No treatment No treatment is an option as hair loss is a natural part of ageing for many men. However some may feel uncomfortable about their appearance and want to do something about it. Without treatment, it is likely to progress with time. Medicines Two medicines that may be effective in treating male-pattern baldness are finasteride (Propecia) and minoxidil (Regaine). Neither treatment is available on the NHS. Finasteride Finasteride comes as a tablet you take every day. It works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size. Studies have suggested finasteride can increase the number of hairs people have (hair count) and can also improve how people think their hair looks. It usually takes three to six months of continuously using finasteride before any effect is seen. The balding process usually resumes within six to 12 months if treatment is stopped. Minoxidil Minoxidil is available as a lotion you rub on your scalp every day. It's available from pharmacies without a prescription. It's not clear how minoxidil works, but evidence suggests it can cause hair regrowth in some men. The medication contains either 5% or 2% minoxidil. Some evidence suggests the stronger version (5%) is more effective. Other evidence has shown this is no more effective than the 2% version. However, the stronger version may cause more side effects, such as dryness or itchiness in the area it's applied. Like finasteride, minoxidil usually needs to be used for several months before any effect is seen. The balding process will usually resume if treatment with minoxidil is stopped. Any new hair that regrows will fall out two months after treatment is stopped. Side effects are uncommon. Other options Wigs A wig is the traditional option for baldness. Some people find them useful; others find them uncomfortable and not very convincing. For male pattern baldness, they cannot be prescribed on the NHS, so they may be expensive. Scalp surgery Techniques such as hair transplantation, scalp flaps and other procedures have been used for a number of years. Newer techniques are giving better results. Success rates vary. It is expensive and not available on the NHS. If you hair loss is NOT due to male-pattern baldness but has another underlying cause such as a skin condition, speak to your doctor for advice about other treatment possibilities.

Finasteride: • Must be taken every day • Needs to be used for 3-6 months to see an effect • Can increase the number of hairs men have by 24% • Nearly 1/3 of men see an improvement if they use finasteride for several years. • If treatment is stopped, hair will start to be lost again in 6-12 months • Side effects include low libido and erectile dysfunction. Minoxidil • Must be rubbed into the scalp daily • Can be used by women for female pattern baldness too • Can slow or stop hair loss and may trigger regrowth • Can be bought over the counter, no prescription required • Needs to be used for at least 4 months before an effect is seen • Hairs will begin to fall out again 2 months after stopping treatment.

Minoxidil is currently the only medicine available to treat female-pattern baldness. Minoxidil lotion may help hair grow in around one in four women who use it, and it may slow or stop hair loss in other women. In general, women respond better to minoxidil than men. As with men, you need to use minoxidil for several months to see any effect.

The manufacturers report that known side effects include loss of libido (sex drive) or erectile dysfunction (inability to get or maintain an erection). Clinical trials have observed a frequency of 1.8% (just less than 2 in 100 men) for loss of sex drive and 1.3% (just over 1 in a hundred men) for erectile dysfunction. The studies do not tell us how many men continue to experience problems after stopping the drug but there are reports of men who have found their symptoms return to normal after stopping, and men for whom they don’t.