Before You Consider Surgery
Medication, and why I'd like you to read this first.
Quick answer: Two medicines are licensed in the UK for male pattern hair loss: finasteride, a prescription tablet, and minoxidil, applied to the scalp and available over the counter. Both slow loss and can produce some regrowth, both only work while you keep taking them, and neither is available on the NHS for this purpose. Finasteride carries serious warnings that were strengthened by the MHRA in 2025, including sexual dysfunction that may persist after stopping, and suicidal thoughts. Those are not small print and you should read them properly before deciding.
I help people get hair transplants, so you might be surprised I've written this page.
But a lot of the people who contact me are in their late twenties or early thirties and still losing hair, and for many of them surgery right now isn't the right answer. Medication can hold on to hair that surgery can't get back, and the earlier you start, the more it can protect. Once a follicle has shrunk past a certain point, it's gone, and a transplant won't bring it back. It only moves hair from somewhere else.
So this is the page I'd have wanted to read.
What is actually licensed in the UK
There are only two treatments licensed in the UK for male pattern hair loss. Everything else you'll see advertised is either not licensed for it, not proven, or a supplement without much evidence behind it.
Finasteride 1mg
- How it works
- It inhibits the enzyme that converts testosterone into DHT, the androgen responsible for shrinking susceptible follicles. Reported reductions in scalp DHT are in the region of 60 to 70 percent. Less DHT means slower miniaturisation.
- What it does
- Its main effect is to slow or halt further loss. Some men also see regrowth, particularly in areas that have thinned recently rather than areas that went years ago.
- How long before you know
- Months rather than weeks. Because it works on the growth cycle, meaningful assessment takes somewhere around six to twelve months.
- If you stop
- The benefit is lost. Whatever the medication was holding resumes thinning over the following months, and you return to where you would otherwise have been. It is a long term commitment, potentially lifelong.
- Availability
- Not prescribed on the NHS for hair loss, which is classified as cosmetic. It is obtained privately, through a GP, a dermatologist, or a regulated online prescriber.
- Not for women of childbearing potential
- It is not licensed for them, because of the risk of harm to a male foetus.
The finasteride safety warnings, in full
The UK regulator (the MHRA) strengthened these warnings in 2025, and they're important enough that I didn't want to bury them further down the page.
Sexual side effects. Reduced sex drive, erectile dysfunction and ejaculation disorders are recognised side effects. Importantly, the regulator states these may persist after treatment is stopped in some men.
Depression and suicidal thoughts. Following a review by the European Medicines Agency's safety committee, suicidal ideation was confirmed as a side effect of finasteride tablets in June 2025. UK patient alert cards, introduced in 2024, highlight this alongside the sexual side effects and are supplied in every pack.
What the MHRA advises. Prescribers should ask about any history of depression or suicidal thoughts before prescribing, and should monitor for psychiatric and sexual side effects afterwards. If you are taking finasteride 1mg for hair loss and you develop depression or suicidal thoughts, the advice is to stop taking it immediately and contact your doctor as soon as possible.
Some context on scale. Yellow Card reports between 1994 and May 2025 include 170 reports of suicidal ideation and related terms for finasteride, and 19 fatal reports of suicide. Yellow Card reports are suspected reactions rather than proven ones, and they are set against many millions of prescriptions. That does not make them nothing. It means the risk is real, uncommon, and worth an honest conversation with a doctor rather than a box ticked on a website.
If you're struggling with your mental health, whether it's related to medication or not, please speak to your GP or call Samaritans on 116 123 in the UK. It's free and they're there any time, day or night.
Minoxidil
- How it works
- Not fully understood, but it appears to prolong the growth phase and improve blood supply to the follicle. It does nothing about DHT, which is why it is often used alongside finasteride rather than instead of it.
- What it does
- Encourages regrowth, with the strongest evidence at the crown. It is generally considered less effective than finasteride for male pattern loss, though the two work differently and are frequently combined.
- Forms and strengths
- Solution or foam, commonly at 2 and 5 percent. It goes on the scalp, not the hair. Available without prescription in the UK.
- The early shed
- Minoxidil can cause increased shedding in roughly the first four to six weeks. This is expected. It is hair already at the end of its cycle being pushed out by new growth, and it settles. A lot of people stop at this point believing it has made things worse.
- Side effects
- Most commonly skin reactions: dryness, irritation, itching. Unwanted hair growth elsewhere can occur if it spreads onto skin beyond the scalp.
- If you stop
- Same as finasteride. Any benefit is maintained only while you keep using it.
- Availability
- Not on NHS prescription, but you can buy it from a pharmacy.
Two things often mentioned that are not licensed for this
- Dutasteride. A related drug licensed in the UK for enlarged prostate, not for hair loss. It is sometimes used off-label for male pattern loss. The MHRA has also updated its product information as a precaution regarding psychiatric side effects, though its review found no direct link for dutasteride.
- Oral minoxidil at low dose. Increasingly used, but not licensed in the UK for hair loss. Off-label, and something that should only be started by a clinician experienced in managing hair loss, with proper monitoring.
Off-label doesn't mean wrong. It just means the licence doesn't cover this use, so more responsibility falls on the prescriber. It should be a proper decision made with a clinician, not just something you buy online.
What none of it does
- It won't bring back what's already gone. A follicle that has fully shrunk won't come back with medication.
- You have to keep taking it. Both licensed options only work while you keep using them.
- It's not a replacement for seeing a doctor. If your hair loss is all over, sudden, patchy or comes with other symptoms, please see a doctor before taking anything. Other conditions can cause hair loss too, and they're treated differently.
Why I'm telling you this
There are two reasons, and I'll be honest, one of them is partly for my benefit too.
First, if you're thirty and still losing hair, a transplant now is planned around hair that will keep changing. Holding on to what you have with medication means any surgery later can be smaller, better planned and less likely to need redoing. A surgeon can plan much better when they know your hair loss is stable.
Second, I'd much rather have a patient in two years who's glad they waited than one next month who isn't. My commission comes from completed treatments, so telling you to wait means I earn less in the short term. I know how that sounds, which is why I've explained exactly how I'm paid on its own page.
Frequently asked questions
What medications are licensed for male pattern hair loss in the UK?
Two. Finasteride 1mg, a prescription-only daily tablet, and minoxidil, applied topically to the scalp and available over the counter. Dutasteride and low-dose oral minoxidil are sometimes used but are off-label in the UK for this purpose.
Can I get finasteride or minoxidil on the NHS?
Not for male pattern hair loss, which is classified as a cosmetic condition. Finasteride is obtained privately through a GP, dermatologist or regulated online prescriber. Minoxidil can be bought from a pharmacy without a prescription. If hair loss is due to an underlying medical condition, investigation of that condition may be available on the NHS.
What are the side effects of finasteride?
Recognised side effects include reduced sex drive, erectile dysfunction and ejaculation disorders, which the UK regulator states may persist after stopping treatment. Depression and suicidal thoughts are also recognised, and suicidal ideation was confirmed as a side effect by the European Medicines Agency in June 2025. UK patient alert cards highlighting these risks are supplied in every pack. Anyone taking finasteride for hair loss who develops depression or suicidal thoughts is advised to stop immediately and contact their doctor.
Does minoxidil make hair fall out at first?
It can. Increased shedding in roughly the first four to six weeks is expected and reflects hair already at the end of its cycle being replaced by new growth. It settles. Many people stop at this stage believing the treatment has made things worse.
What happens if I stop taking hair loss medication?
The benefit is lost. Whatever the treatment was holding resumes thinning over the following months and you return to roughly where you would otherwise have been. Both licensed treatments require continuous use to maintain their effect.
Should I try medication before a hair transplant?
That's a decision for you and a clinician, but it's definitely worth talking about. Medication can hold on to hair that surgery can't get back, and it's much easier to plan surgery when your hair loss is stable. This is especially true for younger men who are still losing hair.
Sources
Regulatory and clinical sources for the statements on this page. Last checked 6 August 2026.
- MHRA, Drug Safety Update: Finasteride and dutasteride, updated safety warnings for psychiatric side effects and sexual dysfunction.
https://www.gov.uk/drug-safety-update/finasteride-and-dutasteride-updated-safety-warnings-for-psychiatric-side-effects-and-sexual-dysfunction - MHRA press release: MHRA strengthens safety warnings for finasteride and dutasteride.
https://www.gov.uk/government/news/mhra-strengthens-safety-warnings-for-finasteride-and-dutasteride - European Medicines Agency: Finasteride and dutasteride containing medicinal products, Article 31 referral, measures to minimise risk of suicidal thoughts.
https://www.ema.europa.eu/en/medicines/human/referrals/finasteride-dutasteride-containing-medicinal-products - British Association of Dermatologists, patient information leaflet: Hair loss, male pattern (androgenetic alopecia).
https://www.bad.org.uk/pils/hair-loss-male-pattern-androgenetic-alopecia - MHRA Public Assessment Report: Safety review of finasteride.
https://assets.publishing.service.gov.uk/media/6825bc05a4c1a40fde4e63e7/Finasteride_PAR_Accessible_1206.pdf
This page is general information, not medical advice, and it is not a substitute for a consultation. Medicines have risks as well as benefits and the right decision depends on your individual circumstances. Speak to a doctor or pharmacist before starting or stopping any treatment.