When topical minoxidil (Rogaine) was introduced in the late 1980s, it became an option for restoring thinning hair. The biggest problem was the greasy look it left, which made people reluctant to use it as often as directed. Now there are effective options that are easy to stick with. It is important to start medical therapy early. When hair is thin but still present, hair loss is potentially reversible—but once it’s gone, only transplants will work.


Prescription Medications

Oral minoxidil (Rogaine) is the latest breakthrough. Its hair-thickening benefits were discovered when it was being tested for its primary purpose—controlling hard-to-treat high blood pressure. Taken orally, minoxidil works even better than its topical counterpart and, when given in a very low dose, it has very few, if any, side effects. Men can start with a 2.5-mg pill daily…women, half that amount.

Potential side effects: Heart events, notably pericardial effusion (extra fluid in the sac around the heart), are rare—but possible. Also, minoxidil at low doses rarely if ever affects blood pressure.

More common side effect: Extra facial hair—this typically happens only when there’s a dramatic regrowth of hair on the scalp. Most women are willing to have unwanted facial hair waxed off in return for thicker hair on their head…or they can take a low dose of the diuretic ­spironolactone (CaroSpir and Aldactone), an androgen blocker used to treat acne that also reduces excess facial hair.

Finasteride (Propecia), a 5-alpha reductase inhibitor that treats enlarged prostate, is approved for hair loss. It blocks the hormone DHT, which causes hair to fall out. It can be taken by men and postmenopausal women (in younger women, it can cause birth defects). A young man with a family history of baldness might benefit from taking finasteride and oral minoxidil at the same time.

Potential side effects: Sexual dysfunction, which affects 2% to 3% of users…loss of concentration or mood changes…possibly depression sometimes to the point of ­suicidal ideation, which affects 1% of users. If any of these occur, stop taking it.

Dutasteride (Avodart), another 5-alpha reductase inhibitor, carries a slightly higher risk for the same side effects as finasteride and has a longer half life—five weeks versus finasteride’s six hours. Because the drug stays in your system longer, side effects will take longer to go away even after you stop taking the drug. This is only for someone who doesn’t respond to other medications.

Bimatoprost (Latisse) is effective for both thinning eyebrows as well as eyelashes. This prescription ophthalmic solution should be prescribed by an eye doctor or dermatologist.


Over-the-Counter Products

Nutrafolwith curcumin, ashwagandha, saw palmetto, marine collagen peptides and vitamins—works better for women, though is not as effective as medication. If you’re averse to taking drugs or using topical minoxidil, it’s worth a try. Downside: It costs $80 a month versus $10 for oral minoxidil. Note: Nutrafol supports the effects of hair-regrowth drugs, so you might want to ask your doctor about taking it in addition to oral minoxidil.

Viviscal uses a proprietary marine collagen complex to strengthen hair. It costs about $33 a month. Beware of copycat products that lack testing.

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