Finasteride inhibits an enzyme that converts testosterone to DHT, or dihydrotestosterone, the hormone that causes hair loss in men, and unlike minoxidil, this drug can actually help hair grow back, as well as prevent further loss. All you have to do is take one pill a day, and according to Dr. Evan Rieder, dermatologist in the Ronald O. Perelman Department of Dermatology at NYU Langone Health, two-thirds of men taking this treatment will see improvements in hair density over time.
Hair: It’s a natural part of being a human. But when the temperature climbs, and skin is exposed, it’s one of those things that a good many of us want to control. This week, we’re tackling hairlessness, not just the process of hair removal (electric shavers and ingrown-hair treatments and aesthetician-approved tweezers) but also what to buy when you’re losing your hair, and even how to take care of a Sphynx cat. Here, we’re talking to dermatologists and hair-loss doctors about hair-loss treatments that actually work.
In men, finasteride (originally marketed as Proscar) is approved for hair loss associated with androgens. In one study, 62% of women also taking oral contraceptives containing the synthetic progestin drospirenone reported improvement. So it may be effective for female hair loss in the setting of increased androgen. But studies are limited and it is harmful to the male fetus so should not be used by women thinking about becoming pregnant or who are pregnant.
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.
The dermatologist also will carefully look at your scalp and hair. During an exam, the dermatologist may pull on your hair. Sometimes a dermatologist needs to pull out a hair to get the necessary evidence. And sometimes a dermatologist needs to look at the hair on the rest of your body to see whether there is too little or too much hair in other areas.
Castor oil, as some might already know, is one of the most popular all-natural "panaceas." Go ahead, Google it: What you'll find is article after article about how the viscous oil can help with shedding, breakage, and regrowth. But unlike rosemary oil and vitamin B5, both of which have studies that back up their aid in hair growth, scientific evidence surrounding castor oil is lacking. (Any testimonials about castor oil for hair growth are anecdotal, coming mostly from blogs, Reddit, and YouTube.)
What worked for me was doing nothing about losing my hair and just letting nature take its course. My hair started receding in my early 20s, but only a little, then it stopped for about 30 years. Then in my early 50s my hair started receding and thinning very rapidly again. I panicked until my wife told me she loves bald men and had been wishing I would go bald. She talked me into just letting myself go bald. In less than two years I went from norwood 2 or 3 to norwood 6. I don’t regret my decision to go bald and have no desire to regrow my hair. My wife and I really enjoyed watching my hair recede and thin away. I love being bald and you couldn’t pay me to regrow my hair. In retrospect, I wish I had kept on balding in my 20s all the way to norwood 7.
Hair transplants will likely lead to better results in the long run (you are introducing new hairs to the balding areas), but you’ll still need to use minoxidil or finasteride after surgery to maintain the results. Like all hair loss treatments, hair transplants are best when combined with other methods, and you’ll want to speak with your doctor to see what combination is best for you.
In either sex, hair loss from androgenetic alopecia occurs because of a genetically determined shortening of anagen, a hair's growing phase, and a lengthening of the time between the shedding of a hair and the start of a new anagen phase. (See "Life cycle of a hair.") That means it takes longer for hair to start growing back after it is shed in the course of the normal growth cycle. The hair follicle itself also changes, shrinking and producing a shorter, thinner hair shaft — a process called "follicular miniaturization." As a result, thicker, pigmented, longer-lived "terminal" hairs are replaced by shorter, thinner, non-pigmented hairs called "vellus."