Finasteride and minoxidil are the only treatments licensed as treatments for male pattern baldness. Used together, they’ve been clinically proven to be effective at stopping hair loss in 94% of men with mild to moderate hair loss. But what does ‘mild to moderate’ even mean, and how can you know if you fall into that category?
This blog will break down how to identify where your hair loss falls on the official scale, what to expect from treatment depending on your stage, and what you can do if you’re further along.
What stage of hair loss are you?
Hair loss from male pattern baldness is categorized on the Norwood-Hamilton Scale, which goes from Stage I (no hair loss) to Stage VII (complete baldness).
In more detail, this looks like:
Stages I-II: the corners of the hairline might have pushed back slightly in a symmetrical, triangular shape at the temples. This isn’t classed as hair loss yet, as it’s usually a small change to the hairline most men notice after puberty.
Stage III: further hair loss at the temples/hairline, and some thinning at the crown.
Stage IV: the hair loss progresses, with more thinning at the hairline and/or crown
Stage V: a band of hair is left separating the areas of loss at the hairline and crown
Stage VI: the hair loss at the crown and hairline connects, so there is complete baldness on the top of the head
Stage VII: complete baldness, or a ‘horseshoe’ of hair left around the back and sides of the head
Stages III-V are usually considered ‘mild to moderate’ hair loss, the stages that proven treatments like Finasteride and Minoxidil are likely to work best.
What to expect based on your stage of hair loss
The timing of starting treatment makes a difference to what you can expect to see from treatment. The earlier you start once you notice signs of thinning, the better results tend to be. That’s because Finasteride and Minoxidil are best at stopping hair loss, rather than reversing it.
Finasteride blocks the enzyme 5a-reductase, which converts testosterone into DHT. DHT is the main driver of male pattern baldness, as it binds to sensitive hair follicles on the scalp and causes them to gradually shrink, so they stop producing thick, healthy hairs. Minoxidil Spray boosts blood flow to the hair follicles, which also helps prevent miniaturisation by making sure follicles are getting the oxygen and nutrients needed for healthy hair growth.
That’s why they work best before miniaturisation is complete, by reactivating the shrinking hair follicle so it can keep growing new hairs.
If hair loss has developed to the point that you’ve got bald spots, that’s an indication that the hair follicles are dormant. Finasteride and Minoxidil will have a harder time bringing these follicles back to life, than keeping them alive.
It might be helpful to think of Finasteride and Minoxidil as helping with maintenance, rather than regrowth. Studies consistently show that Finasteride stabilizes hair loss, aka stops further loss, in most men, but an increase in hair count was seen in 66% of men after two years of treatment. It’s also shown to be more effective in younger men, usually classed as 18-41 years old in trials. In older men, Finasteride was shown to have limited effect on frontal hair loss (the hairline area), but was shown to be effective across all areas of hair loss in younger men.
What can you do if your hair loss is more developed?
Research is developing on hair loss treatments for advanced hair loss, and those who don’t respond to traditional treatments like Finasteride and Minoxidil.
New research on microneedling shows promising early results for non-responders. A small case-study on 4 men who had been using minoxidil and finasteride for 2-5 years with no new hair growth saw a response when microneedling sessions were added to their treatment regime for 24 weeks. The improvement in hair growth was rated on a standardized 7-point scale from -3 (greatly decreased) to +3 (greatly increased).
After 6 months of microneedling, all of the men saw a +2 or +3 improvement. The benefits of microneedling are thought to be stimulating stem cells in the hair follicle, encouraging expression of hairgrowth-related genes, and activating growth factors associated with regeneration.
If you’re interested in knowing more about microneedling, we have an blog which outlines the potential benefits of using a derma roller (at-home microneedling tool) with minoxidil for better results.
You might also be wondering about hair transplants for advanced hair loss. Hair transplants are usually recommended for people with stable hair loss (not actively getting worse), and a good hair transplant surgeon will have a consultation with you to evaluate if it’s a good option for you. Hair transplants take healthy hairs from the back of the head and move them to balding areas to create more density and coverage. The more area to cover means the more donor hairs needed. If you don’t have enough donor hair, or it will leave the donor area ‘over-harvested’, it might not be the best option.
Other regenerative treatment options, like Platelet-Rich Plasma (PRP) and Low-Level Light Therapy (LLLT) are also steadily building more clinical evidence and real-world use as a potential treatment for hair loss, including more advanced cases.
If your hair loss has moved beyond Stages I–V, it’s normal to wonder what treatments can realistically achieve. Medications like finasteride and minoxidil are still useful for helping you hold on to the hair you have, even if regrowth in more advanced areas can be limited. There are also newer treatments being researched that could offer extra support, although they’re still in earlier stages and we’re continuing to learn more about how effective they are long-term
All of our blog articles are reviewed by our Medical Director before publication.
