In clinical studies of mostly white women aged 18-45 years with mild to moderate degrees of hair loss, the following response to 2% minoxidil topical solution was reported: 19% of women reported moderate hair regrowth after using 2% minoxidil topical solution for 8 months (19% had moderate regrowth; 40% had minimal regrowth). This compares with 7% of women reporting moderate hair regrowth after using the placebo, the liquid without minoxidil in it, for 8 months (7% had moderate regrowth; 33% had minimal regrowth).
These anti-androgenic effects can be used to help treat hair loss. Nizoral shampoo contains 2% ketoconazole and is prescribed not only for the treatment of scalp conditions, but also in combination with other treatments for androgenetic alopecia. A 1% version is now available over-the-counter, but it may not be as effective as the 2% prescription strength. There are no significant side effects.
Topical treatments like Rogaine use the active ingredient minoxidil -- originally used to treat high blood pressure. After researchers discovered that it also promoted hair growth, it was the first drug approved by the FDA to treat male pattern baldness. It is used topically on the scalp, and the success of treatment is dependent on the user's extent of hair loss. Researchers at the AHLA find its efficacy to be marginal in the long run since it has no effect on the hormonal process. 
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Great article thx!! I’m 38 and still have a full head of hair but I started to shed about 3 months ago. Typically ~15 hairs on my pillow when I wake up and 20 or so hairs on my hand after I shower. I also notice hairs on my desk during the day. I never noticed any hair loss before 3 months ago. I started to use rogaine 5% twice a day about a month and a half ago and the shedding accelerated. I read that is normal but should it still be doing this after 1.5 months? I haven’t tried propecia yet as I want to see if Rogaine will do the trick but will if the shedding doesn’t stop. Also, do you think stress can play a part in hair loss? I started a super stressful job about 6 months ago so thinking my hair loss could be related to that.
I have taken Propecia for 5 years. The first couple of years the side effects were minimal, but after they became more severe. Lacking morning wood, reduced ejaculate, reduced penile sensitivity are real issues. You’re be hard pressed to accuse some of suffering the nocebo effect in these instances. In which case you’re telling the person to just ignore the problems.
From what I’ve seen and read they can be quite effective–but come with several risks (scarring and unnatural-looking hairline come to mind). I haven’t dwelled much into it, but basically got FUT (follicular unit transfer), FUE (follicular unit extraction) and DHI (direct hair implant)–which is the newest, similar to FUE, most costly and provides the best results in most cases.
The other main hair-loss treatment that was recommended by all four dermatologists I interviewed is finasteride, often called by its brand name Propecia. This FDA-approved medication is only available with a prescription, but these days, it’s found as a generic and ordered online after a virtual consultation, through start-ups like Hims, Keeps, and Lemonaid.
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