Tactical Fitness: Every Treatment for Male Hair Loss, Broken Down by Cost-Benefit
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Eighty percent of men experience some form of hair loss at some point in their lifetime. Genetics have a say in how soon, how quickly, how severe, and in what pattern each person experiences hair loss, but it comes for every guy eventually.
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Dr. Jeannette Graf, a dermatologist and Assistant Clinical Professor of Dermatology at Mt Sinai School of Medicine, said that one’s testosterone levels aren’t the precise thing to blame, either; rather, it’s the hair follicles’ sensitivity to DHT, or dihydrotestosterone, a testosterone byproduct that accelerates hair loss. It gathers at the follicles, shrinks them, and shortens the growth cycle of hairs. Most men’s hair loss treatments are aimed at stopping and/or reversing this exact process. What varies is how quickly they’re able to do so, and at what cost.
What the Experts Say
Early intervention is important, no matter how severe one’s hair loss is or may be. “By the time a man is 30, there’s a high probability that he’s already noticed thinning in some areas,” said Graf. “This is why taking preventative measures by your late 20s is the safest bet especially if you know you’re prone to hair loss genetically.”
If treatment starts after visible signs of loss, then it is only possible to revive those follicles that have gone dormant in the past year or two. Hair lost at the crown is possible to bring back, while hair lost to recession is not. (Again, genetics dictate what types of hair loss one experiences and how aggressively.)
Once treatment starts, Graf said to wait 3-6 months for visible results, and if one is using it preventatively, to trust that it’s working. She said results will vary depending on how severe the initial hair loss was, but keeping up with treatments is important so hair loss doesn’t resume.
In recent years, the number of men’s hair loss treatments available has only increased and gotten more effective. Keep reading to learn the cost-benefit of each one, with insights from dermatologists and surgeons.
Most Accessible and Cost-Effective:
Minoxidil and Finasteride
Oral and topical options abound—with one serious warning.
With expertise from board-certified dermatologists Rina Weimann of Schweiger Dermatology in North Wales, PA, and Dr. Dhaval Bhanusali of Hudson Dermatology and Laser Surgery in NYC.
Minoxidil and finasteride are usually mentioned hand in hand, as they’re generics for drugs that emerged at the same time: Rogaine and Propecia. The popularity of these two methods grew thanks to telemedicine sites like hims, Ro, and Keeps, but these medicines are also available through dermatology clinics, and minoxidil is available over the counter. Some studies about finasteride have shown it can cause side effects related to sexual health including decreased libido and erectile dysfunction. If these symptoms start after beginning usage, speak with a urologist right away.
Until recently, the oral form of finasteride and topical form of minoxidil were the most popular amongst consumers. Recently, the script has flipped, and topical finasteride’s shorter list of side effects has made it more popular and oral minoxidil has become the preferred version because it’s more effective.
Minoxidil is a vasodilator that helps increase hair follicle fortification so they can better withstand DHT. It also increases the amount of time hair spends in its growth phase, the overall effect being more hairs on the head at a given time. There are two formula concentrations, 5% and 2%, and Dr. Weimann recommends both male and female patients use the 5% formulation.
Typical Cost: Topical Minoxidil can be as low as $3/month, oral minoxidil is not available over the counter since it’s not FDA-approved
Time Commitment: Short amounts of time, but often. Apply topical minoxidil around the scalp twice daily. (Morning and night are the easiest intervals.) Take oral minoxidil once daily.
Minoxidil
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How minoxidil works: Minoxidil is a vasodilator, which means it opens up the blood vessels and improves nutrient delivery. In terms of hair retention, this means the follicles get much more fortification and can better withstand the threat of DHT. Minoxidil increases the amount of time hair spends in its growth phase, and shortens the amount of time spent in resting phases. (So hairs stay anchored longer and grow back sooner; the overall effect is that more hairs are on the head at a given time.) Men should use the 5% formula, while women are advised to use 2%. (Dr. Weimann recommends both male and female patients use the 5% formulation as she finds it more effective.) Minoxidil is especially advised for people experiencing thinning around the crown.
Typical cost: Topical minoxidil can cost as low as $3/month (like from Kirkland/Costco). Oral minoxidil is also extremely inexpensive, but cannot be purchased over the counter since it’s not cleared by the FDA. It’s quite easy to obtain from dermatologists and will not cost much. (It is the generic for Loniten, also a vasodilator, and is taken daily in 1.25 mg tablets.) Ro sells it for $30/month as well, though a local doctor’s office can prescribe it for much cheaper.
Time commitment: Apply topical minoxidil twice daily around the scalp. (Morning and night are the easiest intervals.) Oral minoxidil is taken once daily.
Chief complaints: Topical minoxidil can make some hair a little tacky. Oral minoxidil can increase hair growth all around the body— depending on one’s definition of #bodgoals this could be a benefit. Minoxidil will also cause initial shedding in the first months; this is natural and should be endured; it’s effectively re-starting each of those hairs’ growth cycles. It’s likely that only the minoxidil user will notice the excessive shedding; it’s not noticeable to others.
Finasteride
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How finasteride works: Finasteride directly targets DHT. It inhibits the conversion of testosterone into DHT, effectively preventing any shrinking of hair follicles in the first place. Topical finasteride more closely targets DHT’s role in the scalp and follicles and has less of an impact on its DHT’s presence throughout the body than oral finasteride. Finasteride is especially advised for people experiencing a hairline recession.
Typical cost: A non-branded prescription through a local dermatologist might cost $10 or $15 per month with insurance. (Check GoodRx to get the best deal in any area.) Chic telemedicine sites might charge 3-5 times that amount. Topical finasteride is harder to provide a precise price for, because many of the readily available formulas today are actually hybrids of minoxidil and finasteride (like Keeps and hims). As such, they can run upwards of $60 per month but also negate the need to take both drugs separately. Some standalone topical finasteride options do exist, like through XYON.
Time commitment: Finasteride is taken once a day, whether orally or topically.
Chief complaints: Here’s a very important caveat for finasteride: One study reports that 2.1-3.8% of finasteride users can experience sexual side effects, either through decreased libido or with difficulty achieving erections. Other studies promote topical finasteride as a way to get the benefits of the drug without the side effects (since it isn’t as widely circulated in the blood). If these side effects start, speak immediately with a dermatologist and consider switching to topical or staying away from finasteride. In most cases, side effects should go away soon after treatment stops.
The Doctors’ Take on Minoxidil and Finasteride
Bhanusali considers minoxidil the gold standard for hair loss treatments. As for choosing between oral and topical routes, it depends on the patient. “Topical is fine if you are consistent. The main issue is that many aren’t (which I can understand). Oral minoxidil is a great option but there are always more side effects with oral meds vs. topical.” (Again, while rare, minoxidil does have side effects as a vasodilator, so people with heart or blood pressure concerns should be cautious, and anyone on existing vasodilator medicines should absolutely avoid it.)
For anyone interested in a compound topical minoxidil/finasteride product (a singular product with both medicines), Weimann reminds that topical use is usually not as effective as oral options. So, while it’s likely someone will achieve success with a hybrid topical product, it may not be quite as effective if they were to take daily minoxidil and/or finasteride pills. “The role of topical minoxidil and finasteride may be useful when it comes to maintaining hair growth after starting oral finasteride and/or oral minoxidil,” she said. “For those interested in not being on an oral medication long-term, using the topical compounded minoxidil and finasteride in clinical studies has been shown to promote continued hair growth and minimize hair shedding after discontinuation of an oral form of the medication.” So, consider starting with oral finasteride at the very least (alongside oral or topical minoxidil), and assuming no side effects, wane off of it after a couple of years (just as our writer did).
Effective But Expensive Upgrades:
PRP (Plasma Injections) and LLLT (Laser Caps)
Costly treatments that bear fruit. One, in particular, is worth the investment.
With expertise from Dr. Alan J. Bauman, Founder, CEO and Medical Director of Bauman Medical Hair Transplant & Hair Loss Treatment Center.
Two other common hair loss treatments that are often mentioned together are platelet-rich plasma (PRP) and low-level laser therapy (LLLT). However, they aren’t similar at all; it’s more so that these two used to be treatments that required visits to the doctor, and now they’re available via convenient, at-home devices.
PRP
How PRP works: At a PRP session, you give a couple of vials of blood at a dermatology or hair restoration clinic, and then it’s placed in a centrifuge to separate the plasma out. This plasma contains a person’s unique growth factors, which can be injected into the scalp to give follicles some serious muscle (just as growth factors can be injected into joints for tissue repair or at the site of wounds for thorough recovery). “The powerful growth factors in PRP are chemical bio-signals utilized by the body for tissue regeneration and repair,” says Bauman. “Many of the growth factors and other signals stored inside platelets are utilized by the body to stimulate blood flow and collagen production and are also implicated in signaling the anagen (growth) phase of the hair follicle.”
Typical cost: A single PRP can range from $1,000-$3,500 per session, depending on the tech and equipment, skill level of the doctor/clinic, and location
Time commitment: Not all PRP treatments are created equal, Bauman said. Most will require patients to come in monthly for three consecutive months (and up to six months) to enjoy benefits that last up to 18 months, while more advanced and sophisticated options allow a single dose to last 10-18 months. However, PRP sessions will need to resume indefinitely in order to keep seeing results. The frequency of each person’s visits will vary based on their needs and their doctors’ advice. A single session doesn’t take long—between 30 minutes to an hour to allow for blood withdrawal, the plasma extraction, and the injections.
Chief complaints: The cost, of course. Also, it can be a little uncomfortable having a syringe punch at the scalp dozens of times and then endure a few days of fuzzy numbness up there. (No drinking in the days leading up to or following.)
LLLT
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How LLLT works: By sending low-energy red and near-infrared laser light into the scalp, LLLT stimulates tissue regeneration and follicular virility. The wavelengths of these lights are between 600–950 nanometers, which are fine enough to penetrate skin without any side effects. LLLT accelerates the growth phase of hair and also prolongs the growth phase (before hairs enter resting and shedding phases), and it shortens the amount of time hair spends in its resting phase. Studies also suggest that LLLT boosts circulation in the scalp, and might even reduce the accumulation of DHT around the follicles.
While LLLT used to be a clinical treatment, at-home devices are now available. The at-home devices are less powerful, but because users can use them more often at home the benefits are the same.
Typical cost: Clinical treatments can cost thousands of dollars over the course of a year. “Before at-home devices were available, we charged $4000 annually for treatments 3 times per week for 30 minutes per treatment,” Bauman says. Now his office only sells an at-home device, which might have a high price tag ($5,200) but it pays for itself after a year and a half of use. Usually, the cost of an at-home device is based on the number of diodes it has, as well as the intensity of the light it emits, plus things like product design and material quality. Some lower-cost options hover closer to $1,000.
Time commitment: Clinical sessions might require 30 minutes as many as three times per week, for at least 6 months (or ongoing for routine upkeep). At-home options might require the same cadence, although some devices are intended to be used for just 5 minutes daily (like Bauman’s) in order to match those clinical results.
Chief complaints: It can be hard to incorporate LLLT into one’s routine, no matter if done at home or in a clinic. And the price is daunting too, though it starts to look more attractive when weighing out the longevity of a device versus what clinical treatments might cost.
The Doctor’s Take on PRP and LLLT
Bauman typically recommends multi-therapy treatments for his patients—that is, pairing things like PRP and LLLT with one another, or with minoxidil and/or finasteride. “In order for you to know exactly what treatment is working, how well it’s working, and what areas of your scalp are responding, you need to have regularly scheduled, accurate measurements of hair density and hair caliber, including Hair Mass Index evaluations,” he said.
At-home LLLT might actually be the less expensive option compared to minoxidil and finasteride in the long run, Bauman said. “While minoxidil and finasteride may get better results for some patients versus LLLT, the cost for those drugs is ongoing, plus there may be side effects for some patients. In those cases, LLLT is a better option and it’s 100% drug-free and side-effect free.” He adds that getting a high-quality at-home device with a lifetime warranty is one of the best investments anyone can make for their hair retention.
The Final Frontier, With Fluctuating Costs: Hair Transplants
These actually look great now. Just don’t consider it a “last resort”.
With expertise from Dr. William Yates, Founder of Hair Transplantation and Restoration Clinic in Chicago.
How Hair Transplants Work: Fullness is achieved by taking follicles (also known as “grafts”) from the back and sides of the head—which aren’t genetically predisposed to shedding, unlike the hair on top of the head. The grafts are extracted individually and no longer leave permanent scars. Then they’re sorted according to each graft’s growth count (between 1-4 hairs per follicle) and implanted individually on top of the head, at a precise angle to mimic natural appearance. Yates doesn’t advise getting more than 3,000 grafts per session, though that’s enough for most people to get desired coverage. Some people will get two or even three separate transplants spread across 3-6 months if they need more grafts; having two transplants is usually the limit before the back and sides start to look too sparse. (Yates usually caps things between 6-10K grafts per patient.)
It’s also important to have healthy and ample “donor” hair in order to achieve realistic results, says Yates. And guys need to be realistic about what’s feasible. Hairs can then be extracted from the neck and chest, but the quality of hair differs with these, and can only be used to visually “fill in” the hair up top. “How far is too far?,” you may ask yourself if you end up at this point. “Chest and body hair generally does not produce quality hair on the scalp,” Yates said. “Underarm and pubic hair can be used, too, but beard hair is the second best option [after actual head hairs].”
Calling hair transplants a “treatment” is a bit of a stretch. They aren’t a conclusive solution, nor are they a last resort for people whose loss is extremely progressed. Rather, hair transplants are best performed on people who have enough hair up top to help “fill in” as opposed to one giant blanket cover. They’re also only recommended for people who have been taking other treatments (and have seen success) for a year or more, so that the canvas is as naturally full as it can be prior to the procedure.
Also, since the transplanted hairs cannot thin and fall like the native hairs up there, it’s important to continue previous treatments following the transplant. Think of it like this: If treatments are discontinued, then regular male-pattern hair loss will continue, leaving behind just the transplanted hairs indefinitely. In this way, a hair transplant is a commitment to a lifetime of hair loss treatments.
Lastly, for any curly hair patterns (especially coarse, coiled hair), it’s important to visit a doctor who’s practiced in the transplantation of your particular curl pattern (and advertises such).
Typical cost: The cost of hair transplants varies wildly based on the number of grafts, the technology used, the experience and reputation of the clinic/surgeon, and often location. Often, a transplant in Manhattan NYC or Beverly Hills will certainly be more expensive than one in Oklahoma City. But the doctor may also be more practiced and have access to newer technologies. Many people will travel to cosmetic surgery hotspots like Mexico and Turkey, too, where the density of doctors and quality of care can keep pace with large US markets, but at a fraction of the cost. What costs $8,000-$20,000 in the US might range from $2,000-$8,000 in Istanbul, for example (and might even include hotel/car transfers).
Time commitment: Aside from pre-transplant exams or consultations, the procedure usually lasts 6-8 hours and will also require a next-day appointment to undress the wounds and check on the scalp’s reaction. Patients will be given adequate antiseptic, anti-inflammatory, and painkilling meds so that the process is painless (they also get light local anesthesia during the procedure itself, which makes the 6-8 hours feel like one or two). Most people can return to work the next day if they want to, but they’ll look odd and should at least stay home for a few days to recover while any swelling subsides and the wounds scab over.
Transplanted hairs will fall within a month of implantation, and then regrow within 4-6 months. Yates says the first sprouts should reappear in two months, though, with all of them fully expressed within a year. In this first month though, avoid direct water pressure or hot water on the scalp, and direct sun exposure and intense sweating. Expect some compromises in daily life until the transplanted hairs begin to fall out.
Chief complaints: Where to begin? While the results these days are fantastic (spoken firsthand by this writer), it’s just an inconvenient and awkward process, from the facial swelling to the slog that is waiting for the hairs to grow back, not to mention the itch in the month or two after the procedure. It can be taxing to think of a lifetime of hair loss treatments, too, but if a full head of hair is important, then it’s absolutely worth it. Don’t skimp on a cheap doctor either, but do weigh international options if local prices feel out of range.
The Doctor’s Take on Hair Transplants
Yates stresses the importance of using other treatments before committing to a hair transplant. These treatments will also enhance the results: “I always encourage patients to take or use something to help stabilize hair loss due to male pattern baldness,” he said. “A commitment on the client’s part to use a non-surgical treatment will help their overall density as long as possible. We don’t recommend stopping the non-surgical treatments such as finasteride, minoxidil, LLLT or PRP after a transplant.” He recommends taking as many of these non-surgical treatments as one is willing to take; there is no harm in pairing all four of the above options.
Hair transplants may meet their match from emerging technologies in coming decades, Yates said. And other treatments could become obsolete, too. “Regenerative medicine with stem cell therapy is already being used for anti-aging and hair loss with success. Genetic manipulation is a potential in the future, too, where the genes for baldness are deleted entirely.”
How to Proceed: SPY’s Recommendation
Given the above insights from these surgeons and dermatologists, here is the best recommendation for proceeding with hair loss treatments:
1. Start as early as possible (mid-20s onward) with minoxidil and/or finasteride. Gauge the response to these medicines, especially monitoring oral finasteride use for potential side effects. Use generic non-branded prescriptions for the least expensive approach.
While oral versions of both medicines will yield better results, doctors do suggest switching to topical options after this same onboarding period as a more targeted way of maintaining results (and while minimizing potential side effects associated with oral options).
2. Introduce LLLT in the mid-30s, if it’s in the budget. Get an at-home device. It’s expensive, yes, but is a terrific way to keep follicles fortified for the decades ahead. While a $5,000+ device might feel especially costly, some in the $1,500-3,000 range can still produce good results.
Continue using minoxidil/finasteride alongside LLLT.
3. Add PRP if you’re mega-rich. It’s expensive. It works, yes, but it’s SPY’s least-favorite option on this list from a cost-benefit perspective.
4. Only consider a transplant after 1-2 years of minoxidil and/or finasteride use. It’s important to see “the full potential” of your hair before resorting to surgical (and expensive) means. Shop around for ideal prices both domestically and abroad, but only choose a clinic with an excellent reputation—and not just one that they are advertising for themselves. Do the research to really find out.
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