Often primary care providers, if they treat hair loss at all, limit themselves to topical minoxidil (Rogaine) and occasionally finasteride. Many dismiss hair loss concerns entirely as “cosmetic” or refer patients to dermatology, where wait times can stretch months. We recognize that hair loss significantly impacts quality of life, self-esteem, and psychological wellbeing—and we offer evidence-based treatments that go well beyond the basic options many PCPs are comfortable prescribing.¹

Oral Minoxidil – While topical minoxidil has been the standard for decades, oral minoxidil at low doses (0.625–5mg daily) is substantially more convenient—no messy twice-daily scalp application, no scalp irritation, no concerns about inconsistent absorption.^2-3 Emerging evidence suggests oral minoxidil may be more effective than topical formulations in some measures, possibly due to more consistent systemic levels and full scalp coverage.^4-5 Originally developed as a blood pressure medication, low-dose oral minoxidil is generally well-tolerated; increased body hair (hypertrichosis) is common, and mild fluid retention is uncommon.^2-3,6 It works by prolonging the anagen (growth) phase of hair follicles and improving blood flow to the scalp.^2-3 We’re comfortable prescribing oral minoxidil for both male and female pattern hair loss.^3-5

Dutasteride – An alternative to finasteride that blocks both Type I and Type II 5-alpha reductase enzymes (finasteride only blocks Type II), resulting in more complete DHT (dihydrotestosterone) suppression—the hormone primarily responsible for androgenic alopecia.^7-8 Studies suggest dutasteride is likely more effective than finasteride for hair regrowth and maintenance, particularly for men who’ve had suboptimal response to finasteride.^9-10 The side effect profile is similar to finasteride (small risk of sexual side effects), but the enhanced efficacy makes it our preferred 5-alpha reductase inhibitor when appropriate.^7,9-10 Typically dosed at 0.5mg daily.^8-9

Finasteride – We still prescribe finasteride (1mg daily for hair loss) when patients prefer it or when dutasteride isn’t appropriate.⁷ It remains highly effective for male pattern baldness, with clinical trials showing increased hair growth in 66% of men at 2 years and 90% rated as stable or improved at 5 years.¹¹

Spironolactone (for female pattern hair loss) – An antiandrogen that blocks androgen receptors and reduces androgen production, particularly valuable for women with androgenic alopecia.^12-13 While often prescribed for acne or hirsutism, spironolactone (often started at 50mg daily and increased to 100mg daily as needed) can be effective for female pattern hair loss and is commonly combined with minoxidil for additive benefit.^13-14 It addresses the hormonal driver of hair loss in women, particularly those with evidence of hyperandrogenism (PCOS, elevated DHEA-S or testosterone).¹⁵ Requires monitoring of potassium levels and blood pressure but is generally well-tolerated.^12-13

Combination Approach – We frequently combine medications for synergistic effects.¹⁶ Common regimens include:

Men: Oral minoxidil + dutasteride (or finasteride)
Women: Oral minoxidil + spironolactone
For maximum efficacy, some patients add topical treatments on top of oral therapy

Our goal is meaningful hair regrowth and stabilization using the most effective, evidence-based agents available—not the limited toolkit that many PCPs restrict themselves to out of unfamiliarity or discomfort. We take hair loss seriously because you do, and we’re willing to prescribe the medications that actually work.

References

1. Huang C, Fu Y, Chi C. Health-related quality of life, depression, and self-esteem in patients with androgenetic alopecia: a systematic review and meta-analysis. JAMA Dermatology. 2021;157(8):963-970. https://doi.org/10.1001/jamadermatol.2021.2196
2. Ramírez-Marín HA, Tosti A. Role of Oral Minoxidil in Patterned Hair Loss. Indian Dermatology Online Journal. 2022;13(6):729-733. https://doi.org/10.4103/idoj.idoj_246_22
3. Gupta AK, Talukder M, Shemar A, Piraccini BM, Tosti A. Low-dose oral minoxidil for alopecia: a comprehensive review. Skin Appendage Disorders. 2023;9(6):423-437. https://doi.org/10.1159/000531890
4. Yousefi E, et al. Efficacy and safety of oral minoxidil in comparison to topical form in male pattern hair loss: a randomized controlled trial. Archives of Dermatological Research. 2025. https://doi.org/10.1007/s00403-025-04355-z
5. Ramos PM, Sinclair RD, Kasprzak M, Miot HA. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: a randomized clinical trial. Journal of the American Academy of Dermatology. 2020;82(1):252-253. https://doi.org/10.1016/j.jaad.2019.08.060
6. Vañó-Galván S, Pirmez R, Hermosa-Gelbard A, et al. Safety of low-dose oral minoxidil for hair loss: a multicenter study of 1404 patients. Journal of the American Academy of Dermatology. 2021;84(6):1644-1651. https://doi.org/10.1016/j.jaad.2021.02.054
7. Propecia (finasteride) tablets [package insert]. Organon LLC; 2022 (rev. 08/2022). DailyMed label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6f904709-65aa-44ce-b144-b4c8a0416e36
8. Avodart (dutasteride) capsules [package insert]. GlaxoSmithKline; 2020. FDA label (PDF): https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021319s032lbl.pdf
9. Gubelin Harcha W, Barboza Martínez J, Tsai TF, et al. A randomized, double-blind, placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in adult males with androgenetic alopecia. Journal of the American Academy of Dermatology. 2014;70(3):489-498.e3. https://doi.org/10.1016/j.jaad.2013.10.049
10. Jung JY, Yeon JH, Choi JW, et al. Effect of dutasteride 0.5 mg/d in men with androgenetic alopecia recalcitrant to finasteride. International Journal of Dermatology. 2014;53(11):1351-1357. https://doi.org/10.1111/ijd.12060
11. Propecia (finasteride) tablets [package insert]. Merck & Co., Inc.; 2012. FDA label (PDF): https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020788s020s021s023lbl.pdf
12. Rathnayake D, Sinclair R. Innovative use of spironolactone as an antiandrogen in the treatment of female pattern hair loss. Dermatologic Clinics. 2010;28(3):611-618. https://doi.org/10.1016/j.det.2010.03.011
13. Sinclair R. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. International Journal of Dermatology. 2018;57(1):104-109. https://doi.org/10.1111/ijd.13838
14. Vargas-Mora P, Morgado-Carrasco D. Spironolactone in Dermatology: Uses in Acne, Hidradenitis Suppurativa, Female Pattern Hair Loss, and Hirsutism. Actas Dermo-Sifiliográficas (English Edition). 2020;111(8):639-649. https://doi.org/10.1016/j.adengl.2020.03.015
15. Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, Lobo RA, Olsen E. Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. The Journal of Clinical Endocrinology & Metabolism. 2019;104(7):2875-2891. https://doi.org/10.1210/jc.2018-02548
16. Zhou Y, Chen C, Qu Q, et al. The effectiveness of combination therapies for androgenetic alopecia: a systematic review and meta-analysis. Dermatologic Therapy. 2020;33(4):e13741. https://doi.org/10.1111/dth.13741