At a glance
- Follicle sensitivity and genetics are major drivers of androgenic hair loss
- DHT is produced from testosterone by 5-alpha-reductase
- A change in shedding or hair density deserves an individual review
- Hair-loss medications have benefits, limitations, and possible adverse effects
Testosterone, DHT, and susceptible follicles.
Some scalp follicles are genetically more sensitive to DHT. That sensitivity helps explain the typical pattern of recession and thinning seen in androgenic alopecia.
Starting or changing hormone therapy can coincide with hair changes, but age, stress, thyroid disease, iron status, rapid weight change, illness, and other medications may also contribute.
Treatment options require tradeoffs.
Finasteride
An oral or compounded topical 5-alpha-reductase inhibitor. Potential sexual, mood, fertility, and other effects should be reviewed before use.
Dutasteride
A longer-acting inhibitor with broader enzyme activity. Its long half-life and potential adverse effects require careful prescribing.
Minoxidil
A topical hair-growth treatment that works through a different mechanism and generally requires ongoing use to maintain results.
Combination formulations
Compounded topical combinations may be available, but formulation quality, systemic absorption, side effects, and evidence should be discussed.
Ask before adding a medication.
Do not start, stop, or change a hair-loss medication based on an article. Review scalp pattern, timeline, other symptoms, current medications, fertility goals, and relevant lab work with a qualified clinician.