Spironolactone, brand name Aldactone, is in a class of drugs called potassium-sparing diuretics (often called water pills). Spironolactone is typically used to reduce fluid in your body without causing the loss of potassium. It is also used to treat potassium deficiency, high blood pressure (hypertension), swelling (edema), and a hormonal disorder called hyperaldosteronism.
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Side effects and concerns: Minoxidil is safe, but it can have unpleasant side effects even apart from the alcohol-related skin irritation. Sometimes the new hair differs in color and texture from surrounding hair. Another risk is hypertrichosis — excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more likely with the stronger 5% solution.) Because the patent on Rogaine (the brand-name version of minoxidil) has expired, many generic products are available. They all contain the same amount of minoxidil, but some include additional ingredients, such as herbal extracts, which might trigger allergic reactions.
One hard truth: Hair loss is mostly out of your control. “Baldness comes down to your genes,” says Frederick Joyce, M.D., founder of Rejuvenate! Med Spa and a member of the International Society for Hair Restoration Surgery. “If you have the baldness gene, there are some natural remedies that may make your hair stronger and healthier to slow your hair loss slightly—but they won’t prevent you from going bald. Still, maintaining hair health by eating well and using the right products—combined with medical-grade treatments—can really work all together to help you have a fuller, thicker head of hair.”
"I recommend that everyone [with any hair loss] take finasteride," says Robert M. Bernstein, MD. Bernstein is associate clinical professor of dermatology at Columbia University and founder of the Bernstein Medical Center for Hair Restoration. "To patients who are younger,” he says, “I also recommend minoxidil. But the mainstay is finasteride. The data show that, over five years, it significantly retards hair loss in 85% of users."
A commonly prescribed treatment for women is hormone replacement therapy (HRT). HRT is only prescribed to women with AGA during menopause or women who have low estrogen and/or progesterone for other reasons. These female hormones suppress male hormone production and seem to keep hair loss at bay. Physicians, however, do not recommend long periods of HRT treatment because of the increased risk of breast cancer, heart disease and stroke.
First, I am a 39 year-old female and I started using this product about a month ago for genetic hair loss that began last year. My mother, her sister and other family members suffer from hair loss and general thinning of the hair (scalp can be seen.) I was devastated when my ultra thick mane became veil-like. At first, I tried to improve my diet, adding biotin to my daily supplements. Nothing really helped. It just got worse. The final blow came after the birth of my son. Aside from the hormonal clumps of hair that fell out (I cried over this), the thinning continued. Now for the good part: after one month of using this product, I am seeing dramatic results. Knowing that there is an effective and affordable treatment for genetic hair loss is comforting. I realize that I will need to use this product indefinitely, but that's okay. It's fast, easy, relatively inexpensive and it makes me feel better. Man or women - if you fall into the parameters described on the box, please give this a try. I'm so glad that I did.
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Dr. Melissa Piliang, a dermatologist at the Cleveland Clinic, said that Rogaine works better on the top and crown (for reasons not fully understood, the frontal hairline tends to be more resistant to treatment) and ideally should be started as soon as women notice thinning. “Any regrowth you get is a minimal amount,” Dr. Piliang said. “So the more density when you start, the better results you get.”
Oral supplements like Viviscal Extra Strength dietary supplements (Est. $50 per month) have also been proven to have a measurable effect on hair regrowth; a double-blind, placebo-controlled study in the Journal of Clinical and Aesthetic Dermatology found that the nutritional supplement significantly increased hair growth among women with thinning hair.
Studies show that Propecia is effective for 86 percent of men who use it, but doctors interviewed by USA Today say that "anyone who expects miracles will be disappointed." They explain: Only about one-third of men in the early stages of hair loss will regrow some with Propecia. These doctors say that it "primarily slow(s) down hair loss and improve(s) hair quality." As reported at HairLossHelp.com, a five-year study published in 2001 found that Propecia continued to prevent hair loss but there was a "progressive decrease in the amount of hair grown over the five-year period." Experts say that it is effective at growing back more hair than minoxidil (Rogaine) but that it can take up to a year to see results.
But in November, after 10 years of research, Rogaine introduced a new 5 percent minoxidil formulation for women. It’s a mousse (instead of a liquid) that needs to be applied only once a day instead of twice, which means that it can be more easily incorporated into a woman’s evening skin-care routine. Teal replaces the blue and silver palette of the men’s Rogaine, and the packaging bears a lotus flower. (Also last year, Pantene introduced its Hair Regrowth Treatment for Women, which is 2 percent minoxidil.)
I finally gave in and started taking propecia (1.25mg/day) ~15 weeks ago as Rogaine clearly wasn’t going to stop my hair falling out . . . . .the good thing is that I have had ZERO side affects. In fact it also seemed (so I thought) to stop my hair loss for the first 4 weeks or so. However for the last 6 weeks or so, i have been losing hair faster than ever before. I have read that this common typically between the third and fourth month of taking this. Have you heard anything like that? I hope that is the case and it slows soon. I have continued Rogaine liquid twice a day as well as dandruff shampoo a few times a week.

Men may also experience some sexual and emotional side effects while taking it: In a study published in the June 2011 issue of The Journal of Sexual Medicine, Dr. Michael Irwig of George Washington University found as many as 92 percent of test subjects reporting problems in the bedroom. The study also reported that “the mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months,” meaning that side effects lingered long after subjects stopped taking the pill.
Working just like a precise microsurgical extension of the human hand, SmartGraft’s all-in-one ergonomic handpiece and storage system was designed to help accurately separate, extract and store FUE grafts during hair transplantation. Fewer steps, less handling, and manual transferring of grafts allows the FUE procedure to be accomplished at a faster speed, reduced risks of graft failure and poor growth quality as well as with improved patient comfort.
Apply one mL 2 times a day directly onto the scalp in the hair loss area. See carton and enclosed leaflet for complete directions. Using more or more often will not improve results. Continued use is necessary or hair loss will begin again. When using this product do not apply on other parts of the body. Avoid contact with the eyes. In case of accidental contact, rinse eyes with large amounts of cool tap water. Some people have experienced changes in hair color and/or texture.
In-office laser light treatments or at-home handheld devices, such as the HairMax LaserComb, supposedly grow new hair by stimulating blood flow to the area (think: an amped-up version of a scalp-stimulating shampoo). Just don’t expect the device to make your noggin go from looking like George Costanza’s to Jerry Seinfeld’s. “These lasers won’t grow any new hair. If anything, they may just help you hang on to some of the hair that you already have a bit longer,” says Dr. Joyce.
If you think over-the-counter hair loss shampoos are for you or just want to promote growth and strength, Dr. Schwieger recommends formulas with antioxidants such as vitamin E and ginseng, amino acids, and B-vitamins to help rebuild hair and reduce environmental damage. She cautions against those with parabens, sulfates, and fragrances, which can irritate hair and reduce moisture. Ahead, eight vetted hair loss shampoos to try.
While diet alone won’t save your hair, there may be some truth to the old adage that you are what you eat. “You’re not going to have the healthiest hair if you’re living off doughnuts, because being nutrient-deficient weakens strands and makes them more prone to breakage,” says Denise Kernan, owner of DK Hair Techs, Inc., a member of the International Society for Hair Restoration Surgery, and a hair transplant technician who has worked on everyone from senators to sports stars to actors to mafia guys (she won’t name names to protect the privacy of her clients).
One hard truth: Hair loss is mostly out of your control. “Baldness comes down to your genes,” says Frederick Joyce, M.D., founder of Rejuvenate! Med Spa and a member of the International Society for Hair Restoration Surgery. “If you have the baldness gene, there are some natural remedies that may make your hair stronger and healthier to slow your hair loss slightly—but they won’t prevent you from going bald. Still, maintaining hair health by eating well and using the right products—combined with medical-grade treatments—can really work all together to help you have a fuller, thicker head of hair.”
While you won’t find a miracle shampoo on the market, nioxin and some other products can help keep your scalp in tip-top shape to improve the look of any hairs you do have left on your head. In fact, feeding your hair with the proper nutrients both inside and out can make it appear healthier, so you might consider using products with natural herbs, such as rosemary and mint.

3. Nutriceuticals. Rogers recommends that her patients try Viviscal Dietary Supplements ($50 for a one-month supply) or Nutrafol ($88 for a one-month supply), both of which can often be picked up in a salon. The former contains marine-based proteins meant to beef up thinning hair. The latter is packed with antioxidants, like ashwagandha and curcumin, and boasts impressive clinical results.
3. Surgical hair replacement. If you opt for hair transplantation (which runs $5,000 and up), your dermatologist or hair-replacement surgeon will remove single hair follicles from the back of the head, near the nape of the neck, where your hair is fullest. Once those follicles are harvested, they are then dissected and reimplanted into an area of the scalp where hair is thinning. The procedure takes anywhere from three to six hours, and newly implanted hair will usually begin to grow on its own 3 to 12 months after the treatment session. Traditionally, hair transplantation required removal of an entire strip of scalp, Sadick says, but this new follicle-by-follicle technique looks more natural when it heals and allows patients to get heads of hair as dense-looking as before they started losing it.

What’s got less evidence supporting its efficacy are the hair-growth shampoos that claim to block DHT (like those sold by Hims in their Rx Hair Kit). Rieder is skeptical that you’re going to see any tangible benefits by rubbing DHT blockers into your scalp. “I find it very difficult to believe that something that’s applied to the scalp and rinsed off is going to have any appreciable effect.” All four doctors also shut down any suggestions that hair-growth supplements or vitamins, like biotin, could help promote hair growth or stop hair loss — though a couple hypothesized that vitamins or supplements could lead to hair regrowth if your hair loss was a result of a nutritional deficiency. But otherwise, if you’re dealing with regular old male-pattern baldness, “There is no such thing as a ‘hair vitamin,’” says McMichael.
You may have hereditary hair loss, but you don't need to live with it forever. Women's ROGAINE contains topical minoxidil, the only FDA-approved over-the-counter ingredient clinically proven to regrow hair. ROGAINE works by getting inside your scalp to revitalize follicles and stimulate hair regrowth. That's why ROGAINE is the #1 dermatologist-recommended product for hereditary hair loss in women. The sooner you start, the better your chances of regrowing your hair.
The HairMax Ultima 12 LaserComb ($395) makes for a great addition to any hair loss regimen — provided you can afford it. Dr. Wolfeld notes that it’s a popular option in his practice. “Some people like the action of combing something through their hair,” he says. “They find that to be a little bit easier to do as part of their routine in the morning.” Dr. Khadavi also recommends using a laser treatment of some kind in conjunction with other treatments. “Lasers do help in stimulating the hair into the growth phase. We don’t know the exact mechanism of how it works, but it definitely helps.”
Since birth control pills decrease the production of ovarian androgens, they can be used to treat women's androgenetic alopecia. Keep in mind, however, that the same cautions must be followed whether a woman takes contraceptive pills solely to prevent contraception or to treat female pattern baldness. For example, smokers age 35 and older who take the Pill are at higher risk for blood clots and other serious conditions.
A few studies support the use of red ginseng, sometimes called panax ginseng (about $25), for hair regrowth. It can have an anti-apoptotic effect on the hair, Rogers says, meaning it slows cell death so hair follicles can grow for a longer period of time. But before taking any of these supplements, it’s important to consult your doctor; a lab test can confirm whether you need a particular supplement or if taking it will just be a waste of time and money.
There are many potential causes of hair loss, including medical conditions, medications, and physical or emotional stress. If you notice unusual hair loss of any kind, it's important to see your primary care provider or a dermatologist, to determine the cause and appropriate treatment. You may also want to ask your clinician for a referral to a therapist or support group to address emotional difficulties. Hair loss can be frustrating, but recent years have seen an increase in resources for coping with the problem.
The trick about all of these hair-loss products and treatments is that they’ll stop working as soon as you stop using them. “They have to be ready for a lifetime commitment,” says Rieder. But, just like brushing your teeth, as long you keep on keeping on with the scientifically proven preventative treatments, those hairs on your head should be just fine.

2. A strategic cut. Long, layer-free haircuts divert volume from the roots, making your part seem wider than it is, Scrivo says. Going shorter (than your current length — no need for a major chop) helps take weight off so hair can look fuller and bouncier. And layers that angle inward on the sides will build height and body at the crown. If you’re game to try bangs, Scrivo says, they lessen the amount of scalp that shows at the hairline.
Hi, great article. I have an aggressive form of MPB. I am 23 year old with a NW2 hairline, diffuse thinning over the top and crown. Been on 5% Minoxidil and 2% Keto for about 9 months. Went through a period of shedding which has reduced somewhat in the last couple of months. I don’t see any appreciable increase in density anywhere but I do see plenty of thin vellus hair at my hairline. I am waiting for the 1 year mark to see the full effect of this regime. Is there like a test you can do to assess hairfall? Or do we just have to count the hair lost in the shower? Do you reckon I should start the Fin to hold on the the hair I have? Like most guys (actually a bit more than most guys seeing that I am young) I worry a lot about being in the 2% who experience disastrous sides from Fin. I do plan to check my DHT levels before I start, if I do at all, to see if I naturally have high/low DHT. That should tell me what to expect, to an extent. 
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