Male pattern baldness is more than a cosmetic concern – and patients often turn to the pharmacy first for answers.
In this episode, TRC Healthcare Associate Editor and Clinical Pharmacist Don Weinberger, PharmD, PMSP, discusses treating male pattern baldness. He reviews the underlying mechanism of hair loss and compares evidence-based treatment options, including oral finasteride, topical minoxidil, and more. Don also provides practical counseling points, including adverse effects, expected timelines for hair regrowth, and why the effects are typically not permanent once treatment is stopped.
This is an excerpt from our January 2026 Pharmacy Essential Updates continuing education webinar series.
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CE Information:
TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.
Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: Get to the Root of Male Pattern Baldness Treatments
- Chart: Treatment and Prevention of Hair Loss
- Podcast: Rumor vs Truth – Hair Loss Treatments
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Transcript:
This transcript is automatically generated.
00:00:04 Narrator
Welcome to Clinical Capsules from TRC Healthcare, your trusted source for practical, evidence-based updates.
00:00:10 Narrator
On this episode, Associate Editor and Clinical Pharmacist Don Weinberger walks through the science behind male pattern baldness, along with available treatment options.
00:00:21 Narrator
He provides counseling points and safety tips for finasteride, minoxidil, ketoconazole shampoo, and natural supplements…
00:00:29 Narrator
Plus ways to help patients set realistic expectations for hair regrowth in an excerpt from our popular Pharmacy Essential Updates webinar series.
00:00:37 Narrator
This podcast offers Continuing Education credit for pharmacists and pharmacy technicians. Please log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.
00:00:50 Narrator
None of the speakers have anything to disclose.
00:00:53 Narrator
Catch new episodes of Clinical Capsules every 2nd and 4th Tuesday—bringing concise, actionable insights from TRC experts straight to your ears.
00:01:02 Narrator
Let’s take a closer look…
00:01:09 Don Weinberger
Let’s comb through a common topic that has gotten some recent buzz.
00:01:15 Don Weinberger
Specifically, treatments for male pattern baldness.
00:01:20 Don Weinberger
And we’re talking about this topic today because of warnings about topical finasteride will have patients scratching their heads on what is actually safe and effective to treat male pattern baldness.
00:01:33 Don Weinberger
And to help us start thinking about this, let’s kick things off with a patient case.
00:01:39 Don Weinberger
A middle-aged male comes up to your pharmacy counter.
00:01:43 Don Weinberger
He tells you that he’s noticed more hairs seem to be shedding to his hands when he washes his hair.
00:01:50 Don Weinberger
His wife also told him that the hair on top of his head seems to be getting thinner.
00:01:56 Don Weinberger
He feels it’s male pattern hair loss and wants to treat it now.
00:02:01 Don Weinberger
He saw topical minoxidil on your shelves, but wants to know if that’s the most effective product to help regrow his hair.
00:02:09 Don Weinberger
What should the patient know about the available products out there for male pattern baldness?
00:02:17 Don Weinberger
Now let’s look at some quick facts about male pattern baldness.
00:02:22 Don Weinberger
It’s also referred to as androgenic alopecia and affects an estimated 50 million men in the United States.
00:02:31 Don Weinberger
Androgenic alopecia can start early in teenage years,
00:02:34 Don Weinberger
and the risk increases with age.
00:02:36 Don Weinberger
More than 50% of men over age 50 have some degree of male pattern hair loss.
00:02:43 Don Weinberger
It’s called pattern baldness because hair loss occurs in a slow but predictable common pattern.
00:02:50 Don Weinberger
The hair loss can start anywhere on that pattern, from the forehead to the crown, top of the area, and in between.
00:02:57 Don Weinberger
And male pattern hair loss is usually permanent if left untreated.
00:03:02 Don Weinberger
But this is different from other types of hair loss like telogen effluvium.
00:03:06 Don Weinberger
Those tend to be more sudden and hair shedding from a trigger like stress or illness or hormones.
00:03:15 Don Weinberger
But the hair thinning or loss from these are usually temporary and can affect hair anywhere on the body.
00:03:24 Don Weinberger
Okay, so let’s go ahead and do a rumor versus truth.
00:03:27 Don Weinberger
And I’m glad we’re getting to this because this claim has been around a long time.
00:03:31 Don Weinberger
So let’s settle it here and now.
00:03:32 Don Weinberger
The claim is male pattern baldness skips a generation and is mainly inherited from the maternal grandfather’s side.
00:03:42 Don Weinberger
What do you think?
00:03:44 Don Weinberger
Give you a few seconds on this one.
00:03:50 Don Weinberger
Okay, and the answer is rumor.
00:03:54 Don Weinberger
Modern genetic research shows that male pattern hair loss genes can come from the mother’s side and the father’s side.
00:04:03 Don Weinberger
So genetic predisposition comes from maternal grandfather, paternal grandfather, uncles, even aunts or relatives who never lost much hair.
00:04:15 Don Weinberger
It’s not really an on-off switch, but a complex genetic situation.
00:04:20 Don Weinberger
Let’s dive deeper into the mechanism behind male pattern baldness.
00:04:23 Don Weinberger
It’s actually quite simple. I’m going to give you a better understanding of what treatments actually aim to do.
00:04:30 Don Weinberger
So as you can see, the hormone, testosterone, is converted to the more potent form called dihydrotestosterone, or DHT, by an enzyme called 5-alpha reductase.
00:04:43 Don Weinberger
The dihydrotestosterone then binds to genetically DHT-sensitive receptors on follicles on the scalp.
00:04:50 Don Weinberger
And over time, causes the follicles to shrink, which also causes loss of blood flow and nutrients.
00:04:58 Don Weinberger
So in response, the follicle produces thinner and weaker hair.
00:05:02 Don Weinberger
Over time, the follicle becomes so small, it stops producing visible hair.
00:05:09 Don Weinberger
Quite a lot of different treatments for male pattern baldness out there, from things like medications to laser devices to microneedles.
00:05:20 Don Weinberger
But when it comes to terms of safety and efficacy, how do we keep them all straight?
00:05:26 Don Weinberger
Let’s start by diving into the two FDA-approved medications for male pattern baldness, oral finasteride and topical minoxidil.
00:05:37 Don Weinberger
So topical minoxidil is a vasodilator, which means it widens blood vessels.
00:05:42 Don Weinberger
So for hair follicles, it improves blood circulation and delivers more oxygen and nutrients to support hair growth.
00:05:50 Don Weinberger
For men, the 5% strength is used in either topical solution or a foam.
00:05:55 Don Weinberger
Now, heads up.
00:05:56 Don Weinberger
The liquid solution can sometimes leave the hair looking a bit greasy.
00:05:59 Don Weinberger
If that’s an issue, you can recommend a non-propylene glycol formulation like the foam.
00:06:05 Don Weinberger
It tends to be less irritating and doesn’t leave that oily texture.
00:06:10 Don Weinberger
Ensure patients know that minoxidil is applied twice a day to the scalp and not the hair.
00:06:15 Don Weinberger
It works on hair follicles and needs to be applied directly to them to work effectively.
00:06:21 Don Weinberger
And for the generic products, they can cost about $20 per month.
00:06:26 Don Weinberger
When it comes to side effects, one of the most common things people report is scalp irritation and redness, itching, and dryness.
00:06:37 Don Weinberger
Also, some fine hair growth may occur on the cheeks or along the forehead.
00:06:43 Don Weinberger
In more rare cases, side effects like lower extremity swelling, even heart rate bumps may happen, but risk is lowered if the product is applied correctly.
00:06:54 Don Weinberger
And we’ll talk all about that in just one second.
00:06:57 Don Weinberger
And something to warn the patients is about shedding, which can occur during the first two to six weeks of treatment.
00:07:05 Don Weinberger
Now, this could sound scary because they’re trying to treat shedding, so now they’re going to have even more shedding.
00:07:10 Don Weinberger
Well, in this case, with treatment, the shedding could be considered a good sign.
00:07:15 Don Weinberger
It means the hair cycle is reactivating and older, weaker hairs are shedding to make room for new growth.
00:07:22 Don Weinberger
I also think it’s easy to overlook, but minoxidil is actually flammable, the solution and the foam.
00:07:28 Don Weinberger
So patients should avoid open flames or smoking until it’s completely dry.
00:07:32 Don Weinberger
Now I know what you’re going to ask, what about blow drying?
00:07:36 Don Weinberger
Blow drying after application is fine, but only on the lowest setting and after the product has dried.
00:07:43 Don Weinberger
Point to directions on the package to ensure patients understand how to apply minoxidil, whether it’s solution or it’s foam.
00:07:49 Don Weinberger
So they’ll start by creating a part in the thinning hair of the scalp.
00:07:54 Don Weinberger
The hair should be dry or just slightly damp, as wet hair can affect absorption.
00:08:00 Don Weinberger
The patient should fill the dropper provided with the medication, usually about 1 milliliter of solution, or a half cap full of foam using the supplied cap.
00:08:12 Don Weinberger
Apply the medication directly to the part that was created in the hair and rub it gently into the affected area of the scalp.
00:08:20 Don Weinberger
This helps to ensure medications actually reach the skin and not just the hair.
00:08:25 Don Weinberger
Some people are asking about using gloves when applying minoxidil.
00:08:29 Don Weinberger
It’s not documented as necessary since systemic absorption across the skin in the hands is extremely low.
00:08:37 Don Weinberger
But let’s talk about where it could be an issue.
00:08:40 Don Weinberger
If any of the minoxidil product starts to run down the head, wipe it off right away.
00:08:46 Don Weinberger
Thinner skinned areas like neck or cheeks can bump systemic absorption and increase the risk of side effects from minoxidil.
00:08:55 Don Weinberger
Then the patient’s going to wash hands thoroughly with soap and water and let the product dry before laying down.
00:09:00 Don Weinberger
So it doesn’t transfer to clothes, furniture, other humans, things like that.
00:09:07 Don Weinberger
Our next FDA-approved med is finasteride.
00:09:12 Don Weinberger
How does it work?
00:09:13 Don Weinberger
Well, it lowers that dihydrotestosterone concentration in the blood and thus the scalp by inhibiting that 5-alpha reductase enzyme.
00:09:24 Don Weinberger
So oral finasteride is usually taken at 1 milligram once daily.
00:09:29 Don Weinberger
It’s also relatively inexpensive, typically around $20 a month.
00:09:34 Don Weinberger
So anytime finasteride is dispensed,
00:09:37 Don Weinberger
there needs to be a do not handle if pregnant auxiliary label attached to the bottle.
00:09:42 Don Weinberger
Since pregnant individuals should avoid touching crushed or broken tablets because it can affect fetal development if it’s absorbed.
00:09:51 Don Weinberger
So there are some concerns associated with oral finasteride so patients are prepared for them.
00:09:57 Don Weinberger
The ones most people have heard about are erectile dysfunction, or decreased libido.
00:10:03 Don Weinberger
These don’t occur in everyone, but they’re important to discuss ahead of time so patients know what to watch for.
00:10:09 Don Weinberger
We also want patients to report any mood changes, including depression, irritability, or anxiety.
00:10:14 Don Weinberger
These are less common, but we don’t want to overlook them.
00:10:19 Don Weinberger
Another key point that patients should be aware is that some side effects can persist even after stopping the medication.
00:10:26 Don Weinberger
Finally, you may hear patients ask whether taking finasteride less frequently, like 1 milligram three times a week, reduces the risk of sexual side effects.
00:10:36 Don Weinberger
At this point, there’s no solid evidence that alternative dosing schedules lower that risk.
00:10:43 Don Weinberger
If patients ask about combining topical minoxidil along with oral finasteride, they can be told that the combo may be more effective than either one alone.
00:10:53 Don Weinberger
Let’s brush up on other treatments, which are topical finasteride, oral minoxidil, and ketoconazole shampoo.
00:11:02 Don Weinberger
Now, compounded topical finasteride may be seen marketed as having a lower risk of side effects compared with the oral version.
00:11:09 Don Weinberger
This stems from having less systemic absorption from a topical.
00:11:15 Don Weinberger
And while that sounds reassuring, FDA alerted that patients have still reported side effects with the topical version,
00:11:22 Don Weinberger
which include erectile dysfunction and mood changes.
00:11:26 Don Weinberger
So it’s not completely risk-free.
00:11:29 Don Weinberger
And the other point is we don’t have strong definitive evidence showing that topical finasteride is as effective as oral finasteride.
00:11:37 Don Weinberger
And since many patients go looking for compounded or online versions of topical finasteride,
00:11:42 Don Weinberger
it’s important to let them know to stick with accredited digital pharmacies like those from NABP.
00:11:48 Don Weinberger
That helps ensure the product is actually what it claims to be, correctly dosed, safely prepared, and not low-quality formulations that could be floating around online.
00:11:57 Don Weinberger
And patients should know that compounded products, topical ones, usually have a shorter expiration date, around three to six months.
00:12:06 Don Weinberger
So overall, topical finasteride can be an option, but patients should know the facts, limitations, and the realities of the evidence we have so far.
00:12:17 Don Weinberger
Another recent option for male pattern baldness is oral minoxidil,
00:12:22 Don Weinberger
usually gone to when patients have an inadequate response to the standard treatments mentioned earlier.
00:12:28 Don Weinberger
So a low-dose oral minoxidil could be considered as an off-label option.
00:12:34 Don Weinberger
But it’s really important to warn patients about potential side effects.
00:12:39 Don Weinberger
Minoxidil is actually taken systemically.
00:12:41 Don Weinberger
The ones we watch more closely are swelling, chest pain, rapid heart rate.
00:12:47 Don Weinberger
So if the patients want to try it, recommend starting with a low dose.
00:12:51 Don Weinberger
A common approach is 1.25 milligrams daily, and then if needed, gradually increase by 1.25 milligram every three months with a typical maximum dose of 5 milligrams per day.
00:13:04 Don Weinberger
Now,
00:13:05 Don Weinberger
Daily doses can also be split if patients feel side effects are more noticeable with a single dose, since dividing it may make the medication easier to tolerate.
00:13:15 Don Weinberger
And one counseling point that often surprises people with oral minoxidil is since for systemic use, hair growth can occur anywhere on the body, not just the scalp.
00:13:26 Don Weinberger
So patients should be prepared for the possibility of increased facial or body hair as the treatment takes effect.
00:13:34 Don Weinberger
Next up is ketoconazole shampoo, which is sometimes used as an adjunct treatment for hair loss.
00:13:40 Don Weinberger
Ketoconazole topically inhibits 5-alpha reductase, and as I told you about, that converts testosterone to dihydrotestosterone.
00:13:50 Don Weinberger
It decreases scalp inflammation, which has been known to damage hair follicles by controlling a certain yeast, a common cause of dandruff and dermatitis.
00:13:58 Don Weinberger
But evidence is mixed on its efficacy.
00:14:03 Don Weinberger
If the patient wants to try it, ensure they know how to use it.
00:14:06 Don Weinberger
Patients should apply the 2% shampoo, lather it into the scalp, and leave it in for about three to five minutes before rinsing off.
00:14:14 Don Weinberger
And this could be repeated two to three times per week.
00:14:18 Don Weinberger
There’s an OTC version, the ketoconazole 1%, but it’s unsure if the 1% works as well as the prescription 2%.
00:14:26 Don Weinberger
One thing that patients should know is that ketoconazole shampoo may dry out the hair.
00:14:32 Don Weinberger
Especially with frequent use.
00:14:35 Don Weinberger
Where ketoconazole could be a potential dual purpose is in patients with male pattern baldness who also struggle with dandruff.
00:14:44 Don Weinberger
Let’s dive into another area, which are natural supplements.
00:14:48 Don Weinberger
People may reach for these to avoid side effects from other treatments, but let’s ensure they’re getting the correct information.
00:14:57 Don Weinberger
So the two top or part of the top natural supplements used for male pattern hair loss are saw palmetto and rosemary oil.
00:15:10 Don Weinberger
I was researching this and a lot of these get attention online, but the evidence behind them is still pretty limited.
00:15:18 Don Weinberger
Now, patients do want to try it, like everything else, just really know the facts.
00:15:22 Don Weinberger
Saw palmetto.
00:15:23 Don Weinberger
There was a small study where 100 milligrams daily for 16 weeks helped reduce hair shedding and increased hair counts.
00:15:29 Don Weinberger
But it didn’t improve hair thickness.
00:15:32 Don Weinberger
And even though people think of it as natural, side effects are actually pretty similar to finasteride.
00:15:37 Don Weinberger
Something to keep in mind.
00:15:39 Don Weinberger
Next up is rosemary oil.
00:15:42 Don Weinberger
In one study, applying 1 mL to the scalp twice a day for six months worked as well as about 2% minoxidil.
00:15:49 Don Weinberger
It’s interesting.
00:15:49 Don Weinberger
But again, data are limited and I don’t have to say it works reliably.
00:15:57 Don Weinberger
And rosemary oil can cause some side effects like photosensitivity, itching, and redness, especially for people with sensitive skin.
00:16:03 Don Weinberger
So overall, these options aren’t totally off the table, but they’re not as well supported as FDA-approved treatments.
00:16:10 Don Weinberger
It’s important to set realistic expectations if patients want to try them.
00:16:15 Don Weinberger
Okay, time for another round of rumor versus truth.
00:16:19 Don Weinberger
Second claim is hair growth from most male pattern baldness treatments is usually permanent.
00:16:26 Don Weinberger
What do you think?
00:16:31 Don Weinberger
And that is another rumor.
00:16:33 Don Weinberger
Here’s why.
00:16:34 Don Weinberger
Hair growth you get from treatments like finasteride or minoxidil are temporary.
00:16:38 Don Weinberger
Without the treatment, the benefits fade, usually within three to six months, and the hair tends to go back to baseline.
00:16:44 Don Weinberger
These treatments help maintain hair while you’re using them, but don’t create permanent change.
00:16:48 Don Weinberger
The only option that’s considered permanent is a hair transplant.
00:16:53 Don Weinberger
Where the follicles are taken from a healthy area on the scalp to the thinning areas.
00:17:00 Don Weinberger
And if patients do want to try meds for hair loss, they should keep some caveats in mind.
00:17:05 Don Weinberger
For example, meds work best if started at the first signs of balding.
00:17:09 Don Weinberger
All available treatments are only modestly effective and responses vary.
00:17:14 Don Weinberger
Plus it takes about three months of regular use to see some benefit and one year for full effects.
00:17:22 Don Weinberger
On top of that, as I said, hair will return to baseline if patients stop using treatments.
00:17:28 Don Weinberger
So patients need to be patient and persistent if they want to continue to see any benefits.
00:17:34 Don Weinberger
When you’re working with patients who use male pattern hair loss treatments, there are a few important points to keep in mind.
00:17:41 Don Weinberger
First, add these therapies to the patient’s profile.
00:17:44 Don Weinberger
That way you can screen for potential issues, especially cases where they might be unintentionally doubling up.
00:17:51 Don Weinberger
For example, some patients end up using both topical and oral finasteride at the same time.
00:17:57 Don Weinberger
That combination hasn’t been shown to be more effective, and it may increase their risk of side effects.
00:18:01 Don Weinberger
So it’s important to catch that early.
00:18:03 Don Weinberger
Next, be mindful of payer and pharmacy policies when it comes to billing.
00:18:08 Don Weinberger
Medications used for cosmetic purposes usually aren’t covered, and patients typically can’t use their health or flex spending accounts for them.
00:18:16 Don Weinberger
So checking these details ahead of time can prevent surprises at the point of sale.
00:18:21 Don Weinberger
Finally, talk with patients about safe storage.
00:18:24 Don Weinberger
These products should be kept up and away from children and pets.
00:18:27 Don Weinberger
This is especially important with minoxidil because even a small amount can be highly toxic to dogs and cats.
00:18:35 Don Weinberger
Let’s get back to that case.
00:18:36 Don Weinberger
To recap, it was a middle-aged male asking about all the different treatments for hair thinning and wanting to know which one is the best.
00:18:45 Don Weinberger
Let’s go through those comments and see what y’all said.
00:18:51 Don Weinberger
Okay, so I am seeing, okay, some people recommend topical minoxidil, yeah.
00:18:56 Don Weinberger
Oral finasteride, one a day, one milligram a day.
00:18:58 Don Weinberger
Yep, I see that too.
00:19:01 Don Weinberger
Yeah, it looks like most people got it.
00:19:02 Don Weinberger
You know, there’s the two FDA-approved treatments for male pattern baldness.
00:19:06 Don Weinberger
So good job there.
00:19:09 Don Weinberger
There are quite a few treatments that I couldn’t get to today, like laser therapy.
00:19:13 Don Weinberger
And I saw your comments come through asking about what about hair loss treatment for women.
00:19:19 Don Weinberger
To get answers, I want to direct you to our chart, Treatment and Prevention of Hair Loss, for more information.
00:19:27 Narrator
Thanks for listening—we hope today’s episode gave you practical insights you can use right away.
00:19:32 Narrator
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00:19:44 Narrator
We’ve linked the resources we mentioned—and more on today’s topic—right in the show notes. Those links will take you straight to our websites, where you’ll find even more concise, evidence-based charts, articles, and tools.
00:19:57 Narrator
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00:20:13 Narrator
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00:20:27 Narrator
Thanks for listening… stay sharp, stay current—and join us next time on Clinical Capsules!
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