Topical minoxidil is one of the most established treatments for male and female pattern hair loss. Available without a prescription in several strengths and formulations, minoxidil supports follicles by prolonging the active growth phase of the hair cycle. Treatment must be applied consistently, and results usually develop gradually over several months. Some patients notice temporary increased shedding when therapy begins. Scalp irritation, dryness, or unwanted facial hair growth can also occur.

Compounded topical finasteride may be considered for selected patients, particularly men with androgenetic or male pattern hair loss. Finasteride reduces the conversion of testosterone to dihydrotestosterone, or DHT, a hormone involved in progressive follicle miniaturization. Clinical trials in men have found that topical finasteride can improve hair counts while producing lower systemic exposure than oral finasteride. However, compounded topical finasteride is not FDA-approved in the United States, and some systemic absorption remains possible. It should be used only under medical supervision and should not be handled or used during pregnancy.

Topical bimatoprost is a prostaglandin analog that is FDA-approved for eyelash hypotrichosis, where it increases lash length, thickness, and darkness. Dermatologists may sometimes use bimatoprost off-label for selected areas of hair loss, but evidence for scalp-hair regrowth is more limited than the evidence supporting minoxidil. Your dermatologist can determine whether it is a reasonable option based on the location and cause of the hair loss.

Low-dose oral minoxidil is increasingly prescribed off-label for male and female pattern hair loss, especially when topical minoxidil is irritating, difficult to apply, or insufficient by itself. Because minoxidil was originally developed as a blood-pressure medication, treatment requires individualized screening and monitoring. Potential effects include unwanted body or facial hair, ankle swelling, lightheadedness, increased heart rate, and changes in blood pressure.

Oral finasteride is FDA-approved for male pattern hair loss in men. It helps slow progressive thinning by reducing DHT levels and generally must be continued to maintain its benefit. Possible adverse effects include decreased libido, erectile or ejaculatory changes, breast tenderness, and mood-related symptoms. Finasteride is not FDA-approved for women and is contraindicated during pregnancy because of the risk to a developing male fetus.

Oral spironolactone may be prescribed off-label for women with female pattern hair loss, particularly when hormonal factors, acne, or unwanted facial hair are also present. It reduces androgen signaling that can contribute to follicle miniaturization. Blood pressure, kidney function, medications, and potassium levels may need to be reviewed before and during treatment. Pregnancy must be avoided while taking spironolactone. Clinical research supports its use as one option within a broader female-pattern hair-loss plan.

Alopecia areata is an autoimmune condition that can cause smooth, round bald patches or more extensive loss of scalp, eyebrow, eyelash, or body hair. Limited disease may be treated with topical or injected corticosteroids. For severe alopecia areata, FDA-approved oral options now include the JAK inhibitors baricitinib for adults, ritlecitinib for adults and adolescents ages 12 and older, and deuruxolitinib for adults. These medications affect immune signaling and require careful review of infection risks, medical history, laboratory findings, and potential adverse effects.

Inflammatory and scarring alopecias, including lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia, require prompt evaluation. Once a follicle has been permanently destroyed by scarring, it cannot produce new hair; therefore, treatment is primarily directed at controlling inflammation and preserving remaining follicles. Depending on the diagnosis and severity, oral treatment may include doxycycline, hydroxychloroquine, anti-androgen medications, corticosteroids, or other immune-modulating therapies. Treatment often requires ongoing monitoring and may be combined with topical or injected medication