PRP and the Rest
Once you are past finasteride and minoxidil, the evidence varies a lot from one treatment to the next. This page sorts them so you can choose the ones worth adding.
The useful question for anything in this category is not does it work but compared with what, at what cost, and instead of what. A treatment that produces a small effect for a large annual fee is competing with a generic tablet that costs a few pounds a month, so it is worth comparing like for like.
On this page
Platelet-rich plasma
PRP involves taking your blood, spinning it to concentrate the platelets, and injecting that concentrate into the scalp. The theory is that growth factors in the platelets stimulate follicles.
The evidence is genuinely mixed rather than absent. Several small trials show measurable improvements in hair density; others show little. The bigger problem is that protocols vary enormously between clinics, in how the blood is spun, what concentration results and how often it is repeated, so results from one clinic say very little about another.
Where it seems most defensible is as an adjunct for someone already on medication, and sometimes around the time of a transplant. Where it is least defensible is as a replacement for drugs, sold as a course of several sessions a year at a cost that would buy decades of finasteride.
If you want to try it, ask the clinic what protocol they use and what they measure. A clinic that photographs and counts before and after is taking it seriously.
A session is a blood draw, a short wait while the sample is processed, and a series of injections across the thinning area, often with numbing cream. Expect a tender scalp for a day or two. Serious problems are rare when trained staff do it cleanly.
Before booking a course
Ask what the total annual cost is including maintenance sessions, and write that number next to the annual cost of the two proven drugs. Seeing them side by side answers the question faster than any discussion of the evidence.
What to ask before paying for PRP
PRP is usually sold as an initial course of three or four sessions a month or so apart, then maintenance every few months. Prices vary widely. In the UK, private clinics commonly charge a few hundred pounds a session, and in the US, self-pay, it is often more. The first year can easily cost more than a decade of generic finasteride and minoxidil together.
Before agreeing to a package, I would want answers to these:
- How is the sample prepared, and does the clinic know what platelet concentration it produces?
- Who does the injections, and what training do they have?
- How many sessions in the first year, how many after that, and what does the whole thing cost?
- What do they photograph or measure, and when will they tell you it is not working?
- Is it being offered instead of medication, or alongside it?
The last answer matters most. PRP works best alongside proven medication such as finasteride, not instead of it. Be wary of non-refundable prepaid bundles, and of add-ons such as exosomes or stem cell treatments, where the evidence is earlier still and regulation is patchy.
Microneedling
Rolling or stamping fine needles across the scalp to create controlled micro-injury, on the theory that healing stimulates follicles and that it improves absorption of topical minoxidil.
The evidence for microneedling combined with minoxidil is reasonably encouraging, more so than for microneedling alone. It is cheap, it can be done at home, and the main risks are infection and overdoing the depth.
It is a fair adjunct if you are already using minoxidil. Needle length, frequency and hygiene all matter, and doing it weekly with a clean device at a modest depth is the sensible version.
Common advice is to leave about a day between needling and the next minoxidil application, because freshly needled skin absorbs more and stings. Do not needle over a rash, infection or broken skin, never share the device, and after a transplant ask your surgeon before going near the recipient area.
Ketoconazole shampoo
An antifungal shampoo with some evidence of a mild anti-androgenic effect on the scalp, alongside its actual job of controlling the yeast involved in dandruff and seborrhoeic dermatitis.
Cheap, harmless, and plausibly a small positive, particularly if you also have a flaky scalp. Nobody should expect it to hold hair on its own, and using it two or three times a week is a reasonable habit rather than a treatment plan.
Leave the lather on for a few minutes before rinsing, since it needs contact time. It can dry the hair, so many people alternate it with their normal shampoo. If a flaky, itchy scalp does not settle with it, see a GP or pharmacist, since psoriasis and other conditions can look similar.
Other prescription options
Beyond the two first-line drugs, there are prescription options that a doctor may discuss, usually a dermatologist or a prescriber with a particular interest in hair.
Dutasteride blocks more DHT than finasteride and is sometimes used when finasteride has not done enough. It is off-label for hair in most countries, stays in the body much longer, and carries the same pregnancy rule. The detail is on finasteride.
Low-dose oral minoxidil is the other, and for women, anti-androgens such as spironolactone are sometimes prescribed for female pattern loss. All of these are decisions for a prescriber who knows your history and will follow you up, not something to order from a website that asks three questions.
At a dermatology appointment
Bring your baseline photographs and a list of everything you have tried, how long for and what happened. It turns a vague conversation about options into a specific one about what to try next.
Laser devices and supplements
Low-level laser therapy, sold as caps, combs and helmets, has some trial support for modest density improvements and a plausible mechanism. It is also expensive for what it delivers, and the trials are mostly industry-funded. It is not harmful. It is a long way down the list of things to spend money on.
Supplements are the weakest category. Biotin does nothing for hair unless you are genuinely deficient, which is rare. Saw palmetto is sold as a natural DHT blocker with far weaker evidence than finasteride and no dose standardisation. Multivitamins for hair are a marketing category rather than a clinical one.
Correcting a real deficiency is different. If your loss is diffuse rather than patterned, low iron, thyroid problems and significant nutritional deficiency are all worth testing for, and treating one of those can genuinely reverse shedding.
Taking iron, zinc or high-dose vitamins on the off chance is not harmless. Too much iron is damaging, long-term high-dose zinc can cause other deficiencies, and very high vitamin A intake can itself cause hair loss. Test first and treat what the test finds, with a doctor's guidance on dose and duration.
Before buying anything in this category
Get your ferritin and thyroid checked if the shedding is diffuse rather than in a pattern. Finding a treatable cause is worth more than any product on this page, and it costs a blood test.
Frequently asked questions
Does PRP work?
The evidence is mixed and protocols vary between clinics. It is best used as an adjunct alongside medication rather than a replacement for it. See platelet-rich plasma.
Is microneedling worth doing?
Combined with minoxidil, reasonably so, and it is cheap. Alone, less convincing. See microneedling.
Do laser caps work?
There is some trial support for modest gains, mostly industry-funded, at a high price relative to the benefit. See laser devices and supplements.
Should I take biotin?
Not unless you are deficient, which is uncommon. It also interferes with some blood tests, so tell your doctor if you take it. See laser devices and supplements.
What about saw palmetto?
Weaker evidence than finasteride, no dose standardisation, and the same mechanism claimed. If you want DHT blocked, use the drug that was tested.
How much does PRP cost?
Commonly a few hundred pounds a session in the UK, often more in the US, sold as a course plus maintenance. See what to ask before paying.
What is dutasteride?
A stronger DHT blocker than finasteride, used off-label for hair and only through a prescriber. See other prescription options.
Are exosome or stem cell treatments worth trying?
The evidence is earlier than for PRP and regulation is patchy. I would not pay for them as a substitute for anything proven.