Hair Loss Treatment

For pattern hair loss, options include topical minoxidil and oral finasteride for men. Where a reversible cause is found, treating that comes first.

Book if

• Hair is thinning or shedding more than usual
• You want reversible causes excluded before accepting it as permanent
• Loss followed illness, childbirth, stress or significant weight loss

Needs dermatology, not treatment

• Patchy or circular loss — possible alopecia areata
• Scarring, redness or scalp pain — scarring alopecia is permanent if untreated and needs urgent assessment
• Sudden, dramatic loss

Finasteride — important

Not for women who are or may become pregnant, and pregnant women should not handle broken tablets. A small proportion of men experience sexual side effects, which usually resolve on stopping but occasionally persist. This is discussed before prescribing rather than found out afterwards.

1. Rule out what is reversible

Iron deficiency, thyroid disease, and shedding after illness, stress, childbirth or crash dieting all cause hair loss and all resolve when treated. They look different from pattern loss and are frequently missed.

2. Identify the pattern

Diffuse thinning, receding hairline, crown loss and patchy loss have different causes and different treatments.

3. Treat

Topical minoxidil, or oral finasteride for men, where pattern loss is confirmed.

4. Expect it to be slow

Minoxidil commonly causes increased shedding for the first six to eight weeks before improvement. Visible change takes four to six months. Stopping means losing what you gained.

Everything here is slow

Hair grows about a centimetre a month, which sets the timescale for all of this. Judging treatment at eight weeks tells you nothing.

• Weeks 2–8 on minoxidil — shedding often increases. This is expected: old hairs are pushed out by new growth. It is the point at which most people stop
• Months 4–6 — the first honest assessment
• Month 12 — the full effect

Photographs are the only reliable measure

Take them at the start and every three months — same lighting, same position, same parting, dry hair. Nobody can judge their own hair from memory, and this is what settles whether treatment is working.

What is reviewed

• Blood results — ferritin, thyroid function, vitamin D. Ferritin matters more than most people realise: hair is affected at levels well above the threshold for anaemia
• Whether the pattern has changed, which can mean the diagnosis needs revisiting
• Adherence. Minoxidil is applied twice daily indefinitely, which is a real commitment
• Side effects — scalp irritation with minoxidil; sexual side effects with finasteride

Stopping means losing the gains

Both minoxidil and finasteride maintain hair only while they are being used. Stopping means returning to where you would have been within about six to twelve months.

That is worth understanding before starting — this is ongoing treatment, not a course.

Contact us if

• Patchy or circular loss — possible alopecia areata, needing dermatology
• Scarring, redness, scaling or scalp pain — scarring alopecia is permanent if untreated and needs urgent assessment. This is the one not to sit on
• Sudden dramatic shedding
• Sexual side effects on finasteride, which need reviewing rather than enduring
• Loss with irregular periods or excess facial hair, which points to PCOS

Shedding after illness or childbirth

Telogen effluvium follows the trigger by two to three months and recovers on its own over six to nine. It needs the cause addressed rather than pattern-loss treatment — and it is genuinely alarming while it happens, which is why saying plainly that it recovers matters.

Find the reversible causes first

This is the part most private hair loss services skip, and it is where the appointment earns its money.

• Iron deficiency — very common, particularly in women. Hair is affected at ferritin levels well above the anaemia threshold, so "your bloods were normal" often is not the whole answer
• Thyroid disease, over- or underactive
• Telogen effluvium — shedding two to three months after illness, surgery, childbirth, crash dieting or severe stress. It recovers on its own
• PCOS, where hair loss comes with irregular periods or excess facial hair
• Medication — several cause hair loss, and an alternative sometimes exists
• Rapid weight loss, including on GLP-1 medicines, and low protein intake

Pattern hair loss treatments

• Topical minoxidil — for men and women, available over the counter without prescription. The best-evidenced first step
• Oral finasteride — for men. More effective than minoxidil for male pattern loss, and the two work well together
• Spironolactone — used off-licence for female pattern loss, particularly with PCOS

Non-drug options

• Low-level laser devices — modest evidence, expensive, and safe
• Hair transplant — effective for the right candidate, permanent, and expensive. Medical treatment first, since a transplant does not stop ongoing loss of the hair you still have
• Wigs and hairpieces, and NHS wig provision, which is free or subsidised for certain causes of hair loss and is under-claimed

What needs dermatology rather than treatment

Patchy circular loss (alopecia areata), scarring alopecia — which is permanent if untreated and is the urgent one — and anything with redness, scaling or pain.

What does not work

• Hair growth supplements and "gummies" — no useful evidence unless you are actually deficient, and excess biotin interferes with thyroid and cardiac blood tests, which causes real diagnostic confusion
• Caffeine shampoos and "thickening" products, which do nothing for the follicle
• Expensive subscription "hair" plans, which are usually minoxidil and finasteride at a markup

What you pay us

• £40 for the consultation, with photograph review
• Blood tests — ferritin, thyroid and vitamin D — quoted before they are arranged. These are the point of the appointment
• £40 for review at three to six months

What you pay the pharmacy

Minoxidil is available over the counter and is inexpensive. Generic finasteride is also cheap. We earn nothing from what is prescribed.

Said plainly, because this market deserves it

The medicines used for hair loss are cheap and widely available. Most of what the private hair loss industry sells is those same medicines at a substantial markup, wrapped in a subscription.

• Minoxidil needs no prescription at all — buy it from a pharmacy
• Generic finasteride costs very little as a private prescription
• Be wary of subscription "hair plans", which bundle those cheap drugs with shampoos and supplements and create a financial interest in your staying subscribed

So what is the £40 for?

Finding out whether this is pattern hair loss at all. Iron deficiency, thyroid disease, telogen effluvium and PCOS all cause hair loss, all are treatable, and none of them respond to minoxidil.

People spend years and considerable sums on pattern-loss treatment for a ferritin problem. That is what this appointment is meant to prevent.

The ongoing cost

Both treatments maintain hair only while used, so budget indefinitely rather than for a course. Stopping loses the gains within six to twelve months.

The expensive end

Hair transplants cost thousands and are permanent — choose the surgeon on qualifications, not price, and be particularly careful with overseas packages. Medical treatment should come first, since a transplant does nothing to stop continued loss of the hair around it.

Free help worth knowing

NHS wig provision is free or subsidised for certain causes of hair loss, including alopecia areata and treatment-related loss. It is under-claimed and worth asking about.

Is my hair loss definitely genetic?

Not necessarily, and that is exactly why we test before treating.

Iron deficiency, thyroid disease, PCOS and shedding after illness or childbirth all cause hair loss, all are treatable, and none respond to minoxidil. Treating reversible loss as permanent is the commonest and costliest error here.

My blood tests were normal but my hair is falling out.

Worth checking what "normal" meant. Hair is affected by ferritin levels well above the threshold for anaemia — a ferritin that does not flag as low can still be too low for hair.

Bring the actual numbers rather than the word "normal", which is why we ask for results.

I am shedding much more since being ill. Will it grow back?

Almost certainly yes. Telogen effluvium follows illness, surgery, childbirth, crash dieting or severe stress by two to three months, and recovers on its own over six to nine months.

It is genuinely frightening while it happens — but it is a shedding of hairs that will regrow, not a loss of follicles.

The minoxidil is making it worse. Should I stop?

No — this is expected and it is the point at which most people give up.

Increased shedding in weeks 2–8 happens because new hairs are pushing old ones out. It settles, and it is a sign the treatment is doing something. Push through to four months before judging it.

How long before I see improvement?

Four to six months for a first honest assessment, twelve months for the full effect. Hair grows about a centimetre a month, and nothing changes that.

Take photographs at the start and every three months. Nobody can judge their own hair from memory.

Do I have to keep using it forever?

Yes, if you want to keep the benefit. Both minoxidil and finasteride maintain hair only while used, and stopping returns you to where you would have been within six to twelve months.

That is worth deciding before starting, not a year in.

What are the finasteride side effects, honestly?

A small proportion of men experience reduced libido, erectile difficulty or reduced ejaculate volume. These usually resolve on stopping, and a small number of men report persistent symptoms after stopping — which remains debated but should not be dismissed.

You should hear this before deciding, not afterwards. It also lowers PSA, which matters for prostate screening — tell any doctor checking your PSA that you take it.

Can women take finasteride?

Not if pregnant or able to become pregnant, and pregnant women should not handle broken or crushed tablets — it causes birth defects.

Minoxidil is the usual option for women, and spironolactone is used off-licence, particularly with PCOS.

Which hair loss needs seeing urgently?

Scarring alopecia. Redness, scaling, scalp pain, or smooth shiny areas where the follicles have gone — this is permanent if untreated and needs dermatology promptly.

Patchy circular loss may be alopecia areata and also needs assessment.

Do hair supplements work?

Not unless you are actually deficient — in which case treating the deficiency is what works, not the gummy.

One practical warning: high-dose biotin interferes with thyroid and cardiac blood tests, producing misleading results. Stop it a few days before any blood test and tell the doctor you take it.

Is a transplant worth it?

For the right candidate, yes — it is effective and permanent. But medical treatment should come first, since a transplant does not stop you losing the hair you still have around it.

Choose the surgeon on qualifications rather than price, and be careful with overseas package deals — the follow-up is where those most often fail.