Androgenetic Alopecia: The Treatments That Actually Slow It Down

Androgenetic alopecia is common pattern baldness: the receding temples, the crown that opens up, the hair that grows back a little thinner every year. It is the most frequent cause of hair loss, and the European treatment guideline notes that its frequency rises with age, affecting up to 80% of Caucasian men and 42% of women (Kanti et al., 2018).

This guide sorts out what has real evidence for slowing it down, what only works as an add-on, what doesn't work at all, and where a hair transplant fits into the plan. It isn't a prescription; it's what we would explain in a consultation.

Quick answer

• What slows androgenetic alopecia is medication: DHT blockers (finasteride or dutasteride) and minoxidil. They are the treatments with the most and best studies.
• Minoxidil can be topical or oral. In a trial that compared them head to head for 24 weeks, oral minoxidil was not superior to topical on the main outcome.
• PRP and low-level laser have more modest evidence. They work as add-ons, not as the foundation.
• Shampoos, biotin and supplements don't slow androgenetic alopecia unless you have a deficiency. They are the most common spend and the least useful.
• A hair transplant puts hair back where there is none, but it doesn't stop the miniaturization of the hair you still have. That's why medical therapy usually continues after a transplant.
• Everything works only while you use it. Stop the medical therapy and the loss resumes its course over the following months.

Why hair falls out: miniaturization

In androgenetic alopecia, some follicles — at the temples, on top and at the crown — are sensitive to dihydrotestosterone (DHT), a hormone derived from testosterone. Over the years, DHT shrinks them: the hair comes in finer, shorter and lighter until the follicle stops producing it. That process is called miniaturization, and it's what the Norwood scale measures.

Two rules follow from this, and they explain everything else:

1. A miniaturized but living follicle can be slowed down and sometimes recovered. That's the job of medication.
2. A follicle that is already gone doesn't come back. No lotion, pill or injection creates new follicles. For those areas, the only way to have hair again is to move it from the back of the head, which is what a hair transplant does.

What works, in one table

DHT blockers: finasteride and dutasteride

If DHT is the cause, the most direct treatment is to lower it. Finasteride is the drug with the most years of data: in the pivotal trials, with 1,553 men, it improved hair versus placebo at one and two years, while the placebo group kept losing hair (Kaufman et al., 1998). A systematic review of 12 trials confirmed that it increases hair count, at the cost of a small increase in the risk of sexual side effects (Mella et al., 2010).

Dutasteride blocks both enzymes that make DHT, not just one. In the largest head-to-head trial, with 917 men, it increased hair count and thickness more than finasteride, with similar side effects (Gubelin Harcha et al., 2014), and a meta-analysis of three trials reached the same conclusion (Zhou et al., 2019). At Colombia Care it is the option we usually prefer, always after a medical assessment.

Their side effects — how common the sexual effects really are, PSA, why they aren't for women who could become pregnant — are covered in our guide to the real side effects of finasteride. Read it before you start.

Minoxidil: topical or oral

Minoxidil doesn't act on DHT: it stimulates the follicle and lengthens the phase in which hair grows. That's why it can be combined with a DHT blocker, and it's one of the few options with evidence in women as well.

Topical. The classic lotion or foam. In a 48-week trial with 393 men, 5% minoxidil applied twice a day was clearly superior to 2% and to placebo, with an earlier response; the main side effect was itching and local irritation (Olsen et al., 2002). Its weak point is daily consistency.

Low-dose oral. The same drug as a tablet, used off-label for hair. In a double-blind Brazilian trial in men at Norwood stages 3V to 5V, 5 mg of oral minoxidil a day was not superior to 5% topical minoxidil on the main outcome at 24 weeks; on photographic assessment it did somewhat better at the crown. The most common side effect was increased body and facial hair, in about half of those who took it (Penha et al., 2024).

On safety, the largest published series — 1,404 patients from several countries treated with low doses — found excess hair growth to be the most frequent effect (15.1%), and infrequent systemic effects such as lightheadedness (1.7%), fluid retention (1.3%) or a fast heart rate (0.9%); only 1.7% stopped treatment because of side effects (Vañó-Galván et al., 2021). It was a retrospective study without a control group, and oral minoxidil was originally a blood-pressure drug: don't take it without a medical assessment, especially if you have heart or blood-pressure problems.

In practice: topical works for people who use it consistently; oral is an alternative for those who can't tolerate the lotion. Your doctor decides which one, and the dose.

The add-ons: PRP and laser

PRP. It's made from your own blood and injected into the thinning areas. A meta-analysis of 9 randomized trials found more density than placebo at 3 and 6 months, but no difference in hair count or thickness (Zhang et al., 2023). It works as an add-on to medical therapy, on hair that is thinning, not on smooth areas.

Low-level laser. Caps and combs that emit red light. A meta-analysis of placebo-controlled trials included it among the treatments that beat placebo in men, alongside minoxidil and finasteride, though with high heterogeneity between studies (Adil and Godwin, 2017). A more recent review of 38 studies found higher density after 4 to 26 weeks of use, again with very variable results (Perez et al., 2025). Our reading: it may add something, but it doesn't replace medical therapy.

If you're being offered mesotherapy, ampoules or session packages, our guide mesotherapy vs PRP vs hair transplant explains what evidence each one has and what to ask before you pay.

What doesn't slow androgenetic alopecia

This is where most of the money goes. None of these products act on DHT or on miniaturization:

• "Anti-hair-loss" shampoos. They clean the scalp and can make hair look fuller, but a shampoo sits on your head for a few minutes and is rinsed off. There's no evidence that any of them slows androgenetic alopecia on its own.
• Biotin. A literature review found that every published case in which biotin improved hair had an underlying cause, such as a deficiency; in healthy people the evidence for supplementing it is insufficient (Patel et al., 2017). A practical detail: the US FDA has warned that high-dose biotin can interfere with some lab tests, so mention it if you take it before having bloodwork.
• Vitamins and minerals. Iron, zinc or vitamin D matter if you're low, and correcting a deficiency can improve other types of hair loss. But a review of vitamins and minerals in hair loss concludes that their role isn't entirely clear and that large trials are still needed to know whether supplementing them helps (Almohanna et al., 2019). The sensible move is to test, not to supplement blindly.

When a hair transplant makes sense

A hair transplant doesn't compete with medical therapy: it does something different. It takes follicles from the back and sides of the head — areas whose hair is resistant to DHT — and places them where they're missing. Those follicles keep their resistance, which is why we talk about permanent results.

What a transplant doesn't do is stop the miniaturization of the native hair left in and around the treated area. That hair is still exposed to DHT. If it keeps falling out, over the years you can end up with a strip of transplanted hair and a gap behind it. A controlled trial showed exactly this: in men who took finasteride from four weeks before until almost a year after their transplant, the hair around the transplanted area and the final density improved more than with placebo (Leavitt et al., 2005).

That's why medical therapy usually continues after a transplant. Not to protect the transplanted hair, but your own.

For our hair transplant in Medellín the standard rate is $4,900 COP per graft (about US$1.40). As a reference, a 2,000-graft case comes to $9,800,000 COP (about US$2,800). What's included is published on our hair transplant cost in Colombia page.

The practical part, if you start treatment

• Start with a medical assessment. Stress, thyroid problems, low iron or some medications cause similar-looking hair loss that is treated differently.
• Take photos in the same light every three months and judge results at 6 to 12 months.
• Don't double doses on your own: it doesn't speed anything up and it increases side effects.

Summary

Androgenetic alopecia is slowed with medication — a DHT blocker, minoxidil or both — not with shampoos or vitamins. PRP and laser can add something as complements. A hair transplant is the only thing that brings hair back to areas that are already bald, but it doesn't stop the loss of the hair you still have, so medical therapy usually continues afterwards. The best plan almost always combines both, in the right order for your age and stage.

If you'd like a physician to review how active your hair loss is and which combination makes sense for you — even if the answer is that you don't need surgery yet — book a free assessment.

Message us on WhatsApp and a physician will reply →

This article is for information only and does not replace a medical consultation. Don't start, change or stop any treatment without talking to your doctor.

Sources

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