How to read this map
Whether an option needs a prescription depends on the country: finasteride for hair loss, for example, is prescription-only in the UK and not available on the NHS. The evidence is easier to summarise. A meta-analysis of randomized trials found minoxidil, finasteride and low-level laser therapy all better than placebo at promoting hair growth in men, and minoxidil better than placebo in women, though the trials varied a lot. The NHS adds two caveats that apply to every option: none works for everyone, and each works only for as long as it is used. Our articles on each option go into more depth.
Based on: NHS; Adil & Godwin 2017
Without a prescription: topical minoxidil
Topical minoxidil is the most widely used non-prescription option, and the American Academy of Dermatology calls it the most recommended treatment for female-pattern hair loss. It comes as a liquid or a foam applied to a dry scalp; the foam seems to irritate the scalp less. A temporary rise in shedding in the first weeks is common, and it takes six months to a year to judge whether it works. Unwanted hair can grow where it runs onto the face. When it is stopped, the benefit fades and shedding returns. Women who are pregnant, planning a pregnancy or breastfeeding are advised to avoid it.
Based on: American Academy of Dermatology
Without a prescription: lasers, shampoos and supplements
Low-level laser caps, combs and helmets are sold for home use, and some are FDA-cleared, a recognition of safety that is less demanding than drug approval. In the meta-analysis, laser therapy beat placebo devices in men, but the American Academy of Dermatology notes that studies are few, not everyone responds, a device has to be used continuously, and long-term safety is still unknown. Shampoos sold for hair loss can make hair look fuller and reduce breakage, but they cannot regrow hair. Supplements help only when a blood test shows a deficiency, and extra iron, for example, can do harm. Concealers and wigs work at once, without changing the hair itself.
Based on: American Academy of Dermatology; Adil & Godwin 2017
With a prescription: what to discuss with a doctor
Finasteride tablets are approved in the United States for male-pattern hair loss and slow further loss in most men who take them; some also regrow hair, more often when they start early. Possible side effects include sexual ones and low mood, which a dermatologist weighs with you before prescribing. Dutasteride, a related medicine, is another option some dermatologists prescribe. Minoxidil tablets are an off-label option: a review of seventeen mostly small studies found them effective and well tolerated in healthy people who struggle with the topical form, while calling for larger trials. For women, dermatologists often prescribe spironolactone, a medicine approved for other conditions.
Based on: American Academy of Dermatology; NHS; Randolph & Tosti 2021
Pregnancy and other cautions
Prescription hair-loss medicines can cause birth defects, so they are not an option for anyone who is pregnant or planning a pregnancy, and dermatologists advise women who could become pregnant to use birth control while taking them. Minoxidil, too, is best avoided during pregnancy and breastfeeding. Some of these tablets and capsules also carry handling warnings for anyone who is or may become pregnant, which the leaflet in the pack explains. Finasteride can affect the PSA blood test used to check the prostate, so mention it before such a test, and tell the prescriber about any history of depression or liver problems.
Based on: American Academy of Dermatology; NHS
How to judge whether an option is working
Give any option time: hair grows slowly, so results are usually judged after six months to a year, and a prescription medicine that has grown no hair within a year is unlikely to. Expect some shedding early on with minoxidil, and expect hair gained with a medicine to be lost again within a few months if it is stopped. Dermatologists may combine options, because together they tend to work better than one alone. Consistent photos every one to three months, taken the same way, are the fairest test, since day-to-day impressions mislead. Results also tend to be better when treatment starts early, one more reason to talk to a dermatologist sooner.
Based on: American Academy of Dermatology