Version July 2025
Other treatment approaches may be reasonable. Patient preference for the mode of therapy (topical versus oral) and patient tolerance for potential adverse effects strongly influence the selection of therapy. Earlier introduction of additional MPHL therapies (eg, PBM, PRP, topical finasteride) is a reasonable alternative when there is a desire for a more aggressive approach to treatment.
Camouflage techniques, such as topical keratin fibers, wigs, and hairpieces, are additional methods of restoring the appearance of dense hair growth.5-ARI: 5-alpha reductase inhibitor (eg, finasteride, dutasteride); MPHL: male pattern hair loss; PBM: photobiomodulation (eg, low-level laser therapy); PRP: platelet-rich plasma.
* Oral finasteride is our preferred oral 5-ARI for initial treatment. Oral dutasteride may be more effective than oral finasteride but has less long-term efficacy data and lacks regulatory approval for MPHL in some locations (including the United States).
Limited data suggest that combination therapy with oral finasteride and topical minoxidil is more effective than oral finasteride monotherapy.
¶ Although oral finasteride appears more effective than topical minoxidil, some patients prefer to avoid oral 5-ARI therapy because of concern for potential adverse effects (eg, sexual dysfunction, gynecomastia, psychiatric effects, and effects on prostate cancer detection and risk). Long-term daily topical therapy may be less desirable or challenging for some patients.
Δ Our typical next step after an unsatisfactory response to oral finasteride and/or topical minoxidil is to add low-dose oral minoxidil; however, patient preference strongly influences treatment selection. We typically stop topical minoxidil a few weeks after starting oral minoxidil.
◊ Combination therapy refers to adding another MPHL therapy to the treatment regimen. Ideal candidates for hair transplantation are patients with stable or medically controlled MPHL who have moderate baldness (Hamilton-Norwood III to VI), desire permanent improvement in hair loss, are willing to continue medical therapy, and have an adequate reservoir of hair for transplantation.
§ Refer to UpToDate content on the treatment of MPHL for additional treatment options.