The Only Two Medications With Strong Clinical Evidence

For male androgenetic alopecia, two medications have stood up to placebo-controlled trials over decades: finasteride (oral) and minoxidil (topical). Almost everything else on the supplement aisle is anecdotal or outright marketing.

Finasteride — How It Works

Finasteride blocks the enzyme that converts testosterone into dihydrotestosterone (DHT). DHT is the molecule that miniaturises hair follicles in genetically susceptible men. Less DHT, slower miniaturisation. The drug is taken orally — typically 1 mg/day — and works only while you take it.

Most men see stabilisation within 6 months and modest regrowth within 12–18 months on the crown and mid-scalp. The hairline is harder to recover with finasteride alone.

Finasteride — Side Effects, Honestly

Sexual side effects (lowered libido, erectile changes) are reported in 1–2% of users in placebo-controlled trials, though some studies suggest persistent post-finasteride syndrome at lower frequency. Mood changes have been reported. Most side effects resolve on cessation. Have a frank conversation with a doctor before starting; do not skip the consult.

Minoxidil — How It Works

Minoxidil opens potassium channels in the follicle, increases blood flow, and prolongs the anagen (growing) phase. The exact mechanism is still partly unclear. Applied topically as 5% solution or foam, twice daily, it produces visible regrowth in some men within 6 months — strongest on the crown.

The Realistic Result

On finasteride + minoxidil, expect: stabilisation in most men, modest regrowth in about half, and meaningful regrowth in a smaller subset. Neither medication restores a Norwood V back to a Norwood II. They are stabilising drugs, not regenerative ones.

How They Combine With SMP and Transplant

Both medications are compatible with both SMP and transplant. We typically encourage continuing them around any procedure (pause minoxidil 3–5 days before, restart 14 days after a transplant; continue finasteride throughout). If you start a procedure on a stabilised hair pattern, the result lasts longer.