New Canadian consensus guidelines on managing male and female pattern hair loss

Androgenetic alopecia is the most common type of hair loss, affecting 40%–50% of Canadian men and women by 50 years of age. In men, it is characterized by a receding frontal hairline, sometimes accompanied by hair loss at the crown of the scalp. It may start as early as the teenage years. In women, it usually involves hair thinning in the mid‑scalp and at the crown of the scalp. Women usually experience more gradual hair loss, with the rate increasing dramatically after menopause. Most cases of androgenetic alopecia are related to a genetic disposition and hormonal influences, but inflammation, lifestyle factors (e.g., weight, stress, diet) and environmental factors can also play a role. Hair loss can lead to anxiety, anger, depression and embarrassment, which can interfere with the patient’s daily life, including their relationships and career.To date, there have been no Canadian guidelines on the management of androgenetic alopecia. Topical minoxidil is approved by Health Canada for treating both male and female pattern hair loss, while oral finasteride 1 mg/day is approved for male pattern hair loss. Despite these limited number of approved medications for the treatment of androgenetic alopecia, many other products and interventions are available to the public that do not require a prescription. However, the lack of high‑quality data or conflicting information about their efficacy underscores the need for evidence and expert‑based recommendations. To address this issue, an expert panel with members representing all regions of Canada developed Delphi-based consensus recommendations on interventions for the management of androgenetic alopecia in male and female adults. The panel reviewed 45 interventions, with the results summarized below.Recommended interventions (> 75% consensus): oral dutasteride; oral finasteride; oral minoxidil; topical minoxidil; platelet-rich plasma; topical finasteride; microneedling. Recommended with near consensus (55%–74% consensus): ketoconazole shampoo; intralesional dutasteride (must be compounded by a pharmacist); low level laser therapy; aminexil (2,4‑diaminopyrimidine 3‑N‑oxide, a cosmetic).Not recommended: adenosine; cetirizine; carboxytherapy; amla syrup; microfilament thread; Nourkrin (a cosmetic); injectable minoxidil; caffeine; ceramide; topical herbal formulations; piroctone olamine shampoo or leave-on; rosemary oil; shampoo and lotion hair care products containing fermented papaya, fermented mangosteen and caffeine; basic Fibroblast Growth Factor (bFGF); flutamide.The guidelines also include separate tables that outline the preferred treatment sequence in males and females:Preferred treatments for malesFirst-line therapies5% minoxidil foam (twice daily)Oral finasteride 1 mg (once daily)Second-line therapiesTopical finasteride 0.25% (once daily)Oral minoxidil 1.25–5 mg (once daily)Oral dutasteride 0.5 mg (2–3 times/week)Low level laser therapyPlatelet-rich plasmaThird-lineSaw palmettoAminexilKetoconazole topicalTopical caffeine, botulinum toxin, topical cetirizine, and mesotherapy with dutasteridePreferred treatments for femalesFirst-line therapies5% minoxidil topicalSecond-line therapiesOral spironolactone ± oral minoxidilOral finasteride (or oral dutasteride) or spironolactone ± oral minoxidil (Note: Oral finasteride and oral dutasteride are not recommended in females of child-bearing age. Oral finasteride may increase the risk for breast cancer; do not use in women with mainly hormone-dependent breast cancer.)Third-line therapiesProcedural (platelet-rich plasma, laser, mesotherapy)Other options to consider: cosmetics such as aminexil, nutraceuticals and herbal products.The authors point out that the main strength of this consensus is that it was prepared by a diverse, multidisciplinary panel of experts representing all regions of Canada. They also acknowledge the limitation of a Delphi consensus, which relies on expert opinion and, as a result, is subjective.Reference:Landells I, Chow E, Gupta AK, et al. A Canadian consensus on androgenetic alopecia: approach and management. J Cutan Med Surg 2025;Sep 23:12034754251368849. (accessed September 25, 2025).

New Canadian consensus guidelines on managing male and female pattern hair loss

Register for free access or login.

Related Topics

Business Topic