What causes male-pattern hair loss?
Androgenetic alopecia (male-pattern baldness) is driven by dihydrotestosterone (DHT), a more potent androgen than testosterone, binding to receptors in scalp hair follicles. The follicle gradually miniaturizes, producing thinner and shorter hair with each cycle until production stops entirely (Endocrine Reviews 2018).
How does finasteride work?
Finasteride inhibits 5-alpha-reductase, the enzyme that converts testosterone to DHT. Daily 1mg oral finasteride reduces serum DHT by ~70% within 4 weeks. Reduced scalp DHT lets follicles return to normal production (FDA Propecia label; multiple Phase III trials).
Topical vs oral finasteride — which should I use?
Topical finasteride (0.25-0.5% applied to scalp) produces similar hair regrowth to oral 1mg/day but with ~80-85% lower systemic absorption, reducing the risk of sexual side effects (libido, erectile function). It's a good option for men who want results without the labeled side-effect profile (J Drugs Dermatol 2020-2023).
Does finasteride cause sexual side effects?
FDA labeling shows ~1-2% of men report decreased libido, ~1% report erectile dysfunction, and <1% report ejaculation disorders. These are typically reversible after discontinuation. Topical formulations reduce these rates substantially. Discuss any concerns with your clinician.
What's dutasteride and how does it differ?
Dutasteride is a more potent 5-alpha-reductase inhibitor that blocks both Type 1 and Type 2 of the enzyme (finasteride only blocks Type 2). It reduces serum DHT by ~90%. Studies show modestly better hair regrowth than finasteride but a higher rate of side effects. FDA-approved for BPH but used off-label for hair loss (multiple Korean and Japanese trials).
How does minoxidil work?
Minoxidil opens potassium channels in scalp blood vessels, prolonging the hair growth (anagen) phase and increasing follicle size. It does not address the underlying DHT cause but compounds nicely with finasteride. Topical 5% and oral 2.5-5mg daily are both effective (FDA label; J Am Acad Dermatol 2020).
Oral vs topical minoxidil?
Oral low-dose minoxidil (2.5-5mg daily) produces equal or better hair regrowth than topical 5% solution, with fewer scalp irritation issues but a small risk of systemic side effects (mild fluid retention, lower blood pressure). Topical minoxidil has no systemic effects but requires twice-daily application.
How long until I see results?
Hair shedding can briefly increase in weeks 1-8 (existing weakened hairs falling out before stronger replacements grow in). New growth becomes visible at 3-4 months. Full results take 9-12 months. Stopping treatment reverses the gains over the following 6-12 months.
Can I stop finasteride once my hair grows back?
No — stopping treatment causes the regrown hair to gradually shed over 6-12 months. Finasteride and minoxidil are not cures; they suppress the active process of follicle miniaturization. To maintain results, treatment must continue.
Will finasteride cause depression or brain fog?
A small subset of men report mood changes on finasteride (post-finasteride syndrome). The mechanism isn't fully understood and the prevalence is debated. If you experience mood changes, switching to topical formulation often resolves them while preserving hair benefits.
Does shampoo or ketoconazole help?
2% ketoconazole shampoo (used 2-3x/week) has mild anti-androgen and anti-inflammatory effects that may modestly help, particularly when combined with finasteride and minoxidil. The effect is small relative to the core medications but adds with minimal downside.
Is microneedling worth it?
Microneedling at 1.5mm depth combined with topical minoxidil has shown enhanced regrowth in randomized trials (J Cutan Aesthet Surg 2013, 2018). The needling appears to upregulate growth factors locally. Done 1-2x/week at home or in-office, it adds 15-30% to topical minoxidil's effect.
Can finasteride be combined with TRT?
Yes. Many men on TRT add finasteride to manage the increase in DHT (which TRT can elevate). Finasteride does not block testosterone's primary effects on muscle, mood, libido — it specifically blocks the conversion to DHT, which is the scalp-relevant pathway.
What's the difference between male-pattern and other hair loss types?
Male-pattern (androgenetic) starts at the hairline and crown — the DHT-sensitive zones. Telogen effluvium (stress-related shedding) is diffuse across the scalp. Alopecia areata is patchy and immune-mediated. Each has different protocols; the clinician identifies which you have during intake.
Who shouldn't take finasteride or dutasteride?
Men actively trying to conceive (5-alpha-reductase inhibitors can affect male fertility), men with severe depression history, women of childbearing age (these medications cause birth defects), and men with liver disease. Topical formulations have a much narrower contraindication list.
How much does the program cost?
Hair regrowth is $65 for a 4-week plan, $62 a month on the 12-week plan (billed $186), and $59 a month on the 24-week plan (billed $354). Every plan includes your custom-compounded protocol, clinician care and free shipping. Intake and clinician review are free.