First: is it actually male-pattern baldness?
Typical androgenetic, or male-pattern, hair loss develops gradually. You may notice recession at the temples, thinning at the crown, progressive loss over years and a family history of similar hair loss.
Not every type of hair loss should be treated this way. HSE information describes other patterns including telogen effluvium and alopecia areata, so sudden or patchy hair loss deserves proper assessment rather than automatically starting treatment for male-pattern baldness.
How does finasteride work?
Finasteride reduces conversion of testosterone to dihydrotestosterone, or DHT. DHT plays an important role in androgenetic hair loss in genetically susceptible men. Reducing DHT can slow further loss and can produce some regrowth.
Results take time. Benefit is generally maintained only while treatment continues.
How does minoxidil work?
Minoxidil is applied to the scalp. Its effect on hair follicles differs from finasteride and does not depend on blocking DHT. It does not work for everyone, improvement takes months, and benefit usually diminishes if treatment is stopped.
Which works better?
They cannot be compared simply as “stronger” and “weaker” because they act differently. For some men, one treatment is appropriate. For others, a clinician may discuss using both. Choice depends on the pattern and stage of hair loss, medical history, side-effect preferences, age and previous treatment.
What are the side effects of finasteride?
Potential sexual side effects include reduced libido, erectile difficulties and ejaculation problems. Mood effects are also important.
Following an EU-wide safety review, the European Medicines Agency confirmed suicidal thoughts as a possible adverse effect of oral finasteride tablets, with frequency unknown. Men taking 1 mg finasteride for hair loss are advised to stop treatment and seek medical advice if they develop depressed mood, depression or suicidal thoughts.
What are the side effects of minoxidil?
- Scalp irritation
- Dryness or itching
- An initial period of increased shedding in some users
- Unwanted hair growth if product is transferred to other areas
Do I need blood tests?
Typical male-pattern baldness often does not require extensive testing. Investigation may be appropriate when hair loss is sudden, diffuse, patchy, accompanied by systemic symptoms, associated with significant weight change or occurring alongside other endocrine or nutritional symptoms.
| PrivateGP.ieMale-pattern hair loss is often suitable for online assessment using a detailed history and clear photographs. PrivateGP.ie offers a private route to discuss whether treatment such as finasteride or minoxidil is appropriate, while sudden, patchy or atypical hair loss may need examination or blood tests. |
When should I seek further assessment?
Arrange a more detailed review if hair loss is very sudden, patchy, associated with scalp inflammation or scarring, or accompanied by other new symptoms.
References and further information