Hair loss affects approximately 80 million Americans. Despite how common it is, navigating treatment options can feel overwhelming — especially with so many products, supplements, and unproven claims competing for attention. Here's a clear-eyed look at what actually works.
## Understanding Why Hair Falls Out
Hair grows in cycles: anagen (growth), catagen (transition), and telogen (resting/shedding). Most hair loss conditions disrupt this cycle.
**Androgenetic alopecia (AGA)** — the most common type — is driven by DHT (dihydrotestosterone), a byproduct of testosterone. DHT miniaturizes hair follicles over time, leading to progressively finer, shorter hair until the follicle stops producing visible hair altogether.
Other common causes include:
- **Telogen effluvium**: Diffuse shedding triggered by stress, illness, major surgery, rapid weight loss, or hormonal shifts (including postpartum)
- **Alopecia areata**: An autoimmune condition causing patchy hair loss
- **Traction alopecia**: Caused by sustained tension on hair follicles from tight hairstyles
## Evidence-Based Treatments for AGA
### Minoxidil (Topical and Oral)
The most widely used hair loss treatment. **Topical minoxidil** is FDA-approved for both men (5%) and women (2% or 5%) and works by prolonging the anagen phase and increasing blood flow to follicles.
**Oral minoxidil** (low-dose, 0.625–2.5mg for women; 2.5–5mg for men) is increasingly used off-label and appears more effective than topical forms for many patients. It requires monitoring of blood pressure, especially at higher doses.
Results: Most patients see stabilization and some regrowth after 4–6 months of consistent use.
### Finasteride and Dutasteride (DHT Blockers)
**Finasteride** (Propecia, 1mg daily) is FDA-approved for men with AGA and works by inhibiting the conversion of testosterone to DHT. Studies show it reduces hair loss progression and promotes regrowth in ~66% of men.
**Dutasteride** (Avodart, 0.5mg) inhibits more DHT-producing enzymes and is used off-label for hair loss with stronger evidence for efficacy.
For women (post-menopausal): these medications can be used off-label with appropriate monitoring.
### Spironolactone (For Women)
An anti-androgen commonly used in women with hormonal hair loss. It blocks androgen receptors in the scalp. Effective for women with female-pattern hair loss, particularly those with signs of elevated androgens.
Not appropriate for men due to hormonal side effects.
### Platelet-Rich Plasma (PRP)
PRP involves drawing a small amount of your blood, concentrating the platelets (which contain growth factors), and injecting the concentrate into the scalp. Evidence is promising — multiple randomized controlled trials show PRP increases hair density and thickness.
PRP is not covered by insurance and requires in-person treatment (not available via telehealth), but it complements topical and oral therapies well.
## Telogen Effluvium: What Works
TE is typically **self-limiting** — once the trigger resolves, shedding usually stops within 6 months and hair gradually regrows over 12–18 months.
**Supportive measures**:
- Address the underlying trigger (nutritional deficiencies, thyroid issues, stress)
- Ensure adequate iron, ferritin, zinc, and vitamin D
- Minoxidil can help shorten the shedding period and support regrowth
## When to Seek Evaluation
Seek dermatological evaluation if:
- You're losing more than ~100 hairs per day consistently
- You notice a receding hairline or widening part
- Hair loss is accompanied by other symptoms (fatigue, weight changes, hormonal symptoms)
- Hair loss is affecting your confidence or quality of life
Early intervention significantly improves outcomes — most treatments work better at maintaining existing hair than regrowing hair that has been lost for years.
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*Sarah Frierson, MMS, PA-C provides telehealth hair loss consultations for patients in North Carolina, New York, and Delaware. Labs can often be ordered through your local lab for review at your appointment.*