What actually works

Green means stronger evidence. Every card gives what it does, an example of use and the side effects.

• Minoxidil 5% foam Best OTC starter Helps hairs stay in growth phase longer. Must continue. Some people respond less (follicle enzyme SULT1A1).
• Finasteride 1 mg (men) FDA-approved men Lowers DHT, the main driver of male pattern miniaturization. Many stabilize; some thicken over 6 to 12 months. Sexual changes in a minority.
• Spironolactone (women) Anti-androgen Androgen-receptor blockade, helpful in many cases of female pattern loss. Pregnancy is a hard no.
• Ketoconazole shampoo Easy win adjunct Helps scalp yeast and inflammation. An adjunct, not a substitute for 5% minoxidil in progressive loss.
• Rosemary, pumpkin seed, saw palmetto Modest data One rosemary oil trial came out roughly equal to 2% minoxidil, not 5%.

All fifteen cards, with doses and the FDA alerts on compounded products, are in the full treatments section.

On a typical minoxidil path, expect no visible change for the first weeks, a possible shed at weeks 2 to 8, early signals at months 3 to 4, and a fair judgment at months 6 to 12. That is what “working” looks like, month by month.

You are not comparing your hair to how it looks now. You are comparing it to how it would have looked if you had done nothing, and that version was still getting worse. How to judge it honestly covers photos and the review date.

• In one retrospective study, about 86% of patients had discontinued topical minoxidil.
• People who stopped had used it a median of 3.5 months. People who stuck with it, a median of 24 months.
• The most common reason given for stopping was “no improvement”, cited by about half.

The point at which this class of treatment can fairly be judged is six months, so the most common time to give up falls inside the stretch where “nothing yet” is the expected result. The chart is in most people quit, and the timing is cruel.

Minoxidil is a prodrug. It does nothing until an enzyme in the hair follicle, sulfotransferase (SULT1A1), converts it into minoxidil sulfate, the form that actually works. Applying more, for longer, does not fix an enzyme shortage.

Do this Before concluding you are a non-responder, confirm three things: a correct diagnosis, at least six months of genuinely consistent use, and photos rather than memory. The options after that are in the non-response card.