Doctor-led hair loss care, built on what actually works.

The foundation of every hair loss treatment plan is understanding what's causing it. Without this step, treatment selection is guesswork - and the most common reason hair loss treatments fail is treating the wrong condition.

The workup typically includes clinical history and scalp examination (pattern, distribution, hair quality), bloodwork (ferritin and iron studies, TSH and free T4, vitamin D and B12, zinc, total and free testosterone, DHEA-S and SHBG, HbA1c), and sometimes additional studies such as trichoscopy, hair pluck test, or biopsy if a scarring pattern is suspected.

What typical findings change about treatment: iron deficiency (low ferritin) is treated with iron supplementation; hair density often improves dramatically over 4-6 months without topical or oral hair-loss medication initially.

Thyroid dysfunction (both hypothyroidism and hyperthyroidism) accelerates hair loss; endocrine evaluation and treatment of the underlying thyroid issue typically returns hair over months. Low testosterone can contribute to hair loss patterns; hormonal evaluation guides whether testosterone optimisation is part of the approach.

Vitamin D and zinc deficiencies are supplemented and retested at 3 months. Where androgenetic alopecia is confirmed without a reversible cause, treatment proceeds to one or a combination of the three therapies offered at Hisential: Minoxidil, Oral Finasteride, and Topical Finasteride.

Where telogen effluvium is identified, the typical approach is reassurance, supportive treatment (sometimes topical minoxidil), and watchful waiting; recovery is usually spontaneous over 6-12 months. Where a scarring alopecia is identified, early intervention is critical to preserve remaining follicles.

Why this matters: many patients arrive having already tried topical minoxidil for months without effect, having self-diagnosed androgenetic alopecia when they actually had iron-deficiency telogen effluvium or undiagnosed thyroid dysfunction. The workup converts treatment from guesswork to targeted intervention.

Minoxidil (Rogaine, Loniten) is the most studied and most commonly used topical hair loss treatment, and the only over-the-counter topical with strong clinical evidence for androgenetic alopecia.

Available as 2% (typically for women and milder cases) or 5% (for men and more advanced cases) solution or foam, applied twice daily to a dry scalp. Hisential also prescribes compounded formulations combining minoxidil with topical finasteride for patients who want a single daily topical.

How it works: minoxidil prolongs the anagen (growth) phase, increases follicle size, and improves perifollicular blood flow. The mechanism is not fully understood but the effect is well-documented in randomised trials.

Effectiveness: approximately 40% of users see meaningful regrowth and another 40% see stabilisation (preventing further loss); the remaining 20% see minimal benefit.² Effects build over 3-6 months and require continued use to maintain - stopping leads to loss of any gained hair over 3-6 months.

Side effects are usually mild - scalp dryness, irritation, occasionally an initial “shed” in the first 2-4 weeks (paradoxically, this often precedes regrowth). Rare effects include unwanted facial hair growth from minoxidil contacting other skin and dizziness if absorbed in larger amounts.

Often combined with ketoconazole shampoo (Nizoral) 2-3 times weekly, which reduces scalp inflammation and may have mild local anti-androgenic effects.

Best suited for first-line treatment of confirmed androgenetic alopecia, patients preferring a topical-only approach, and combination with oral or topical finasteride for more advanced cases.

Oral finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT) - the hormone primarily responsible for follicle miniaturisation in male pattern hair loss. It is the single intervention with the strongest evidence base intervention for male androgenetic alopecia.

Finasteride (Propecia, Proscar) at 1 mg daily for hair loss blocks type-2 5-alpha reductase, reducing scalp DHT by approximately 60%. The 5 mg dose of the same drug is used for benign prostate enlargement - same molecule, different indication.

Effectiveness: approximately 80% of men experience either visible regrowth or stabilisation of hair loss over 1-2 years.³ Effects build slowly - 3-6 months for stabilisation, 6-12 months for visible regrowth. Dutasteride (0.5 mg daily, off-label) is sometimes used as an escalation when finasteride response is incomplete; it blocks both type-1 and type-2 5-alpha reductase with more complete DHT suppression (~95%).

Side effects: the well-known concern is sexual side effects - reduced libido (approximately 3-5% of users), erectile difficulty (~3-5%), reduced semen volume (more common, usually unconcerning), and occasional breast tenderness or gynaecomastia. Most resolve when the medication is stopped. A small minority report “post-finasteride syndrome” with persistent symptoms after stopping; uncommon but real.

Other considerations: 5-alpha reductase inhibitors halve PSA values - important context for prostate cancer screening. Not used in women of reproductive age (teratogenic risk to a male fetus). Treatment is essentially lifelong if effective - stopping returns hair loss to its baseline trajectory.

Fertility note: finasteride does not typically reduce fertility but can reduce semen parameters. For men actively trying to conceive, the decision is individual and discussed at consultation.

Best suited for male pattern hair loss not adequately responding to topical alone, men comfortable with the hormonal mechanism and willing to commit long-term, and combination with topical Minoxidil for synergistic effect.

Topical finasteride is a compounded formulation - finasteride dissolved in a vehicle that allows it to penetrate the scalp where it blocks DHT locally at the follicle. Hisential compounds it as a standalone topical or combined in a single bottle with minoxidil.

Mechanism is identical to oral finasteride - inhibition of 5-alpha reductase and reduction of scalp DHT. The clinical advantage is route: topical application achieves meaningful scalp DHT suppression while keeping systemic finasteride exposure substantially lower than the oral tablet.

Effectiveness: emerging evidence is favourable. Randomised studies comparing topical to oral finasteride show comparable scalp DHT reduction and hair count improvement, with significantly lower serum finasteride and lower rates of reported sexual side effects. The evidence base is younger and smaller than for oral finasteride but is growing rapidly.

Side effects: scalp irritation and dryness are the most common local issues. Systemic side effects (libido, erectile function) appear to be substantially less frequent than with the oral form, though not zero - some absorption does occur and the same teratogenic precautions apply (not used in women of reproductive age).

Practical use: applied once daily to a dry scalp. Often prescribed as a combined minoxidil-plus-finasteride compounded solution to simplify the routine to one bottle. Like all hair loss treatments, effects build over 3-6 months and require ongoing use to maintain.

Best suited for men who want DHT blockade but are uncomfortable with the systemic side-effect profile of the oral tablet, men who tried oral finasteride and stopped due to side effects, patients preferring a topical-only regimen, and combination with topical minoxidil in a single compounded formulation.