Hair treatments

Targets: Androgenetic alopecia (male & female pattern); also used adjunctively in telogen effluvium and traction alopecia

A topical solution or foam applied directly to the scalp once or twice daily. Originally a blood-pressure drug, minoxidil is a potassium-channel opener and vasodilator that prolongs the anagen (growth) phase, increases follicle size, and improves blood flow to follicles. The 5% strength is standard for men; 2-5% is used in women (5% foam once daily is common to limit unwanted facial hair). Results take 3-6 months and require indefinite continued use, as stopping reverses gains. Possible early 'shedding' phase and scalp irritation/itch (sometimes from the propylene glycol vehicle; foam avoids this).

Targets: Androgenetic alopecia (adjunct) and seborrheic dermatitis/dandruff-related shedding

An antifungal shampoo used 2-3 times weekly, left on the scalp a few minutes before rinsing. Beyond treating dandruff and seborrheic dermatitis (which can worsen shedding), it has anti-androgenic and anti-inflammatory effects on the scalp and is used as a low-cost adjunct to minoxidil/finasteride in pattern hair loss. The 1% concentration is available over the counter; the 2% concentration is prescription (or pharmacist-supplied depending on region). Generally well tolerated; occasional dryness or scalp irritation.

Targets: Androgenetic alopecia (male & female pattern)

Devices (caps, helmets, headbands, or handheld combs) that deliver red light, typically around 650-680 nm, to the scalp. The photobiomodulation is thought to stimulate mitochondrial activity in follicle cells, prolonging the growth phase and increasing density. Several FDA-cleared home devices exist; treatment is done several times per week for months and must be continued to maintain results. Considered safe with few side effects; efficacy is modest and most pronounced in early-stage loss, often used alongside drug therapy.

Targets: Androgenetic alopecia (and as an enhancer for topical drug delivery)

Use of a roller or pen with fine needles to create controlled micro-injuries in the scalp, triggering a wound-healing response, growth-factor release, and improved penetration of topical minoxidil. Professional (deeper) sessions are done by clinicians every 1-4 weeks; shallow at-home dermarollers (commonly 0.5-1.5 mm) are available but carry infection risk if not cleaned and used correctly, and deeper needling is best left to professionals. Most effective when combined with minoxidil rather than used alone. Mild redness and tenderness afterward are common.

Targets: Telogen effluvium and diffuse thinning caused by deficiency; supports overall hair health

Identifying and correcting underlying deficiencies is central to treating telogen effluvium (diffuse shedding often triggered 2-3 months after illness, childbirth, crash dieting, or stress). Low iron/ferritin, vitamin D, and zinc are common contributors and should be checked with bloodwork and supplemented only if deficient, since excess iron or zinc can be harmful. Biotin is widely marketed but helps only in genuine (rare) biotin deficiency and has no proven benefit otherwise; importantly, biotin supplements can distort thyroid and cardiac lab tests. Adequate protein and overall balanced nutrition also matter. Deficiency-driven shedding usually recovers once the cause is addressed.

Targets: Traction alopecia (prevention/early reversal); general scalp health and seborrheic dermatitis

For traction alopecia (loss from chronic pulling by tight braids, ponytails, weaves, or extensions), the key intervention is removing the tension: looser, varied hairstyles, avoiding chemical/heat damage on stressed areas, and giving follicles time to recover. Caught early it is reversible; long-standing traction can cause permanent scarring loss that then needs transplantation. General scalp care includes gentle cleansing, treating dandruff/seborrheic dermatitis (which can aggravate shedding), avoiding harsh styling, and not over-manipulating fragile hair. Largely self-managed at home, with dermatologist input if scarring or inflammation develops.

Targets: Male androgenetic alopecia (FDA-approved); used off-label in post-menopausal women

A once-daily oral 5-alpha-reductase type II inhibitor that lowers scalp and serum dihydrotestosterone (DHT), the androgen that miniaturizes genetically susceptible follicles. It slows or halts loss and produces partial regrowth in many men, especially at the crown and mid-scalp; benefit is maintained only while taking it. Onset of visible effect takes 3-6 months. Possible side effects include decreased libido, erectile dysfunction, and ejaculatory changes (usually reversible; persistent symptoms are debated/uncommon), reduced PSA values, and rare mood changes. Contraindicated in pregnancy (teratogenic) and not used in pre-menopausal women of childbearing potential.

Targets: Severe alopecia areata (extensive, totalis, or universalis)

Oral Janus kinase inhibitors that dampen the immune signaling driving alopecia areata. Baricitinib and ritlecitinib are FDA-approved for severe alopecia areata in adults (ritlecitinib also for adolescents 12+), producing meaningful regrowth in many patients with extensive disease. They require prescription and specialist monitoring (infection risk, blood counts, lipids, and other labs) and must be continued to maintain regrowth. Reserved for significant disease that has not responded to first-line measures; not used for ordinary pattern hair loss.

Targets: Alopecia areata (autoimmune patchy loss); also inflammatory scalp conditions

First-line treatment for limited alopecia areata. Intralesional triamcinolone is injected by a clinician directly into bald patches every 4-6 weeks to suppress the local immune attack on follicles and prompt regrowth; potent topical corticosteroids (creams, foams, solutions) are an at-home option, especially for children or extensive disease. Possible side effects include temporary skin thinning or small dents at injection sites. Does not cure the autoimmune tendency, so relapses can occur.

Targets: Androgenetic alopecia (male pattern primarily; off-label in females)

An oral 5-alpha-reductase inhibitor that blocks both type I and type II isoenzymes, lowering DHT more completely than finasteride. Used off-label for hair loss (FDA-approved for it only in some countries, e.g., South Korea, Japan), often when finasteride response is inadequate. May produce greater regrowth but carries a similar or somewhat higher side-effect profile (sexual dysfunction, lowered PSA) and a much longer half-life. Contraindicated in pregnancy and women of childbearing potential. Sometimes also given as intradermal scalp mesotherapy injections by clinicians.

Targets: Androgenetic alopecia (male & female pattern); sometimes telogen effluvium and other non-scarring alopecias

Low-dose oral minoxidil (typically 0.625-5 mg/day) prescribed off-label as a once-daily pill. It works systemically by the same mechanism as the topical form and is favored for people who dislike or react to topical application or want better adherence. Considered more convenient and often more effective than topical for some patients. Requires medical supervision because of systemic effects: possible fluid retention/ankle swelling, increased body/facial hair (hypertrichosis), lightheadedness, and rare cardiovascular effects (palpitations, pericardial effusion). Not first-line in patients with significant cardiac disease.

Targets: Female androgenetic alopecia (and hirsutism); used in women only

An oral anti-androgen (originally a potassium-sparing diuretic) prescribed off-label for female pattern hair loss, usually 50-200 mg/day. It blocks androgen receptors and reduces androgen production, slowing miniaturization and helping maintain or modestly regrow hair, often combined with topical minoxidil. Onset takes several months. Monitoring is needed for elevated potassium, low blood pressure, menstrual irregularity, and breast tenderness. Contraindicated in pregnancy (risk of feminizing a male fetus), so reliable contraception is advised; not used in men for hair loss due to feminizing effects.

Targets: Androgenetic alopecia (male & female pattern)

A finasteride solution/gel applied to the scalp, used as an alternative to oral finasteride to lower local DHT while reducing systemic absorption and the associated sexual side effects. Often compounded or combined with topical minoxidil. Some systemic absorption still occurs, so the same pregnancy precautions apply. Evidence is growing but less extensive than for the oral form; requires ongoing use to maintain benefit.

Targets: Androgenetic alopecia and stable scarring/traction alopecia (permanent loss)

A surgical procedure that relocates DHT-resistant follicles from a donor area (usually the back/sides of the scalp) to balding regions. FUE (follicular unit extraction) harvests individual follicular units, leaving tiny dot scars and no linear scar; FUT (follicular unit transplantation/'strip method') removes a strip of donor scalp and dissects it into grafts, leaving a linear scar but often yielding more grafts per session. Both are done under local anesthesia by a surgical team; results are permanent and natural-looking but the procedure is costly, and patients are usually kept on medical therapy (minoxidil/finasteride) to protect non-transplanted native hair. Best suited to stable loss; not appropriate during active areata or unstable scarring conditions.

Targets: Androgenetic alopecia; some use in alopecia areata

An in-office procedure in which the patient's own blood is drawn, centrifuged to concentrate platelets and growth factors, and then injected into the scalp. The growth factors are thought to stimulate dormant follicles, prolong the growth phase, and increase hair density and thickness. A typical protocol is an initial series of about 3 monthly sessions followed by maintenance every 3-6 months. Evidence is moderate and variable; works best as part of a combination regimen. Requires a trained clinician, so it is not an at-home treatment; minimal downtime, with transient scalp soreness/swelling.