The index · read September 2026
Sixteen treatments, two questions, and the worse of the two answers
Every hair-loss treatment men are sold, graded on what a regulator said about it and what randomised trials have been pooled. The two that grade highest are generic, cheap, and pay this site nothing.
The index in full
| Grade | Treatment | What a regulator has said | What the trials add up to | Who decides |
|---|---|---|---|---|
| AMx | Minoxidil, applied to the scalp | Approved for this useSold over the counter as a hair regrowth treatment; the carton names regrowth on the top of the scalp as the use it is for. | Pooled, independentOne of the conventional monotherapies pooled in the 2025 network meta-analysis of male pattern hair loss. | A pharmacy or supermarket shelfNot graded here: No dose and no brand pick — the carton and a pharmacist settle those. |
| AFn | Finasteride, taken orally The EU confirmed suicidal ideation as a side effect of the tablets in 2025 at a frequency it recorded as unknown; the UK tightened the product information again in May 2026. | Approved for this useA prescription tablet approved for male pattern hair loss in men only; the label says it is not indicated for women. | Pooled, independentPooled with minoxidil and dutasteride in the 2025 network meta-analysis of monotherapies. | A prescriberNot graded here: Side effects are summarised, not weighed for you; that needs your history. |
| BDu | Dutasteride, taken orally The EU added a mood-related class note to dutasteride in 2025 as a precaution, having found insufficient evidence of a causal association for dutasteride itself. | Off-label, or cleared not approvedApproved in the US for prostate enlargement, not for hair loss, so using it for hair is off-label and only a prescriber can make that call. Japan approved it for androgenetic alopecia in men in 2015; this scale reads the FDA, and an approval elsewhere does not carry. | Pooled, independentRanked first of the conventional monotherapies in the 2025 network meta-analysis. | A prescriber, off-labelNot graded here: Off-label means a prescriber decides. This index does not argue the case either way. |
| BoM | Minoxidil, taken orally | Off-label, or cleared not approvedA blood-pressure medicine. There is no oral minoxidil approved for hair loss, so this is off-label prescribing. | Pooled, but thin or seller-fundedIncluded as a comparator arm in the 2025 network meta-analysis; the trial base is thinner than for the topical form. | A prescriber, off-labelNot graded here: A blood-pressure drug: monitoring is a clinical matter, not an index entry. |
| BLa | Low-level laser caps, combs and helmetsTheradome → partner link · a grade never moves for one | Off-label, or cleared not approvedCleared under the FDA's 510(k) route as substantially equivalent to an existing device. Cleared is a lower bar than approved, and the two words are not interchangeable. | Pooled, but thin or seller-fundedSham-controlled randomised trials have been pooled and show a hair-density difference, but most of the trials were run by device makers. | A shop, at your own expenseNot graded here: No device is ranked against another here; the grade is for the category. |
| CtF | Finasteride, applied to the scalp The FDA received 32 adverse-event reports for compounded topical finasteride between 2019 and 2024. | Neither approved nor clearedThe FDA said in April 2025 that there is no FDA-approved topical formulation of finasteride; what is sold is compounded, and compounded drugs are not FDA approved. | Pooled, but thin or seller-fundedTopical finasteride arms appear in the 2025 network meta-analysis, so controlled trials exist. | A prescriber and a compounding pharmacyNot graded here: Compounded formulas vary by pharmacy, so no single label can be read for you. |
| CPR | Platelet-rich plasma injections | Neither approved nor clearedA clinic procedure using your own blood. Nothing here is approved for hair loss; the devices that spin the blood are cleared for preparing plasma, not for growing hair. | Pooled, but thin or seller-fundedForty-three randomised trials with 1,877 participants were pooled in 2025; the authors called the evidence moderate and the preparation protocols inconsistent. | A clinic, session by sessionNot graded here: Session counts and prices are a clinic question, not a grade. |
| CMn | Microneedling the scalp | Neither approved nor clearedNot approved or cleared as a hair-loss treatment. Rollers and pens are sold as cosmetic devices. | Pooled, but thin or seller-fundedThirteen randomised trials with 696 patients were pooled in 2024, and nearly all of them tested microneedling added to something else rather than on its own. | A clinic, or a shop for the at-home versionNot graded here: Needle lengths and at-home technique are a safety question for a clinician. |
| CKz | Ketoconazole shampoo | Neither approved nor clearedAn antifungal. It is sold for dandruff and seborrhoeic dermatitis, not for pattern hair loss. | Pooled, but thin or seller-fundedCarried as one of the over-the-counter comparators in the 2025 network meta-analysis. | A pharmacy shelfNot graded here: No shampoo is picked for you here; the grade is for the active, not a bottle. |
| CRo | Rosemary oil on the scalp | Neither approved nor clearedA cosmetic ingredient. No regulator has approved it for hair loss, and cosmetics do not require FDA approval. | One or two small trialsOne of the non-conventional agents the 2025 network meta-analysis found measurable against conventional treatments, from a small trial base. | A shopNot graded here: Essential oils can irritate skin; that is a patch-test question, not a grade. |
| CMe | Melatonin on the scalp | Neither approved nor clearedSold as a cosmetic scalp preparation, and in some countries as a supplement. Neither route is an approval for hair loss. | One or two small trialsThe other non-conventional agent the 2025 network meta-analysis measured against conventional treatments; the trial base is small. | A shopNot graded here: Sold in several forms with different rules; the grade covers the scalp version. |
| DSp | Hair supplements taken by mouth | Outside drug approvalDietary supplements. The FDA does not approve supplements for safety and effectiveness, and no supplement is approved for pattern hair loss. | No independent controlled trialWhere controlled trials exist at all they are usually run by the company selling the capsule, and nobody independent has repeated them. | A shop or a subscriptionNot graded here: Individual brands are not graded here, and a deficiency is a blood-test question. |
| DCk | Thickening shampoos and cosmetic volumisers | Outside drug approvalCosmetics. Their labels do not require FDA approval, and a cosmetic may not claim to treat a condition. | No independent controlled trialNo controlled trial shows regrowth, because these products are built to coat and stiffen a hair, not to grow one. | A shopNot graded here: These are cosmetics doing a cosmetic job, and the grade says only that. |
| XEx | Exosome and stem-cell injections Public FDA safety notification; the agency has reported serious adverse events after unapproved exosome products. | Warned about by the FDAThe FDA has published a safety notification on exosome products and says there are no FDA-approved exosome products. | No independent controlled trialNo pooled randomised evidence for pattern hair loss. The reports the FDA does hold are of harm, not regrowth. | A clinic selling something unapprovedNot graded here: Nothing here should be read as a route to obtaining one. |
| –Tp | Hair transplant surgery | Not a medicineSurgery, not a medicine. It moves hair you still have into a place where hair has gone; it does not slow what is causing the loss. | Not measured this wayOff this scale on purpose. Judging an operation needs surgeon, clinic and consent questions the scale was not built to ask. | A surgeonNot graded here: Surgeon, clinic and consent questions are outside what this scale asks. |
| –Cm | Micropigmentation, fibres and hair systems | Not a medicineCosmetic camouflage. It makes a scalp look fuller in a mirror and changes nothing about the hair underneath. | Not measured this wayOff this scale on purpose. There is nothing to regrow, so a regrowth trial would measure nothing. | An artist, a shop or a studioNot graded here: How it looks after a few years is a portfolio question, not a trial question. |
Every document behind these two columns is listed, with the date it was read, on the grading rule page.
How a grade is made
Tier A — Approved for this use, and the randomised trials have been pooled by someone with nothing to sell. (2 of 16)
Tier B — One answer is a step down: prescribed off-label, or cleared rather than approved, or pooled from trials the sellers paid for. (3 of 16)
Tier C — Nobody approved it for hair loss, but real controlled trials exist and have been counted. (6 of 16)
Tier D — Sold for hair loss with no independent controlled evidence behind it. (2 of 16)
Tier X — The FDA has published a safety warning about the category and no approved product exists. (1 of 16)
Off the scale — Not a treatment for the condition — it moves hair or hides its absence. (2 of 16)
Read across for what a regulator has said, down for what the trials add up to. The letter in the square is the worse of the two — that is the whole rule.
| Evidence ↓ · Standing → | Approved for this use | Off-label, or cleared not approved | Neither approved nor cleared | Outside drug approval | Warned about by the FDA |
|---|---|---|---|---|---|
| Pooled, independent | AMxFn | BDu | |||
| Pooled, but thin or seller-funded | BoMLa | CtFPRMnKz | |||
| One or two small trials | CRoMe | ||||
| No independent controlled trial | DSpCk | XEx |
Two things on this site are not on the map at all: Tp and Cm — hair transplant surgery, and micropigmentation, fibres and hair systems. Neither treats the condition, so grading them against trials would measure the wrong thing.
The index grades sixteen hair-loss treatments on two questions, and the grade a treatment gets is the worse of the two answers. The first question is what a regulator has actually said about that product for this use. The second is what randomised controlled trials of it have been pooled, and who paid for them. Both are answered from documents anyone can open, and every document is dated on the grading rule page.
Two treatments come out in tier A. Both of them are old, both are cheap in their generic form, and neither pays this site a penny. That is not modesty, it is what applying one rule to sixteen products produced.
Tier A: the two approved for this, with the trials to match
Topical minoxidil and oral finasteride are the only two treatments in the index that clear both questions. The FDA has approved each of them for male pattern hair loss, and both appear as conventional monotherapies in a 2025 network meta-analysis that pooled randomised trials of minoxidil, finasteride and dutasteride and ranked them against each other.
That is the whole basis of the top tier, and it is narrower than it sounds. An approval says a regulator was satisfied that a product does something for a defined group of people, on a label that also lists what can go wrong. It does not promise it will do that for you.
The approved topical is sold over the counter. Its carton names regrowth on the top of the scalp as the use it is for, and says in as many words that it is not intended for a receding hairline at the front — a limit most marketing leaves out. What strength to buy and how to use it is a question for the label and a pharmacist, not for this page, and if the front of your hairline is your worry, the honest reading of that carton is that it was not tested there.
The approved tablet is prescription-only and approved for men only; its own label says it is not indicated for use in women, and that women who are or may become pregnant should not handle crushed or broken tablets. The same label reports sexual side effects, including reports of dysfunction that continued after treatment stopped, and depression and suicidal ideation in post-marketing reports. In 2025 a European Union review confirmed suicidal ideation as a side effect of the tablets used for hair loss, at a frequency it recorded as unknown, and required a patient card in the pack; the UK's regulator had introduced its own patient cards in 2024 and strengthened the product information again in May 2026, its expert group summarising the published research with the phrase that the literature data showed mixed outcomes. None of that removes the drug from tier A, because the tier measures approval and evidence, not comfort. It does mean the conversation belongs with a prescriber who knows your history, and that a site with no clinician on it should hand the argument over rather than settle it.
The label also answers the question people ask last: stopping reverses the effect within twelve months. Neither tier A treatment is a cure, and nothing in this index is.
Tier B: off-label, or cleared rather than approved
Three entries sit one step down because one of their two answers is weaker, even though the other is strong.
Oral dutasteride ranked first of the conventional monotherapies in that 2025 network meta-analysis — ahead of both tier A treatments. It is still tier B, because in the United States it is approved for prostate enlargement and not for hair loss, which makes using it for hair off-label prescribing that only a prescriber can decide. Japan approved it for androgenetic alopecia in men in 2015; this scale reads the FDA, so an approval in another jurisdiction does not move a row, and saying so is part of the rule rather than an oversight. The European Union added a mood-related class note to dutasteride in 2025 as a precaution while finding insufficient evidence of a causal association for the drug itself.
Oral minoxidil is the same shape of answer: a blood-pressure medicine, prescribed off-label, with a thinner trial base for hair than the topical form has.
Laser caps, combs and helmets are tier B for a different reason. They are cleared, not approved. Cleared is not approved: clearance is the 510(k) route, where a maker shows a device is substantially equivalent to one already on sale, while approval is the higher bar the FDA applies to new drugs and the riskiest devices. Sham-controlled randomised trials of these devices have been pooled and show a difference in hair density, but most were run by device makers, so the evidence answer is a step down too. Two steps down from nowhere would be unfair; one step down is what the rule gives. The device link on this page is one of them, and it grades below the two generics above it.
Tier C: real trials, no approval for hair loss
Tier C is the crowded one, and it is where most of the money in this market sits. Six entries are here: topical finasteride, platelet-rich plasma, microneedling, ketoconazole shampoo, rosemary oil and topical melatonin. Every one of them has genuine controlled trials behind it. Not one is approved or cleared for pattern hair loss.
Topical finasteride is the sharpest example. The FDA said in April 2025 that there is no FDA-approved topical formulation of finasteride, that what is sold is compounded, and that compounded drugs are not FDA approved; it published the alert after receiving adverse-event reports naming erectile dysfunction, anxiety, suicidal ideation, brain fog and depression, most of which the reporters said persisted after they stopped. The trials exist and are in the network meta-analysis. The approval does not exist. The rule takes the worse answer.
Platelet-rich plasma has the largest trial base of anything in this tier: forty-three randomised trials with 1,877 participants were pooled in 2025, and the authors reported an improvement in hair density but called the evidence moderate and the preparation protocols inconsistent enough to affect the result. Microneedling has thirteen randomised trials with 696 patients pooled in 2024, almost all testing it added to something else. Ketoconazole shampoo, rosemary oil and topical melatonin were all carried as comparators in the 2025 network meta-analysis, which is exactly why they are in tier C and not below it.
None of that makes a tier C treatment useless. It makes the claim you are being sold weaker than the claim on an approved product, and it makes the price worth arguing about.
Tier D and tier X: sold anyway
Tier D holds the two categories that are sold hardest and evidenced least: hair supplements taken by mouth, and thickening shampoos and cosmetic volumisers. Supplements are not approved by the FDA for safety and effectiveness — the agency says so plainly — and the controlled work that does exist is usually funded by the company selling the capsule and has not been repeated by anyone independent. Cosmetic volumisers are honest products doing a cosmetic job: they coat and stiffen a hair so it casts a wider shadow. Neither grows hair, and a label that promised it would be making a drug claim.
Tier X has one entry. The FDA has published a safety notification on exosome products, says there are no FDA-approved exosome products, and has reported serious adverse events in patients treated with them. A clinic selling exosome or stem-cell injections for hair is selling something unapproved, and the only pooled evidence anyone holds on it is evidence of harm.
What the index does not grade, and why
Two entries sit off the scale on purpose, and saying so is part of the method.
Hair transplant surgery moves hair you still have into a place where hair has gone. It does not slow whatever is causing the loss, which is why surgeons routinely expect patients to keep treating the hair that was never transplanted. Grading an operation against drug trials would answer the wrong question: the real questions are about the surgeon, the clinic, consent and what happens if it goes wrong.
Micropigmentation, fibres and hair systems are cosmetic camouflage. They change how a scalp looks and nothing about the hair underneath. There is nothing to regrow, so a regrowth trial would measure nothing at all. Both categories are legitimate choices that plenty of people are happy with. They simply are not answers to the question this scale asks.
| Tier | What it tells you | The question it leaves you |
|---|---|---|
| A | A regulator approved this for pattern hair loss and independent authors have pooled randomised trials of it. | Is it right for you, and can you live with what is on the label? A doctor answers that, not a tier. |
| B | Either it is prescribed off-label, or it is cleared rather than approved, or the pooled trials were largely paid for by sellers. | Who is carrying the risk of the missing approval — you, or a prescriber who has examined you? |
| C | Controlled trials exist and have been counted, but nobody approved or cleared it for hair loss. | Is the price being charged in proportion to evidence that thin? |
| D | Sold for hair loss with no independent controlled evidence behind it. | What, specifically, is the seller claiming, and where is that claim written down? |
| X | The FDA has published a safety warning about the category and no approved product exists. | Why is a clinic offering it at all? |
| Off the scale | Not a treatment for the condition: it moves hair, or it hides that hair has gone. | A different set of questions entirely — surgeon, clinic, aftercare, or how it looks in a year. |
One thing the standing question cannot see
The standing question asks what the FDA has said, and that is a choice with a cost. A treatment approved by a regulator somewhere else still grades on what the FDA has done, which is why dutasteride sits in tier B despite a Japanese approval for this exact use. The scale is scoped to one regulator because mixing jurisdictions would make every grade ambiguous, and because most readers of this site are being sold to under US rules.
It also means a grade can be wrong about you. If you are prescribed something in a country whose regulator has approved it for hair loss, the standing answer that produced the grade here does not describe your situation, and the prescriber in front of you does.
The cheapest honest answer, and what it pays us
The two treatments at the top of this index are among the cheapest things in it, and both pays us nothing in their generic form. Minoxidil is sold as a supermarket or pharmacy store brand carrying the same active ingredient and the same drug-facts label as the branded bottle beside it. Finasteride is prescribed generically and filled at a local pharmacy. Neither runs an affiliate programme this site could join, and the index would grade them identically if they did.
The other honest answer costs a consultation and pays us nothing either: a GP or a board-certified dermatologist. That is not a polite hedge. Effective treatment starts with finding the cause, and several common causes of thinning hair are not pattern baldness at all — thyroid disease, low iron, alopecia areata, scarring alopecias, a medicine you already take, or a heavy shed months after illness, surgery, weight loss or a period of acute stress. A dermatologist can tell shedding from loss, and can order the blood test or the scalp biopsy that settles it. Buying a tier A product for a problem it was not approved for is the most expensive mistake on this page.
Three companies are linked for money on this site, each flagged where its link sits: two telehealth services, which are one route to a prescriber rather than a treatment, and one laser cap, which this index grades in tier B. Every one of them grades below the two generics named above. No account is approved on this domain yet, so today they earn nothing at all; when one is, the link target changes and nothing else does.
What to do with this page
Start with the condition, not the product. If you are not certain the pattern you see is pattern baldness, read what male pattern baldness is and how it is staged and then the signs that it is something else. If you are certain, the tier A row is the shortest honest starting point and a prescriber decides whether the tablet is one of your options.
If a product is being sold to you, look it up in the table above and read the two middle columns aloud. Most of the marketing in this market lives in the gap between "cleared" and "approved", and in the difference between a trial that exists and a trial that was independent. That gap is the only thing this index measures.
Questions this index gets asked
What is the most effective hair loss treatment?
Why is a treatment with good trials graded below an approved one?
Is there a new hair loss treatment coming?
Do hair loss shampoos and supplements do anything?
Does this site take money to move a grade?
Paid links, and what they are not
Partner links, marked sponsored and nofollow. None of them is a recommendation to take anything: the first two are ways to reach a prescriber who will decide, and the third is a device this site grades in tier B, below two generic products that pay us nothing and are named first anyway. No account is approved on this domain yet, so today these links earn nothing at all — see how the money works.