Hair & scalp · 24 weeks
Men's Pattern Hair Loss: Treatment
24 weeks of guideline treatment for a receding hairline or thinning crown — the follow-on to Men's Hairline — with the doctor route for tablets.
- Length
- 24 weeks
- For
- Men
- Evidence A
- Strong evidence: guidelines or reviews of trials
- What to expect
- Shedding may increase in weeks 2–8 of treatment. First visible change: 3–4 months. Judge at 6 months (finasteride can take up to 12).
The goal: Most men keep the hair they have, and many regrow some at the crown and front within 6–12 months. Gains reverse if treatment stops.
Minoxidil 5% and finasteride are both recommended by the EDF S3 guideline (Grade A); finasteride is a doctor decision with UK regulator (MHRA 2024) safety warnings. Trials were mostly in white men; barber and Afro-hair advice is expert consensus.
Start this program
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The plan
Weeks 1–2
Baseline & doctor talk
Photos, rule out other causes, decide on treatment with a doctor or pharmacist.
Pattern loss is genetic and hormone (DHT) driven; patchy loss, scaling or nape bumps are different conditions.
Morning
Hairline & crown photos
Same light, hair dry: front, both temples, crown. Repeat monthly.
Why: Objective tracking is what you and your doctor need.
Evening
Gentle wash
Wash the scalp 1–3 times a week with a mild shampoo; no hard towel rubbing.
Why: Reduces breakage that exaggerates thinning.
Habits
Doctor or pharmacist conversationDoctor or pharmacist
Ask about the scalp treatment in this program and whether finasteride tablets suit you. Tell them about any past depression or anxiety, prostate tests, or plans to father a child. Your doctor will advise.
Why: The EDF S3 guideline recommends both for men 18 and over with pattern loss; finasteride needs a medical decision.
Is it pattern loss?
Pattern loss is gradual at the temples and crown. Round smooth patches, scaling, pus, or bumps and scars at the back of the neck are different (for example acne keloidalis) — see a doctor.
Why: Close-cut styles are common; nape bumps need their own treatment.
Buy genuine, from a registered pharmacy
Check the NAFDAC number and expiry date. Avoid unlabelled "growth oils" or mixtures sold as hair-loss medicine — they are often not what they claim.
Why: Fake and diluted products are common; the real effect comes only from the tested medicine.
Food
Protein & iron foods
Beans, eggs, fish, meat, groundnuts and leafy greens (ugu, efo) every day. No crash diets.
Why: Low protein and iron deficiency worsen shedding; a doctor can test ferritin.
Weeks 3–12
Treat
Minoxidil 5% twice daily; finasteride only if prescribed.
Minoxidil lengthens the growth phase; finasteride lowers DHT. Benefit needs months of continuous use.
Morning
Minoxidil 5% — morning dose
Twice daily in total: 1 ml solution (dropper) or half a capful of foam to the DRY scalp of the thinning areas (front and crown). Part hair with a comb if it is long; wash hands after; leave 4 hours before washing. If you keep a low cut, apply after the barber, not before, and never on freshly shaved or nicked skin. Keep it off a partner and children: let it dry before close contact. Not in pregnancy or breastfeeding — a partner who is pregnant or breastfeeding should not handle it. Not for under-18s.
Leave on: scalp dry; 4 h before washing
Why: The EDF S3 guideline recommends topical minoxidil for men 18 and over, with 5% suggested over 2% for greater effect.
Evening
Minoxidil 5% — evening dose
Twice daily in total: 1 ml solution (dropper) or half a capful of foam to the DRY scalp of the thinning areas (front and crown). Part hair with a comb if it is long; wash hands after; leave 4 hours before washing. If you keep a low cut, apply after the barber, not before, and never on freshly shaved or nicked skin. Keep it off a partner and children: let it dry before close contact. Not in pregnancy or breastfeeding — a partner who is pregnant or breastfeeding should not handle it. Not for under-18s.
Leave on: scalp dry; 4 h before washing
Why: The EDF S3 guideline recommends topical minoxidil for men 18 and over, with 5% suggested over 2% for greater effect.
Habits
Finasteride — only if your doctor prescribes itDoctor or pharmacist
Finasteride is a prescription tablet; your doctor will advise whether it suits you and the dose and duration. It is often sold without a prescription in Nigeria — take it only after a doctor's assessment. Tell your family you take it. If you develop low mood, depression or thoughts of suicide, STOP it at once and see a doctor. Report sexual side effects (lower sex drive, erection or ejaculation problems), which in some men have continued after stopping. Do not donate blood while taking it. Women who are or may become pregnant must not handle crushed or broken tablets. It lowers PSA (prostate) blood test results — tell any doctor checking your prostate.
Why: Recommended by the EDF S3 guideline. The UK medicines regulator (MHRA, April 2024) warns that finasteride can cause low mood, depression, suicidal thoughts and sexual dysfunction that may persist after stopping.
MHRA Drug Safety Update: Finasteride — psychiatric and sexual side effects (April 2024)
Expect early shedding
Some extra shedding in the first 2 months is common. Keep going unless a stop sign appears.
Why: Resting hairs are pushed out as new growth starts.
Barber hygiene
Your own clippers, or confirmed-sterilised tools. No razor line-ups on treated scalp if you get bumps.
Why: Cuts and folliculitis make the treatment sting and can spread infection.
Food
Protein & iron foods
Beans, eggs, fish, meat, groundnuts and leafy greens (ugu, efo) every day. No crash diets.
Why: Low protein and iron deficiency worsen shedding; a doctor can test ferritin.
Weeks 13–24
Continue & judge
Keep going; compare photos; 6-month verdict with your doctor.
Most of the benefit appears between 6 and 12 months; stopping reverses it.
Morning
Minoxidil 5% — morning dose
Twice daily in total: 1 ml solution (dropper) or half a capful of foam to the DRY scalp of the thinning areas (front and crown). Part hair with a comb if it is long; wash hands after; leave 4 hours before washing. If you keep a low cut, apply after the barber, not before, and never on freshly shaved or nicked skin. Keep it off a partner and children: let it dry before close contact. Not in pregnancy or breastfeeding — a partner who is pregnant or breastfeeding should not handle it. Not for under-18s.
Leave on: scalp dry; 4 h before washing
Why: The EDF S3 guideline recommends topical minoxidil for men 18 and over, with 5% suggested over 2% for greater effect.
Evening
Minoxidil 5% — evening dose
Twice daily in total: 1 ml solution (dropper) or half a capful of foam to the DRY scalp of the thinning areas (front and crown). Part hair with a comb if it is long; wash hands after; leave 4 hours before washing. If you keep a low cut, apply after the barber, not before, and never on freshly shaved or nicked skin. Keep it off a partner and children: let it dry before close contact. Not in pregnancy or breastfeeding — a partner who is pregnant or breastfeeding should not handle it. Not for under-18s.
Leave on: scalp dry; 4 h before washing
Why: The EDF S3 guideline recommends topical minoxidil for men 18 and over, with 5% suggested over 2% for greater effect.
Habits
Monthly photo comparison
Same light and angles as week 1.
Why: Slow change is easy to miss without photos.
6-month doctor reviewDoctor or pharmacist
Bring your photos. Discuss whether to continue, add or change treatment. Your doctor will advise.
Why: The S3 guideline judges response at 6 months (finasteride up to 12).
About hair supplements
Biotin and "hair vitamin" gummies have no proven benefit unless you are deficient, and biotin can distort blood tests (thyroid, heart) — stop it 3 days before any test. Iron tablets only if a blood test shows you are low.
Why: Reviews find no hair benefit from biotin in people with normal levels; too much iron is harmful.
Food
Protein & iron foods
Beans, eggs, fish, meat, groundnuts and leafy greens (ugu, efo) every day. No crash diets.
Why: Low protein and iron deficiency worsen shedding; a doctor can test ferritin.
Milestones
Your weekly check-in
Ask yourself these once a week. If an answer worries you, stop and see a doctor or pharmacist.
- (If on finasteride) Low mood, loss of interest, or any thoughts of self-harm?No / Yes
- Palpitations, dizziness, chest pain, swollen ankles or sudden weight gain?No / Yes
- Scalp itch, redness or flaking after applying the treatment?None / Mild / Lasting or spreading / Swelling, or rash on the face
- How many days did you complete most steps?0–2 / 3–4 / 5–6 / 7
Stop and see a doctor if
- Low mood, depression or thoughts of suicide on finasteride: stop it at once and get help now
- Sexual side effects or breast lump or tenderness on finasteride: see your doctor
- Palpitations, chest pain, dizziness or swollen ankles: stop minoxidil and see a doctor
- Round patches, scaling, scalp pain or pustules, or bumps and scars at the nape: see a doctor
- No change by 6 months: doctor review
In an emergency, call 112112999911911.
Sources
- Kanti et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men (EDF; J Eur Acad Dermatol Venereol, 2018)
- MHRA Drug Safety Update: Finasteride — psychiatric and sexual side effects (April 2024)
- DermNet: Folliculitis keloidalis (acne keloidalis nuchae)
- AAD: Hair loss treatment
- NHS: Hair loss
- DermNet: Pseudofolliculitis barbae
Education, not diagnosis. This plan cannot examine you; pending physician review where marked.
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