Hair loss is a common condition affecting both men and women, including a significant proportion of Australians. It can have psychological and emotional effects, impacting self-esteem and overall quality of life. The most common types are androgenetic alopecia (pattern hair loss) and telogen effluvium (shedding due to stress or illness). Understanding the causes, treatment options, and potential side effects is important for managing hair health effectively.

Understanding Hair Thinning

Hair thinning is a gradual process that can affect both men and women at various stages of life. Understanding the underlying causes, recognising early signs, and implementing evidence-based treatments can help slow progression and improve hair density. The following section outlines the key factors that contribute to hair thinning and provides insight into how these mechanisms impact hair follicle health.

What causes hair thinning?

Genetics and Androgenetic Alopecia

• Androgenetic alopecia (AGA) is the most common form of hair loss in men and women.
• It is influenced by genetic sensitivity of hair follicles to dihydrotestosterone (DHT), which shortens the hair growth cycle.
• Men often experience receding hairlines and crown thinning, while women typically have diffuse thinning along the part (Hirsso et al., 2005; Sawaya & Shapiro, 2000).

Telogen Effluvium

• Triggered by physical or emotional stress, surgery, illness, or hormonal changes.
• Hair follicles prematurely enter the shedding phase, causing diffuse thinning (Blume-Peytavi et al., 2011).

Nutritional and Hormonal Factors

• Deficiencies in iron, zinc, protein, and vitamin D can weaken hair follicles (Rushton, 2002).
• Thyroid disorders, menopause, and certain medications may also contribute

Recognising Early Signs of Hair Loss

• Increased hair shedding (more than 100 hairs per day)

• Widening hair part or thinning ponytail

• More visible scalp at the crown or hairline

• Receding hairline in men

Early recognition improves treatment outcomes, making consultation with a healthcare professional important.

Evidence - Based Treatments and Possible Side Effects

Topical Treatments

• Minoxidil (solution or foam): Minoxidil is a widely studied topical therapy approved for both men and women. It stimulates hair follicles by opening potassium channels, increasing blood flow, oxygen, and nutrient delivery to the scalp. Clinical trials demonstrate significant improvements in hair density after 4 - 6 months of continuous use (Olsen et al., 2002). Common side effects include scalp irritation, itching, dryness, and, in rare cases, unwanted facial hair growth in women. Some individuals may experience transient shedding during the first few weeks of treatment as follicles shift into the growth phase.
• Tretinoin (solution, cream or gel): Tretinoin is a topical retinoid that enhances minoxidil absorption and promotes scalp health. It has been shown to convert non-responders to minoxidil into responders (Kim et al., 2006). Side effects may include mild redness, irritation, peeling, and increased sensitivity to sunlight. Tretinoin is typically used in low concentrations to minimise adverse effects.
• Tacrolimus (solution, gel or ointment): Tacrolimus can be applied topically to affected areas, usually once or twice daily. It works by reducing local inflammation and modulating the immune response, which may benefit patients with inflammatory or autoimmune - related hair loss. Side effects are generally mild and include local irritation, burning, or itching; systemic absorption is rare but should be monitored in extensive use (Castro et al., 2018)

Oral Medications

• Minoxidil (capsule or troche): Minoxidil taken at a low dose of 0.25–2.5 mg daily is an effective systemic treatment for hair loss. It is converted to the active metabolite minoxidil sulfate, promoting hair growth through vasodilation, activation of the Wnt/β-catenin pathway, reduction of perifollicular inflammation, and partial inhibition of dihydrotestosterone (DHT). Clinical studies report efficacy comparable to topical minoxidil, with improved adherence. Common adverse effects include hypertrichosis, fluid retention, tachycardia, and dizziness. Due to systemic effects, regular monitoring is recommended, especially in patients with cardiovascular, hepatic, or renal conditions (Rogers et al., 2021; Shapiro et al., 2020; Frontiers in Pharmacology, 2025).
• Finasteride (capsule): Finasteride is an oral 5 - alpha-reductase inhibitor that lowers DHT levels in the scalp, slowing hair loss and promoting regrowth in men. Clinical studies report improved hair count and density after 6 - 12 months of daily use (Clark et al., 2004). Potential side effects include decreased libido, erectile dysfunction, mood changes, and, rarely, breast tenderness or enlargement. Women, particularly those who are pregnant or may become pregnant, should avoid handling finasteride tablets due to the risk of teratogenic effects.
• Dutasteride (capsule): Dutasteride is a more potent 5-alpha-reductase inhibitor that blocks both type I and II isoenzymes, providing a greater reduction in DHT levels. Clinical trials indicate higher efficacy than finasteride for male pattern hair loss, but side effects are similar, including sexual dysfunction and mood changes. Medical supervision is required before use.
• Spironolactone (tablet): Used primarily in women, spironolactone blocks androgen receptors and reduces DHT production. It has shown significant improvements in female pattern hair loss, typically over six months or longer (Mayo Clinic Proceedings, 2013). Side effects may include menstrual irregularities, breast tenderness, dizziness due to changes in blood pressure, and electrolyte imbalances such as elevated potassium. Regular monitoring is recommended for safe use.

Nutritional Support

• Adequate intake of zinc, iron, protein, vitamin D, and B vitamins is essential for hair follicle function and hair growth (Rushton, 2002; Almohanna et al., 2019). Nutritional supplementation can complement topical and oral therapies, especially in individuals with deficiencies. However, excessive supplementation can cause side effects such as gastrointestinal upset, nausea, or systemic toxicity, so doses should be guided by healthcare professionals.

How to Use These Treatments Effectively

Image Source: National Council on Ageing

Success with hair thinning treatments depends on your usage method as much as your product choice. The right application and consistent use will give you optimal results.

Daily routine for topical foams or solution

Proper application of topical treatments like minoxidil is critical for effectiveness. Research indicates that applying the product to a clean, completely dry scalp maximises follicle absorption (Olsen et al., 2002). Parting the hair into rows ensures even distribution and exposure to affected areas. For foam formulations, hold the can upside down and dispense approximately half a capful onto clean fingers, then massage gently into thinning regions. Allow 2 - 4 hours for the product to dry before styling or going to bed to prevent transfer to bedding or clothing (Messenger & Rundegren, 2004). Consistent daily application is key, as irregular use reduces therapeutic outcomes.

Best practises for taking capsules

Oral treatments such as finasteride and dutasteride require steady plasma levels for optimal efficacy. Take these medications at the same time each day, as supported by pharmacokinetic studies, to maintain consistent DHT suppression (Clark et al., 2004). Most vitamin and mineral supplements, including zinc, iron, and B vitamins, are better absorbed with food, unless otherwise directed by a healthcare provider. Consistent use for at least three months is necessary to observe measurable effects, due to the natural hair growth cycle of approximately 3 - 6 months per phase (Blume-Peytavi et al., 2011).

What to expect in the first 3 months

Initial months of treatment require patience. Early shedding may occur as hair follicles transition from the resting (telogen) to the growth (anagen) phase, a phenomenon well-documented in minoxidil and finasteride trials (Olsen et al., 2002; Clark et al., 2004). By three months, most patients notice reduced hair loss, although visible regrowth may take longer. These early improvements primarily manifest as decreased shedding rather than new hair density.

Tips for consistency and long-term success

Maintaining a structured routine improves long-term outcomes. Evidence suggests that documenting progress with monthly photographs under consistent lighting conditions provides objective measures of treatment efficacy (Sinclair et al., 2011). Integrating treatments into daily habits, such as oral medication with breakfast or topical application after showering, enhances adherence. Focus on reduced hair fall rather than immediate new growth. Clinical studies show that significant hair density improvements typically appear after 6 - 12 months of continuous use (Olsen et al., 2002; Clark et al., 2004). Setting realistic expectations and maintaining consistent application are essential for long-term success in managing hair thinning.

Lifestyle and Hair Care Recommendations

• Avoid tight hairstyles that pull on hair (traction alopecia)

• Maintain a balanced diet rich in protein, iron, and vitamins

• Manage stress through mindfulness, exercise, or counselling

• Protect hair from excessive heat and chemical damage

Conclusion

Hair loss is a prevalent condition affecting both men and women and can have significant emotional and psychological impacts. Understanding the causes, recognising early signs, and initiating timely treatment are crucial for achieving the best outcomes. Evidence-based therapies, including topical treatments such as minoxidil and tretinoin, oral medications like finasteride, dutasteride, and spironolactone, alongside targeted nutritional support, have been shown to improve hair density and slow progression of hair loss. Adhering to proper usage instructions, monitoring for side effects, and consulting with a healthcare professional can maximise effectiveness and ensure safe management. Combining consistent treatment with a healthy lifestyle and balanced diet further supports optimal hair health and overall well-being.

References

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