Male pattern baldness: minoxidil, finasteride, hair transplant, what works

Your hair is falling out. Your hairline is receding, the crown of your head is thinning. You may have already searched for "hair transplant" or "minoxidil" online. Before you go any further, here's what the science really says — the solutions that work, their limitations, and what you can do concretely right now.

Understanding what's happening is the first step. Acting at the right time is the second.

What's happening on your scalp: the role of DHT

The most common cause of hair loss in men is androgenetic alopecia. It affects between 70% and 80% of men during their lifetime.

The mechanism is precise: an enzyme called 5-alpha-reductase converts testosterone into DHT. In genetically predisposed men, hair follicles on the temples and crown of the head are sensitive to this hormone. It causes their progressive miniaturization — hairs grow back thinner and thinner until they disappear. It is not an excess of testosterone. It is a genetic sensitivity of the follicles, transmitted mainly through the maternal line.

Not all hair loss is androgenetic. Intense stress, an iron, zinc or vitamin D deficiency, or a thyroid problem can cause diffuse and temporary hair loss. These situations do not require the same solutions.

From minoxidil to transplant: what really works

Topical minoxidil is the reference over-the-counter treatment, available in pharmacies without a prescription. It prolongs the hair growth phase and stimulates follicular vascularization. Clinical studies show that approximately 30 to 40% of users observe a measurable improvement in density after 3 to 6 months, with 5% being superior to 2%. The 5% concentration is more effective than 2%. Discontinuation of treatment leads to a resumption of hair loss — it is a continuous treatment, not a one-time treatment.

Oral finasteride is the reference prescription medication. It directly blocks the enzyme that produces DHT, reducing its level by about 70%. A study conducted on 1,553 men over 5 years showed a significant slowdown in progression in a majority of patients. It requires medical supervision and is contraindicated in women of childbearing age. Dutasteride acts on the same mechanism with broader inhibition, used when finasteride is not sufficient.

PRP (platelet-rich plasma) involves injecting growth factors extracted from the patient's own blood into the scalp. Studies show an improvement in density in about 70% of treated patients. It is a complementary approach, performed in a medical office, particularly effective in combination with other treatments.

Microneedling creates micro-perforations in the scalp that stimulate follicular regeneration and improve the penetration of topical active ingredients. Used alone or in combination with minoxidil, it shows documented results on hair density in several clinical trials.

Hair transplant (mainly FUE technique) is the only solution that permanently restores density in bald areas. It involves taking DHT-resistant follicles from the occipital areas and reimplanting them in thinning areas. Its results are real — but three essential points to understand before deciding. It does not stop hair loss in non-grafted areas: without parallel medical treatment, baldness continues to progress around transplanted areas. It requires sufficient follicular capital. And it gives the best results when hair loss is stabilized, not in active progression. In practice, a transplant is relevant for advanced stages, after medical treatments have been exhausted, or for men who do not tolerate them.

What you can do without a prescription: the complete routine

Medical treatments work. But they require a prescription or medical follow-up. In parallel — or as a first step if hair loss is just beginning — a complete, scientifically validated, over-the-counter approach can be effective.

Specific scalp shampoo formulated with zinc pyrithione or piroctone olamine cleanses the follicular environment, often disturbed by associated seborrheic dermatitis. Caffeine stimulates local microcirculation. An ordinary shampoo does not fulfill this role.

Scalp serum delivers concentrated active ingredients directly to the follicle: caffeine, niacinamide, stimulating active ingredients. It is the natural topical complement to minoxidil, or an alternative for those who want a progressive approach before resorting to it.

Food supplements are the third pillar. Saw palmetto is the best-documented natural alternative — it acts on the same enzymatic pathway as finasteride, more gently and without systemic hormonal effects. Available trials, though small, show a real but modest effect: it lowers DHT by about 25 to 35% (compared to 60 to 70% for finasteride) and its benefit remains lower than that of prescription treatments. Combined with zinc and biotin, it forms a coherent oral protocol, as a supplement rather than a substitute. Only fatty acid-titrated extracts are effective.

The Paradermia approach

Our pharmacist selects each hair care product and food supplement based on its actual formulation: active ingredient titration, effective dosage, overall coherence. The goal is to give you access to what really works, integrated into a coherent routine adapted to your situation.

Frequently Asked Questions

Can I find an effective hair care routine on Paradermia?
Yes. Our pharmacist has selected care and supplements formulated to act in synergy: specific scalp shampoo, topical serum, and food supplement with titrated saw palmetto. This routine provides a solid foundation, for prevention as well as in conjunction with medical treatment.

Should I consult a doctor before starting?
For minoxidil and finasteride, medical advice is recommended. For the care and supplements available on Paradermia, you can start without a prescription. If hair loss is rapid or diffuse, a biological assessment is still useful to identify a treatable cause.

At what age should I act?
From the first signs, regardless of age. An active follicle can respond to treatment. A definitively destroyed follicle no longer grows back — and that is precisely why early action changes everything.