annals of Dermatology. 31(2). 256-259. Available … Continue reading 

OTC vs Prescription Minoxidil for Women

Over-the-counter (OTC) minoxidil for women typically comes at 2-5% concentrations, while prescription or compounded products may use 5-8% or higher strengths in customized products.

2% minoxidil is the classic, label-approved strength for women, with clear evidence of a benefit versus placebo.^[10]van Zuuren, E.J., Fedorowicz, Z., Schoones, J. (2016). Interventions for female pattern hair loss. Cochrane Database of Systematic Reviews. 2016(5). CD007628. Available at: … Continue reading 

Compounded “high-strength” minoxidil (5-8%+) is prescription only and relies in part on carrier agent formulation.^[11]Sattur, S.S., Sattur, I.S. (2021). Pharmacological Management of Pattern Hair Loss. Indian Journal of Plastic Surgery. 54(4). 422-434. Available at: https://doi.org/10.1055/s-0041-1739254 Simply raising the percentage does not guarantee better results and may raise the risk of irritation, hypertrichosis, or systemic absorption of the drug.^[12]Ghonemy, S., Alarawi, A., Bessar, H. (2021). 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

So, with that in mind, let’s take a look at our top six minoxidil brands of 2025.

Best Minoxidil Brands for Women

#1 Best Overall: Ulo Women’s Rx Minoxidil (7%)

Pros:	Cons:
✓ Prescription-only 7% minoxidil, higher than standard OTC strengths	✗Prescription products are only available in the USA
✓ Optional evidence-based add-ons
✓ Quality-tested ingredients free of irritants
✓ Includes medical consultation and ongoing monitoring

Ulo Women’s Rx Minoxidil+ is our go-to product for topical minoxidil treatment. It is designed for those who want more than “pink-labeled” 2-5% solutions and are comfortable with a prescription approach guided by specialists. The 7% concentrated and layered actives (including cetirizine 1%, tretinoin 0.01%, melatonin 0.01%, and caffeine 0.2%) target multiple facets of hair loss with a level of customization that goes beyond typical off-the-shelf products.

Bottom Line: Ulo offers the most precise, clinically guided minoxidil-based treatment for women in 2025, combining higher-strength therapy with thoughtful formulation and ongoing medical oversight.

#2 Best for Strength: Musely The Hair Topical Solution-Classic

Pros:	Cons:
✓ High-strength 8% prescription minoxidil.	✗ Use of corticosteroids increases the risk of skin thinning.
✓ Optional evidence-based add-ons like dutasteride and spironolactone for hormonal control.	✗ Propylene glycol and ethyl alcohol base, which can sting or dry out sensitive scalps.
✓ Additional scalp-supporting actives like tretinoin, ketoconazole, caffeine, and melatonin.	✗ More expensive than simpler OTC or lower-strength prescription options.
✓ Includes periodic medical follow-up.

Musely’s 8% “Classic” Hair Topical is designed for women with advanced thinning or those who have plateaued on conventional strengths, combining high-dose minoxidil with potent anti-androgens and supportive ingredients in a single solution, including optional add-ons such as dutasteride 0.3%, spironolactone 0.075%, tretinoin 0.01%, ketoconazole 2%, hydrocortisone 1%, plus adjuncts like caffeine and melatonin. 

It functions more as an intensive, prescription-only protocol than a starter product, and is best reserved for users willing to tolerate a stronger propylene glycol/ethyl alcohol vehicle, and possible skin thinning if using long-term due to the addition of corticosteroids.

Bottom line: For women with stubborn, progressive hair loss who have outgrown basic 5% formulas, Musely’s high-strength, multi-active topical offers one of the most powerful at-home options, provided they are comfortable with higher cost and higher irritation risk.

#3 Best for Sensitivity: Rogaine Women’s Foam

Pros:	Cons:
✓ Propylene-glycol-free foam vehicle, often better tolerated on sensitive or irritated scalps.	✗No medical consultation or follow-up after buying
✓ Widely available OTC	✗ No customization.

Rogaine Women’s Foam is a classic choice for those looking for a gentle-on-the-scalp option of minoxidil. The propylene-glycol-free foam base, robust clinical evidence, and once-daily 5% option make it a gentle yet effective starting point for treating female pattern thinning. It should be noted that if you wanted to try the lower dose option (2%), you need to buy the solution, which contains propylene glycol, and so may not be as beneficial for those with sensitive skin. 

Bottom Line: Get the foam if you have a sensitive scalp or are a beginner, wanting a low-irritant minoxidil option. 

#4 Best Value: Hers Minoxidil Foam and Solution

Pros:	Cons:
✓ Budget-friendly option at around $30 for a 2-month supply.	✗No advanced customization available.
✓ Offers both 2% and 5% strengths at the same price.
✓ Available in solution and foam formats.

Hers Minoxidil is designed for women who want a clinically supported minoxidil treatment without paying premium prices for branding or heavy telehealth layering. With standard 2 and 5% options in familiar vehicles, it delivers an approachable, budget-conscious package for those comfortable managing a simple daily routine themselves.

Bottom Line: For cost-conscious women who want an easy, no-frills entry into proven minoxidil therapy, Hers Minoxidil offers standard concentrations with good value.

#5 Best Alternative: Happy Head Minoxidil and Spironolactone for Women

Pros:	Cons:
✓ Prescription-strength 6% minoxidil, higher than standard OTC options but below ultra-high-dose protocols.	✗ Uses a propylene glycol-containing vehicle, which can increase irritation, dryness, or stinging on sensitive scalps.
✓  Customizable blends that include spironolactone, tretinoin, and hydrocortisone	✗ Inclusion of topical corticosteroids carries a risk of skin thinning and barrier damage if used long-term.
✓ Strong telehealth model with online prescribing and adjustments to treatments over time.	✗ More expensive than generic 5% minoxidil and some standard telehealth offerings.
✓ Good fit for women who need more than basic 2-5% formulas but do not want to jump straight to 8%+ multi-drug cocktails.

Happy Head’s 6% formulas are aimed at women who want a personalized, prescription-only topical that goes beyond standard strengths while still staying below the most aggressive high-dose regimens. By combining minoxidil with spironolactone, retinoic acid, and short-term hydrocortisone in a single bottle, it offers a modular approach that can be tuned to individual tolerance and response rather than a one-size-fits-all solution. It should be noted that Happy Head uses corticosteroids in their topicals to offset the potential irritation from propylene glycol usage. However, this can cause skin thinning with long-term use.

Bottom line: For women who need a tailored, mid-high-strength minoxidil blend with added anti-androgens and supportive ingredients, but prefer not to escalate to ultra-high-dose, steroid-heavy cocktails, Happy Head provides a strong option.

#3 Best for Woman-Centered Care: Winona 7% Minoxidil

Pros:	Cons:
✓ Women-focused clinic model that addresses broader menopausal health alongside hair loss.	✗ Uses a propylene glycol-containing vehicle, which can increase irritation, dryness, or stinging on sensitive scalps.
✓  Prescription-strength 7% minoxidil specifically targeted to menopausal and perimenopausal thinning.	✗ No customization
✓ Guided supportive care pathway, with structured programs, check-ins, and follow-up.	✗ Premium pricing at around $150 for a 3-month supply.
✓ Treatment plans that can integrate other menopause therapies where appropriate

 

Winona’s 7% minoxidil is designed for women who want more than a stand-alone bottle and value a structured, woman-centered approach that fits into a broader menopause-care framework. The higher-strength prescription formula, combined with clear guidance, follow-up, and attention to hormonal context, makes it particularly suited to postmenopausal and perimenopausal hair loss rather than general early thinning. However, it should be noted that its carrier agent, propylene glycol, may be irritating for sensitive scalps.

 

Bottom line: For women seeking a guided, menopause-focused program built around prescription-strength minoxidil, Winona offers a structured, woman-centered care pathway, albeit at a higher price and with a more irritant-prone vehicle.

Regrowth Timeline

Setting realistic expectations is essential when beginning topical minoxidil for female pattern hair loss. Unlike quick cosmetic fixes, minoxidil works by gradually altering the hair growth cycle, and visible changes take time to develop.

 

Timeframe	What to Expect	Clinical Evidence
Months 0-3	An initial increase in shedding may occur as follicles shift out of the resting (telogen) phase and re-enter growth. This temporary “dread shed” phase typically improves within 4–8 weeks and is considered a normal response to treatment initiation.	[13]Nohria, A., Desai, D., Sikora, M., Mandal, S., Shapiro, J., Lo Sicco, K. (2024). Combating “dread shed”: The impact of overlapping topical and oral minoxidil on temporary hair shedding during … Continue reading
Months 3-6	Early visible signs of improvement may appear, including reduced shedding and the emergence of fine, new hairs (vellus to terminal transformation), particularly along the part line and crown.	[14]Amit, K., Mansukh, G., Satyaprakash, M., Dhiraj, D., Hanmant, B. (2023). Real-World Effectiveness, Safety, and Tolerability of Cetosomal Minoxidil 5% Alone and a Fixed Drug Combination of Cetosomal … Continue reading
Months 6-12	More noticeable cosmetic improvements are typically seen, including increased overall density, thickening of existing strands, and improved scalp coverage in areas of diffuse thinning. For many women, this is the point at which changes become easily visible in the mirror and in photos.	[15]Katz, H.I., Hien, N.T., Prawer, S.E., Goldman, S.J. (1987). Long-term efficacy of topical minoxidil in male pattern baldness. Journal of the American Academy of Dermatology. 16(3). 711-718. Available … Continue reading
Months 12+	Hair density gains typically plateau. At this point, continued use is required to maintain results and prevent gradual regression back toward baseline. Stopping treatment may allow thinning to resume over time.	[16]Katz, H.I., Hien, N.T., Prawer, S.E., Goldman, S.J. (1987). Long-term efficacy of topical minoxidil in male pattern baldness. Journal of the American Academy of Dermatology. 16(3). 711-718. Available … Continue reading

Why Do I Need to Stay Consistent When Using Minoxidil?

Topical minoxidil works by extending the anagen (growth) phase of the hair cycle and shortening the telogen (resting) phase, thereby increasing the amount of time that follicles spend actively producing hair. Maintaining this effect requires regular, consistent application. When doses are frequently missed, follicles spend less cumulative time in a growth-biased state, which reduces the likelihood of noticeable improvement.^[17]Messenger, A.G., Rundegren, J. (2004). Minoxidil: mechanisms of action on hair growth. British Journal of Dermatology. 2(1). 186-194. Available at: … Continue reading

This principle is especially important in women, whose hair loss is often more diffuse and gradual, making subtle changes harder to notice in the early months. Because the human scalp hair cycle progresses slowly, with the anagen phase potentially lasting several years, many follicles need prolonged, uninterrupted exposure to minoxidil before visible gains in density and coverage can be achieved.^[18]Hoover E, Alhajj M, Flores JL. Physiology, Hair. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: … Continue reading

For this reason, most clinical guidance advises committing to at least six months of daily, consistent use before evaluating the effectiveness of treatment, with continued use required to sustain and build upon results.

What Minoxidil Formulations Are Available?

You can find topical minoxidil in several different delivery vehicles, each with its own advantages in terms of scalp tolerability, ease of use, and fit for a woman’s lifestyle and hair type. In most cases, the “best” option is not defined by pure strength alone, but by how well the formula matches skin sensitivity, styling habits, and consistency of application.

Foam – Best for Sensitive Skin

Propylene glycol–free foam formulations were developed to reduce the risk of contact dermatitis, itching, and dryness that can occur with traditional liquid solutions. Clinical observations suggest that foam is generally better tolerated and faster-drying, making it a strong choice for women with sensitive scalps or those who wash and style their hair frequently.^[19]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

Liquid – Best for Cost and Precision

Classic liquid solutions, usually formulated with alcohol and propylene glycol, remain widely available and affordable. While effective, they may cause itching, dryness, or flaking in some women. These solutions can work well for individuals without scalp sensitivity who prefer a more targeted, dropper-based application, especially along the part line.

Spray – Best for Quick, Even Coverage

Spray or mist-style applicators make it easier to cover larger areas of diffuse thinning, such as along the crown or upper scalp. However, they can be less precise, with some product landing on the hair shafts or surrounding skin rather than directly on the scalp.

Gel – Best for Targeted Areas

Gel or cream-gel formulations tend to stay in place, minimizing runoff and improving control. These are helpful for women treating specific areas of thinning, such as the temples, frontal hairline, or post-partum thinning zones.

Liposomal Delivery

Some prescription and premium products use liposomal or phospholipid-based carriers that are designed to improve follicular penetration while reducing irritation and systemic absorption. These advanced bases may be especially attractive for women who need stronger formulations but have experienced irritation with traditional vehicles.

How Safe is Minoxidil?

Topical minoxidil is generally well tolerated by women, but like any active medication, it can produce local scalp irritation, a brief increase in shedding during the early treatment phase, and, in very rare cases, systemic side effects, particularly in individuals with underlying skin or cardiovascular conditions.

Common local reactions may include:

• Mild itching
• Flaking or dryness
• Redness
• Burning or stinging
• Temporary increase in shedding

These symptoms are typically mild, tend to improve as the scalp adapts, and can often be reduced by switching to a foam-based formula, lowering concentration, or using a gentler vehicle.

Systemic and heart-related reactions are extremely uncommon with proper topical use. However, isolated case reports and safety data recommend seeking medical attention if symptoms such as chest tightness, heart palpitations, lightheadedness, dizziness, or unexplained swelling develop, as these could indicate increased systemic absorption or accidental ingestion. The risk of cardiovascular effects is significantly higher with oral minoxidil or improper dosing, where hypotension, tachycardia, and even heart failure have been reported.^[20]Tripathee, S., Benyovszky, A., Devbhandari, R., Quiza, K., Boris, J. (2024). A Very Bad Hair Day: Minoxidil Ingestion Causing Shock and Heart Failure. Cureus. 16(8). E66039. Available at: … Continue reading

To minimize the risk of side effects, many clinicians recommend starting with once-daily application, gradually increasing only if tolerated. Women with reactive skin often benefit from foam formulations, lower-alcohol bases, or liposomal delivery systems, which can reduce irritation and improve comfort during long-term use.

Individuals with active inflammatory scalp conditions, such as psoriasis, eczema, or severe seborrheic dermatitis, are generally advised to first address the underlying condition before beginning minoxidil therapy. Applying treatment to an inflamed or compromised skin barrier can increase irritation, worsen symptoms, and lead to unpredictable absorption patterns.^[21]Junge, A., Jic-Hoesli, S.R., Bossart, S., Simon, D., de Viragh, P., Hunger, R.E., Heidemeye, K., Seyed Jafari, S.M. (2025). Contact Dermatitis Caused by Topical Minoxidil: Allergy or Just Irritation. … Continue reading

Although topical minoxidil has lower systemic absorption than oral formulations, it is generally not recommended during pregnancy or while breastfeeding unless specifically advised by a healthcare provider. Women who are pregnant, trying to conceive, or nursing should consult a qualified medical professional to fully review potential risks and alternative treatment options.

Final Verdict

A range of minoxidil-based options is available to support different needs among women experiencing hair thinning, from strength-focused prescriptions to gentle, sensitivity-friendly alternatives and highly customized compounded formulas. While each product relies on the same core ingredient, differences in concentration, delivery vehicle, add-on actives, and level of medical support can significantly influence both tolerability and long-term adherence.

Whichever option you choose, consistent use of minoxidil remains one of the most evidence-backed ways to slow progression and improve hair density in women with pattern hair loss. With today’s expanded access to prescription platforms, foam-based formulations, and individualized treatment models, it is now easier than ever to find an approach that aligns with your scalp sensitivity, stage of hair loss, and lifestyle needs.

Finasteride is among the most effective drugs for androgenic alopecia. And while side effects are often overstated, it can lead to reduced libido or lowered sperm counts in some men. For this reason, many choose topical versus oral finasteride, hoping to limit the drug’s DHT-reducing effects to the scalp. But at certain doses, even topical finasteride can become systemic. So, to minimize side effects, which finasteride dosage, formula and application is best? 

In this article, we’ll review 

• About oral versus topical finasteride
• Why topical finasteride can still go systemic
• Why choosing the lowest percentage solution isn’t the only answer
• How to maximize finasteride gains, while minimizing side effects

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.

About Finasteride 

Finasteride, also known under the brand name Propecia or Proscar, is a prescription medication approved by the FDA for the treatment of androgenic alopecia (AGA). The anti-androgen works by reducing the production of Dihydrotestosterone (DHT), a hormone linked to pattern hair loss. In use since 1992, Finasteride is among the most powerful and well-studied drugs for hair loss.

Oral Finasteride

Oral finasteride stops AGA progression 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 For men wanting a “hands-off” approach to hair maintenance, oral finasteride can be an excellent option. With a once-daily pill, it’s expected that hair loss will stop at approximately 6 months, and thereafter, improve.

However, oral finasteride isn’t for everyone. While the risk of side effects are often overstated online, the drug appears to reduce libido in a certain percentage of men. Oral finasteride can also temporarily lower sperm counts, which might make conception more difficult during its first six months of use. In some men, the use of finasteride appears to increase anxiety and/or depression. While the true incidence and magnitude of these reports are hard to discern, it’s understandable that many are weary of taking this once daily pill.

Fortunately, recent improvements in finasteride’s delivery may mean we no longer need to throw the proverbial baby out with the bathwater.

Topical Finasteride

The biggest reason people seek out topical finasteride (instead of oral finasteride) is because they want to minimize systemic exposure to the drug, and in doing so, localize finasteride’s effects to the scalp.

While research is still in the early stages, evidence suggests that topical finasteride can produce similar levels of hair regrowth compared to oral finasteride, with a significantly reduced incidence of side effects.

Topical finasteride works identically to its oral counterpart: by inhibiting the type II 5-alpha reductase enzyme to reduce DHT. It is designed to target scalp DHT instead of systemic DHT levels.

However, limiting finasteride’s reach to scalp, not serum, DHT is harder than perhaps anticipated. To understand why, let’s take a closer look at scalp versus serum DHT.

Serum vs Scalp DHT 

There’s a lot of evidence that the hormone DHT is directly implicated in androgenic alopecia. In fact, research directly links DHT to all three of AGA’s defining characteristics:

1. Increased telogen:anagen ratio. DHT’s influence on DKK-1 expression increases hair shedding
2. Increased anagen cycling. DHT’s effects on signaling pathways limit the growth phase of hairs 
3. Hair follicle miniaturization. DHT’s effects on dermal papilla sizing thins hair with each cycle 

There are a wide variety of DHT reducers available, including prescription drugs, over-the-counter products, intradermal injections, and even herbal supplements. Finasteride reduces DHT in two ways. 

1. Oral finasteride reduces DHT everywhere in the body. Beyond just the scalp, it reduces DHT in the blood, brain, and prostate. 
2. Topical finasteride attempts to reduce DHT only where it is applied – in the scalp – with minimal effects on DHT levels elsewhere.

However, it’s far easier than most realize for topical finasteride to go systemic. And when it does, it potentially reduces DHT everywhere – leading to the very side effects it’s meant to prevent.

Topical Finasteride Can Still Go Systemic

Why? When it comes to lowering DHT (the goal of the drug), finasteride has a highly-sensitive, dose-dependent response curve. This means that while 0.01 mg of finasteride barely reduces any DHT at all, 0.1 mg reduces almost as much DHT as 5 mg, a much larger dose.

This implies that when applying topical finasteride, only a tiny fraction of it needs to go systemic in order to produce the same DHT-lowering effects as oral finasteride. If this happens, the purpose of using the topical formulation is completely defeated. 

Research suggests a 1% topical finasteride formulation, applied twice daily, is ‘non-inferior,’ meaning equivalent, to 1 mg oral finasteride tablets.^[2]https://www.ncbi.nlm.nih.gov/pubmed/19172031 And while that’s a positive in terms of hair growth, using this amount topically twice daily pretty much guarantees systemic absorption. In other words, if 1% topical is the equivalent of 1 mg oral, we can expect it to reduce serum DHT levels by 71%.

So what if we choose a formula with even lower percentages of the active drug? A study on 0.25% topical finasteride showed just a 35% reduction in serum DHT levels versus 55% for the oral medication, and yet similar outcomes for hair regrowth in both oral and topical groups.^[3]https://onlinelibrary.wiley.com/doi/10.1111/jdv.17738

So what if we go even lower? A study on 0.005% alcohol-based topical finasteride instructed participants to use the formulation twice daily, with 1 mL applied per session.^[4]https://dx.doi.org/10.3109%2F09546639709160517 This led to no appreciable changes in serum DHT levels… meaning that for this ultra-low topical formulation, there was little-to-no systemic absorption (and presumably, few-to-no side effects). The good news? This group still experienced great hair growth outcomes.

So Just Reach for the Lowest Percentage, Yes?

It’s tempting from the above to infer we’ve reached the end of our story. As long as we reach for the lowest percentage of topical finasteride, we can be free from worries about the drug’s systemic effects. But, reality is a bit more complicated than that.

Systemic absorption isn’t just about dilution percentages. Topical finasteride’s systemic absorption actually depends on (at least) for variables:

1. The drug’s formulation. Common carrier agents include alcohol and propylene glycol.
2. The amount applied per use. The amount of topical finasteride applied to the scalp greatly varies.
3. The application frequency. Applying the drug twice per day can more than double its effects on serum DHT. 
4. The days of application. Topical finasteride can take many days to “leak” into the blood before its final effects on serum DHT are realized.

For an example, see this figure from a 2014 study measuring how one versus two applications of 1 mL of 0.25% topical finasteride affected serum DHT levels.^[5]https://www.ncbi.nlm.nih.gov/pubmed/25074865 

Over a 24-hour period, what were the findings?

• One application (i.e., 1 mL of 0.25% topical finasteride) lowered blood DHT levels by ~20%
• Two applications (i.e., 2 mL total) lowered blood DHT levels by ~70%

As such, we need to factor in these variables if we plan on sticking with topical finasteride for the long-term. Otherwise, we risk lowering our DHT levels to the same degree as 1 mg of oral finasteride, which would defeat the purpose of using the topical in the first place.

Topical Finasteride and Serum DHT: What Do The Clinical Studies Say?

Let’s take a closer look at some of the studies mentioned above. In addition to the percentage of active drug in the formula, there are a few more variables to understand. How much of the topical was applied, and which carrier agents were used?

The table below shows how even a .25% formula, for example, can reduce DHT in the serum by 24-70% 

Based on this table, our total mg of daily finasteride exposure is probably the biggest factor in determining systemic leakage. And our total daily exposure (in mg) is a function of topical finasteride dilution (%) and the amount (mL) applied daily.

Knowing this, we can turn this table into a chart and sort it by mg of daily exposure. In doing so, we see a clear trend:

The good news? At both extremes of this chart – 0.091 mg and 2.275 mg daily – topical finasteride was shown to produce clinical results in improving hair parameters. Based on this, if we’re going for topical finasteride, we probably want to be prescribed topical finasteride solutions that net us daily exposure volumes of 0.228 mg and lower. After all, at 0.091 mg of topical finasteride daily, no systemic effects on DHT were observed.^[6]https://www.tandfonline.com/doi/abs/10.3109/09546639709160517

In other words, low dilutions (i.e., 1-2 mL of 0.005% to 0.02% of topical finasteride) confer significant benefits but at reduced risks of side effects due to lower systemic absorption – provided that guidelines for daily amounts (in mL) are also followed.

So What’s the Perfect Amount and Formula?

Our analyses from member-submitted lab tests and the clinical data suggest that 10-15% of topical finasteride will enter the bloodstream, at least when it’s formulated with alcohol and/or propylene glycol as carrier ingredients (as most compounding pharmacies do). So, if we apply 1-2 mL of 0.005% to 0.02% topical finasteride, this might equate to just 0.01-0.03 mg of systemic drug exposure.

For the overwhelming majority of people, that’s not enough systemic leakage to significantly lower DHT levels in the body. But it is enough to produce great hair loss outcomes. 

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Long-story short: stick to 1-2 mL of 0.005% to 0.02% topical finasteride solutions. This equates to roughly 0.1-0.2mg of daily finasteride exposure to the scalp. Any more than that, and there’s risk of significant systemic leakage, which defeats the purpose of using topical finasteride altogether.

How to Maximize Gains and Minimize Side Effects

Maximizing gains while minimizing the side effects of finasteride can be done, but it’s not a perfect science. We’ve outlined several tips below that we think might help. Due to individual variance, the most important step is to always start with testing.

1. Get Lab Tests for DHT

The goal with topical finasteride is to reduce the risk of side effects. To do this, we must minimize the amount of finasteride that leaks into the bloodstream. The best way to do this isn’t to rely on estimated metrics from clinical studies, but to collect personal data.

Get a serum DHT test before using the topical to establish a baseline. Then, DHT levels should be retested at one month to gauge just how much is going systemic. Testing is easier than most expect, and in our experience, the expenses are worth the peace of mind.

If future lab tests deviate from baseline, it’s an indication of just how much topical finasteride is going systemic. According to the clinical data, 30 days of application is more than enough time for finasteride to saturate at its maximum levels in the scalp and serum. 

As such, measuring DHT levels after one month of finasteride use offers a great reference point to see if topical finasteride is impacting serum DHT levels. If needed, changes can be made to the application or use frequency depending on any changes to your blood levels of DHT.

2. Understand That DHT Levels Fluctuate Diurnally

Keep in mind, some fluctuation in DHT levels is normal. DHT levels fluctuate throughout the day and across seasons. As such, 15-20% differences across tests are normal and expected. Anything beyond 20% suggests that topical finasteride might be having slight systemic effects.

Because of this fluctuation, however, it’s important to get blood draws done at the same time of day – preferably in the morning and while in a fasted state. Also, try not to make drastic changes to diet, lifestyle, or environment prior to testing. Heavy drinking, deviations from a typical daily diet, the introduction of creatine powders, and/or sleep deprivation can all influence DHT levels and muddy test results. In the 3-5 days prior to the second test, try to keep things as they were when you first went in for testing.

3. Avoid supplementing with Quercetin and/or Creatine

Maintaining systemic DHT levels, while maximizing the effects of finasteride, isn’t just about the drug. There are other activities that could potentially affect DHT levels. Supplementing with quercetin and/or creatine is one common mistake that could impact results.

Studies on mice suggest that quercetin can inhibit the DHT-reducing effects of finasteride.^[7]https://joe.bioscientifica.com/view/journals/joe/181/3/493.xmlWhile the translatability to humans has not yet been studied, the dosages used in these mouse models were comparable to what humans typically consume from quercetin supplements. As such, it may be best for those using finasteride to avoid this supplement.

When it comes to creatine, one study found that in training athletes, creatine supplementation increased serum DHT levels by over 70%.^[8]https://pubmed.ncbi.nlm.nih.gov/19741313/ While the study was small, we have to reconcile these findings with the reality that for the overwhelming majority of training athletes, creatine is unnecessary. Bodybuilders can still look great without using it, and so can the every-day gym goer. Competitive bodybuilders are, however, a different story.

4. Set Realistic Expectations and Track Progress

Finasteride is the best-studied intervention for androgenic alopecia. In order to appreciate its full effects, consider the following:

1. Know the timeline for results. Clinical studies show that finasteride improves pattern hair loss outcomes in 80-90% of men. Having said that, cosmetic degrees of hair regrowth don’t often occur until after 10-12 months of treatment. Moreover, the drug’s full effects typically take two years to manifest, with the biggest degrees of cosmetic regrowth occurring between year one and year two. As such, don’t expect any miracles in the first six months, it may take the full two years to see an effect. 
2. Track progress. It’s hard to know if something is improving without objective measurements. While not all of us have access to trichoscopic hair-counting equipment, most of us do have a smartphone, which can easily be used to take photos to track progress (particularly when the photosets are standardized). This can be done relatively effortlessly. 

Following the tips above allows for the best possible shot at measurable hair growth results, while minimizing the potential effects of systemic DHT reduction.

Summary

Oral finasteride works great for male pattern hair loss, but by significantly reducing serum DHT, it can cause unwanted side effects. 

Topical finasteride was developed as a solution, with a goal to reduce DHT in the scalp only. But when applied in high percentages or large amounts, it too, can go systemic and reduce serum DHT levels. 

To minimize the side effects of finasteride without missing out on the benefits, stick to 1-2 mL of 0.005% to 0.02% topical finasteride solutions. This equates to roughly 0.1-0.2mg of daily finasteride exposure to the scalp. 

The best way to ensure a reduced risk for side effects is to track serum DHT levels. Establish a baseline by taking one test before using finasteride, then test again one month later. 

Men’s hair loss is a booming multi-billion-dollar industry, yet the vast majority of over-the-counter products fall short when measured against rigorous clinical evidence. This landscape is cluttered with quick-fix promises, leaving consumers sifting through marketing claims with little scientific support. Among all topical hair regrowth options, minoxidil is one of the most extensively studied. It is also one of two FDA-approved treatments for male pattern hair loss (in its topical form). 

In this comprehensive guide, we rank our top minoxidil picks of 2025 across Best Overall, Best Value, and other categories to help you navigate the crowded hair loss market with more clarity and confidence.

Quick Look: Best Minoxidil for Men in 2025

Product	Strength	Format	Customization	Price	Best:
Ulo	7%	Solution	High	$41.65	Overall
Kirkland Minoxidil	5%	Solution	None	$17.99	Value
Rogaine	5%	Solution/Foam	None	$49.97	Sensitive Scalp
Keeps	5%	Solution/Foam/Spray	Low	$16.67	Subscription Convenience
Happy Head	5-8%	Solution/Gel	High	$59	Strength

What is Minoxidil and How Does it Work?

Minoxidil was originally developed to treat high blood pressure and is now widely used in both topical and oral forms as a first-line therapy for androgenic alopecia (AGA).

What is Minoxidil?

Minoxidil was first introduced in the 1970s as a powerful oral vasodilator for resistant hypertension. Clinicians soon noticed a frequent side effect, generalized increased hair growth (hypertrichosis).^[1]Gupta, A.K., Talukder, M., Venkataraman, M., Bamimore, M.A. (2021). Minoxidil: a comprehensive review. Journal of Dermatological Treatment. 33(4). 1896-1906. Available at: … Continue reading This led to the development of topical formulations specifically for AGA. Today, 2-5% topical minoxidil is FDA-approved for both male and female pattern hair loss and is used off-label for other alopecias.

How Does Minoxidil Work?

Minoxidil is a potassium-channel opener that causes vasodilation and improves microcirculation around hair follicles.^[2]Hussein, R.S., Dayel, S.B., Abahussein, O., El-Sherbiny, A.A. (2024). Applications and efficacy of minoxidil in dermatology. Skin Health and Disease. 4(6). E472. Available at: … Continue reading It also acts as a prodrug; sulfotransferase converts it to minoxidil sulfate, which prolongs the anagen (growth) phase and shortens the telogen (resting) phase, shifting more hair follicles into active growth.^[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 Additional data suggests that induction of key growth factors like vascular endothelial growth factor (VEGF) and activation of Wnt/ꞵ-catenin signaling further support hair regrowth.^[4]Gupta, A.K., Talukder, M., Shemer, A., Piraccini, B.M., Tosti, A. (2023). Low-Dose Oral Minoxidil for Alopecia: A Comprehensive Review. Skin Appendage Disorders. 9(6). 423-437. Available at: … Continue reading 

Although minoxidil doesn’t target dihydrotestosterone, it can improve the effectiveness of other treatments by targeting multiple other targets. When combined with anti-DHT drugs like finasteride, which reduce the hormonal trigger of AGA, minoxidil provides a complementary, non-hormonal pathway. The two treatments have been shown to provide synergistic improvement in hair density in men.^[5]Asad, N., Naseer, M., Ghafoor, R. (2024). Efficacy of Topical Finasteride 0.25% with Minoxidil 5% versus Topical Minoxidil 5% Alone in Treatment of Male Pattern Androgenic Alopecia. Journal of Drugs … Continue reading 

OTC vs Prescription-Strength

Over-the-counter (OTC) minoxidil solutions (2% and 5%) can be effective for many men, but absorption and vehicle limits mean “stronger” drug percentages above 5% often add irritation rather than results unless the entire formulation is engineered and supervised medically. 

Early minoxidil development work showed a clear dose-response between low strengths (1-2%) and mid-strength (5%) solutions, with 5% yielding larger gains in hair counts and shaft diameter in AGA.^[6]Olsen, E.A., Dunlap, F.E., Funicella, T., Koperski, J.A., Swinehart, J.M., Tschen, E.H., Trancik, R.J. (2002). A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and … Continue reading

Other companies offer concentrations of 10% or over; however, recent head-to-head studies have shown that 5% topical minoxidil is moderately superior to the higher concentration.^[7]Ghonemy, S., Alarawi, A., Bessar, H. (2021). 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 Additionally, the 10% minoxidil was associated with more marked irritation.

So, with that in mind, let’s take a look at some of our top minoxidil picks of 2025.

Best Minoxidil Picks for Men

#1 Best Overall: Ulo Minoxidil Rx

Pros:	Cons:
✓ Clinically-backed combinations	✗Prescription products are only available in the USA
✓ Ongoing medical monitoring and a user-friendly platform
✓ Quality-tested ingredients free of irritants

Ulo’s Minoxidil Rx takes the top spot for men who want a data-driven, medically supervised approach rather than a one-size-fits-all bottle. Custom strengths and evidence-based optional add-ons allow precise targeting for hair regrowth. 

Their high-strength concentration can be combined with tretinoin 0.01% to enhance absorption and efficacy, as well as cetirizine 1%, melatonin 0.01% for antioxidant protection, and caffeine 0.2% to boost circulation, which further improves the product’s effectiveness.

This treatment begins at $49 per month, increasing to $54 if you choose to have all of the add-ons.  

Bottom Line: Ulo’s customizable, science-driven minoxidil prescription offers one of the most advanced, value-conscious options for men who are serious about long-term hair regrowth.

#2 Best Value – Kirkland Signature Minoxidil 5%

Pros:	Cons:
✓ Lowest cost we could find for 6 months’ worth.	✗Contains propylene glycol, which can cause irritation or dryness in some users.
✓ Same core 5% minoxidil strength.	✗ No customization possible for strength or add-on ingredients.
✓ Widely available at multiple stores, including Amazon, Costco, etc.	✗ No medical consultation or tailoring of treatment included.
✓ Simple formula.

Kirkland Signature Minoxidil 5% is the classic value choice for me who want an over-the-counter treatment without paying for branding or bundled medical services. You get a standard 5% solution similar in strength to more expensive competitors, making it ideal for cost-conscious users who are happy to follow a simple twice-daily routine and do not need personalized compounding. 

Bottom line: If you want the most affordable entry point into 5% minoxidil, Kirkland’s no-frills formula is hard to beat for sheer value per effective dose.

#3 Best for Sensitive Scalps: Rogaine 5% Foam

Pros:	Cons:
✓ Clinically proven 5% minoxidil strength	✗On the higher end in terms of price.
✓ Foam vehicle is propylene glycol-free, so it is usually better tolerated on sensitive or irritated scalps.	✗ Fixed strength for men with no customization or add-on actives.
✓ Quick drying, less greasy texture	✗ No medical consultation or tailoring of treatment included.
✓ Widely available OTC

Rogaine 5% is a strong pick for men who need minoxidil but find traditional liquid formulas too irritating or cosmetically heavy. The foam format avoids common irritants found in many solutions and tends to be more comfortable for daily use, which can improve adherence and long-term outcomes.

Bottom Line: For sensitive scalps that still need full-strength 5% minoxidil, Rogaine Foam provides a gentler, easy-to-use option that balances proven efficacy with better tolerability.

#4 Best Subscription Convenience: Keeps Minoxidil

Pros:	Cons:
✓ Automatic subscription refills so you rarely run out or miss doses.	✗More expensive than buying generic minoxidil in bulk.
✓ Offers both 5% foam and 5% solution to suit different scalp and styling preferences.	✗ Limited to preset strengths and formulas with no true custom compounding.
✓ Option to bundle with finasteride and other treatments for a complete regimen.
✓ Online prescribing and follow-up.

Keeps Minoxidil is designed for men who value a set-and-forget routine, trading a price increase ($16.67 for 3 months compared to Kirkland’s $17.99 for 6 months) for automatic deliveries and integrated telehealth support. The ability to pair minoxidil with finasteride and keep everything managed through a single platform could make adherence simpler for busy users.

Bottom Line: If you want 5% minoxidil with minimal hassle, Keeps’ subscription model is a strong fit for convenience-focused men who prefer not to manage refills and prescriptions on their own. 

#5 Best High-Strength Formula: Happy Head

Pros:	Cons:
✓ Offers high-strength minoxidil concentrations beyond standard 5%.	✗Higher strengths may carry a greater risk of irritation or systemic absorption.
✓ Can be combined with topical finasteride and other actives in a single solution.	✗ More expensive than generic 5% minoxidil and some standard telehealth offerings.
✓ Telehealth model with online consultation and prescription management.	✗Corticosteroids used to offset irritation from propylene glycol.
✓ Multiple formula options aimed at men who have plateaued on basic OTC products.

Happy Head is built for men who want to move past entry-level minoxidil and explore higher-strength, prescription-only blends under medical oversight. By pairing elevated minoxidil concentrations (8%) with agents like tretinoin and topical finasteride, Happy Head targets users seeking a more comprehensive protocol. With that said, some ingredients included, like the carrier agent propylene glycol, which is used in their base formula, can cause irritation. To offset this, Happy Head uses corticosteroids; however, this may cause skin thinning long-term.

You can read more about corticosteroid usage in hair loss treatments here.

Bottom Line: Happy Head delivers a good jump in strength for minoxidil users who need to increase efficacy. 

Timeline: What Results to Expect from Minoxidil

It’s important that realistic expectations are set for regrowth when starting out on your minoxidil usage journey.

Timeframe	What to Expect	Clinical Evidence
Months 0-3	This is the initial shedding phase, which usually resolves in the first 4-8 weeks.	[8]Nohria, A., Desai, D., Sikora, M., Mandal, S., Shapiro, J., Lo Sicco, K. (2024). Combating “dread shed”: The impact of overlapping topical and oral minoxidil on temporary hair shedding during … Continue reading
Months 3-6	Early visible improvements, like the appearance of new hairs, can be expected.	[9]Amit, K., Mansukh, G., Satyaprakash, M., Dhiraj, D., Hanmant, B. (2023). Real-World Effectiveness, Safety, and Tolerability of Cetosomal Minoxidil 5% Alone and a Fixed Drug Combination of Cetosomal … Continue reading
Months 6-12	Cosmetic changes peak, with stronger hair, increased density, and most coverage is seen.	[10]Katz, H.I., Hien, N.T., Prawer, S.E., Goldman, S.J. (1987). Long-term efficacy of topical minoxidil in male pattern baldness. Journal of the American Academy of Dermatology. 16(3). 711-718. Available … Continue reading
Months 12+	Further gains plateau, continued use needed to maintain improvements.	[11]Katz, H.I., Hien, N.T., Prawer, S.E., Goldman, S.J. (1987). Long-term efficacy of topical minoxidil in male pattern baldness. Journal of the American Academy of Dermatology. 16(3). 711-718. Available … Continue reading

Consistency is Everything

Minoxidil works by prolonging the anagen phase and shortening the telogen phase. Regular dosing maintains these effects at the follicle level; repeatedly missing applications reduces the cumulative time that hair follicles spend in a pro-growth, anagen-biased state.^[12]Messenger, A.G., Rundegren, J. (2004). Minoxidil: mechanisms of action on hair growth. British Journal of Dermatology. 2(1). 186-194. Available at: … Continue reading

Because human scalp follicles cycle slowly (anagen can last years), many follicles need months of uninterrupted exposure before visible density gains can be seen.^[13]Hoover E, Alhajj M, Flores JL. Physiology, Hair. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: … Continue reading This is why most guidance recommends at least 6 months of continuous use before judging the response.

Why Stopping Reverses Progress

Minoxidil is not disease-modifying for AGA, meaning that it does not correct androgen-driven miniaturization but counteracts it while present by improving hair cycle dynamics and follicle size. When treatment is stopped, these pharmacologic effects wane, and follicles gradually revert toward their genetically determined, androgen-sensitive pattern.

Clinical and patient information sources consistently note that any gain from minoxidil is maintained only while therapy continues. After discontinuation, increased shedding and loss of density over months are typical, ultimately leading to a reversal of gains to the original starting point.

What Minoxidil Formulations are Available?

You can buy minoxidil in several different vehicles that differ mainly in tolerability, practicality, and how well they fit a given scalp and routine. Choosing the “best” format is less about raw efficacy and more about matching the base to skin sensitivity and your preference of application.

• Foam – Best for Sensitive Skin: Propylene glycol-free foams were developed to reduce contact dermatitis and dryness seen with classic liquid solutions. Reviews note lower rates of irritation and quicker drying, which makes them better for patients with reactive or dry scalps.^[14]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

• Liquid – Best for Cost-Effectiveness: Traditional solutions with alcohol and propylene glycol are widely available, inexpensive, and easy to use, but they may cause increased itching, flaking, and stinging. This formulation may suit users with non-sensitive skin who are price-conscious.

• Spray – Easiest for Coverage: Spray tops or aerosolized formats can make it faster to hit broad thinning areas, especially in longer hair. However, the product may end up more on the hair shafts or adjacent skin.

• Gel – Targeted and Controlled: Gel or cream-gel vehicles (often from compounders) sit where you place them, minimize dripping, and are useful for localized areas such as temples or post-transplant zones. 

• Liposomal Delivery: Newer liposomal or phospholipid bases aim to enhance follicular penetration while limiting systemic absorption and irritation. This is usually marketed as an “advanced delivery” method.

Side Effects and Safety

Minoxidil is generally well tolerated, but like any active drug, it can cause local irritation, a transient shedding phase, and very rare systemic effects, especially in people with underlying skin or cardiovascular issues.

Common local side effects include:

• Itching
• Flaking
• Redness
• Burning
• Temporary shedding 

Systemic and heart-related side effects are very rare with correctly used topical minoxidil, but case reports and product information advise seeking medical help if symptoms like chest pain, palpitations, dizziness, or unexplained swelling occur, as these could reflect systemic absorption or accidental ingestion. Risk is higher with oral minoxidil or overdose, where hypotension, tachycardia, and even heart failure have been documented.^[15]Tripathee, S., Benyovszky, A., Devbhandari, R., Quiza, K., Boris, J. (2024). A Very Bad Hair Day: Minoxidil Ingestion Causing Shock and Heart Failure. Cureus. 16(8). E66039. Available at: … Continue reading 

To minimize problems, many clinicians suggest starting once daily and titrating up, choosing foam or gentler vehicles to reduce dermatitis, and using custom compounded formulas (for example, lower alcohol, lower strength, or liposomal bases) in those with sensitive or disease-prone scalps. 

People with chronic inflammatory scalp conditions such as active psoriasis, eczema, or severe seborrheic dermatitis are typically advised to get the primary condition under control before adding topical minoxidil or other actives, as applying them to an inflamed barrier increases irritation, may worsen the disease, and can unpredictably alter absorption.^[16]Junge, A., Jic-Hoesli, S.R., Bossart, S., Simon, D., de Viragh, P., Hunger, R.E., Heidemeye, K., Seyed Jafari, S.M. (2025). Contact Dermatitis Caused by Topical Minoxidil: Allergy or Just Irritation. … Continue reading 

Final Verdict – Best Minoxidil for Men in 2025

In 2025, several minoxidil-based options stand out for different priorities, from cost to customization. All of them rely on the same core ingredient, but vehicle, strength, and add-ons make a real-world difference in adherence and results. 

Whichever route you choose, there is strong evidence that consistent minoxidil use can stabilize loss and improve density for many men, and modern platforms make it easier than ever to find a formulation that fits your scalp, schedule, and risk tolerance.