How to read this ranking
The six ingredients are numbered from 1 to 6. The number is a position on the page, not a score. Nothing here is marked out of ten, because the studies measure different things in different ways and cannot be put on one scale.
Each ingredient also belongs to one of three tiers. The tiers are our order of consideration, and the tier tells you more than the number next to it.
1-2
Core optionsMinoxidil and finasteride
The two to weigh first. Our review does not establish a winner between them, and sharing a place does not mean they work equally well or are equally safe.
3
Conditional alternativeDutasteride
A prescription alternative for the right context. It is not placed lower because it works less well.
4-6
Limited evidenceSaw palmetto, rosemary and pumpkin seed oil
Narrow signals, each tied to the specific preparations that were studied. There is no order among the three.
Two things follow from that. Minoxidil is listed first and finasteride second, but they share the top tier: our review does not establish a winner between them, and sharing a tier does not mean they work equally well or are equally safe. The same goes for saw palmetto, rosemary and pumpkin seed oil. The order among those three is ours, for reading. It is not a finding that one works better than another. For the top tier, the page comparing minoxidil with finasteride explains why we do not pick one.
A tier weighs eight things at once, set out under how we rank. Effectiveness alone does not decide it, which is why dutasteride sits one tier below finasteride even though it raised total hair count more in a direct 24-week trial.
Side by side
The two tables below put the same eight criteria next to each other. Each cell is the short verdict. The reasoning behind it is in the section for that ingredient further down.
The three medicines
Minoxidil, finasteride and dutasteride
Each column is the form the position is based on. Minoxidil and finasteride share the top tier.
| Criterion | No. 1MinoxidilTopical solution or foam | No. 2FinasterideOral tablet | No. 3DutasterideOral capsule |
|---|---|---|---|
| Benefit shown | Benefit shown against an inactive vehicle | Benefit shown against placebo | Greater total hair-count gain than finasteride in one trial |
| Evidence | Broader clinical support | Broader clinical support | Limited support |
| Main risk | Scalp irritation; labels also carry systemic warnings | Sexual and psychiatric warnings | Systemic warnings; stays in the body for a long time |
| Routine | Twice-daily scalp application | One tablet a day, on prescription | One capsule a day; long persistence matters |
| Time point | Review point set by each product's label | Three months or more before benefit | Compared at 24 weeks |
| If you stop | Benefit lasts only with continued use | Benefit lasts only with continued use | Data during use; not established after stopping |
| Access | Labelled products available (US and UK checked) | Tablet approved (US and UK checked); spray varies | Hair-loss approval varies by country |
| Cost | Depends on country and form | Depends on country and provider | Only one local price observed |
Prices and labels were checked for the United States and the United Kingdom at the end of September 2026. They are examples for identified products, not a global picture.
Minoxidil holds its place because of the solution and foam used on the scalp. Finasteride holds it because of the tablet, and dutasteride because of the capsule. Other forms of the same medicines, such as minoxidil tablets or a finasteride spray, are assessed separately in each profile.
The three botanicals
Saw palmetto, rosemary and pumpkin seed oil
Each column is the preparation that was studied. The three share one tier, and the order among them is editorial.
| Criterion | No. 4Saw palmettoOral, identified extracts | No. 5RosemaryOne studied lotion | No. 6Pumpkin seed oilOne studied oral preparation |
|---|---|---|---|
| Benefit shown | Limited signal for specific preparations | Limited signal for specific preparations | Limited signal for specific preparations |
| Evidence | Limited support | Limited support | Limited support |
| Main risk | Little hair-specific safety data | Tolerability versus minoxidil unresolved | Safety data from one small trial |
| Routine | Daily capsule; amount depends on the extract | Twice-daily lotion in the trial | Four capsules a day in the trial |
| Time point | Study time points only | Study time points only | Study time points only |
| If you stop | Not established after stopping | Not established after stopping | Not established after stopping |
| Access | Studied extract not matched to shop products | Studied preparation not matched to shop products | Studied preparation not matched to shop products |
| Cost | No comparable price yet | No comparable price yet | No comparable price yet |
We found no price for a product matched to a studied preparation, so the cost row has no figure to show.
A botanical result belongs to the preparation that was tested. It does not carry over to another capsule, oil or shampoo with the same ingredient on the label.
The six ingredients, one by one
1. Minoxidil
Core optionMedicine · Position based on the scalp solution and foam
Minoxidil is listed first. Its place in the top tier rests on its two scalp forms, a 5% solution and a 5% foam, which each increased hair counts in trials of men compared with the same product without minoxidil, and on the label instructions that come with the men's products in the US and UK. [1, 2, 3, 4] It shares that tier with finasteride: our review does not establish which of the two works better.
- Reference use
- Twice a dayOn the scalp, on the US and UK men's labels.
- First signs
- About 2 monthsAs expected by the product labels.
- Lasts
- While you use itRegrowth depends on continued use.
The clearest numbers come from the foam. The UK product information reports a trial of 352 men aged 18 to 49: after 16 weeks the men on 5% minoxidil foam had gained about 21 hairs per square centimetre in the measured area, against about 4 with the same foam without minoxidil. [5]
Hairs gained after 16 weeks of foam
5% minoxidil foam180 men
+21.0hairs per cm²
Foam without minoxidil172 men
+4.3hairs per cm²
Change in non-vellus hair count in a marked target area, as reported in the UK product information. A target area is a small patch of scalp chosen for the study, not the whole head. [5]
Advantages
- Solution and foam each beat a product without minoxidil in trials of men. [1, 2]
- In the US the men's 5% solution and foam are sold over the counter, and in the UK the men's foam is on general sale. [4, 6, 5]
- The labels say how to use it: two applications a day, with an amount specific to each product. [3, 5, 4, 6]
Trade-offs
- Twice a day, for as long as you want to keep the result: the regrowth lasts only while you keep using it. [3, 4]
- The scalp can become irritated, and the labels also list warning symptoms that affect the rest of the body. [3, 4]
- The two US men's labels are for the top of the scalp, not a receding hairline, and the UK products have upper age limits. [4, 6, 3, 5]
- Tablets are a separate decision for a prescriber: in the one head-to-head trial, minoxidil by mouth brought more unwanted hair growth than the solution. [7]
Two of these points have a page of their own: how to use minoxidil, label by label, and the side effects of minoxidil on the scalp and as tablets.
How minoxidil rates on all eight criteria
- Effectiveness
- Benefit shown against an inactive vehicleThe 5% solution and the 5% foam each showed a benefit in men against the same product without minoxidil. The solution was studied for 48 weeks and the foam for 16, so these trials do not show which form is better, and they do not set an order against finasteride or dutasteride.
- Evidence strength
- Broader clinical supportA broader body of evidence on scalp use supports this place. It is a provisional description, not a formal certainty grade: our appraisal of the main trial reports was limited by access to the full text, the link between the foam trial and the foam label is provisional, and consistency across studies and publication bias have not been worked through.
- Risks and tolerability
- Scalp irritation; labels also carry systemic warningsFor the scalp forms, irritation and how well the scalp tolerates the product matter, and official labels also list body-wide warning symptoms. The tablets carry their own risks: more unwanted hair growth elsewhere, fluid retention and heart-related cautions. No form is risk-free.
- Time
- Review point set by each product's labelTrials measured results at 16 weeks for the foam and 48 weeks for the solution. The UK labels say to stop if there is no improvement after 16 weeks for the foam and one year for the solution. The US men's labels we checked say four months. These are product instructions, not a universal waiting period or a promised response.
- Cost
- Depends on country and formPrices were observed on 29 September 2026 in the US and the UK, for identified products and pack sizes. In the US examples topical minoxidil cost less than the finasteride subscription we looked at. In the UK examples generic finasteride tablets cost less. That does not make a global price order or show value for money.
- Routine
- Twice-daily scalp applicationThe men's labels we identified say to apply it to the scalp twice a day, with a measure and handling rules specific to each product. Choosing foam or solution can change how acceptable the routine feels. Fewer steps or a different texture have not been shown to change how well it works.
- Maintenance
- Benefit lasts only with continued useThe labels we checked say treatment has to continue to keep the benefit. The UK solution label says, on the basis of anecdotal reports, that the benefit is lost within three to four months of stopping. That is not a tested timeline for every form.
- Access
- Labelled products available (US and UK checked)The US and UK men's scalp products we identified have usable local labels, each with its own age limits and areas of the scalp. That supports their use as a reference in those two countries. It does not show approval worldwide, or approval of tablets for hair loss.
2. Finasteride
Core optionMedicine · Position based on the 1 mg tablet
Finasteride is second on the page and in the same top tier as minoxidil. Its position rests on the 1 mg tablet, which has trials against placebo, follow-up to five years and a simple daily dose on the US and UK labels. [8, 9, 10] What you have to weigh with it is not how well it works but what it asks you to accept: a prescription, and warnings about sexual side effects and mood.
- Reference use
- Once a dayOne 1 mg tablet, on the US and UK labels.
- First signs
- 3 months or moreAs expected by the US label.
- Lasts
- While you take itThe effect reverses within 12 months of stopping.
The main evidence is summarised in the US product label. Two trials enrolled 1,553 men with thinning at the crown, who took finasteride 1 mg or a placebo every day. After 12 months the men on finasteride had 107 more hairs than the men on placebo in the patch of scalp that was measured, an area of 5.1 cm². That is the gap between the two groups in that patch, not the gain over the whole head. [8]
The same label reports the side effects that most people ask about.
Sexual side effects attributed to treatment in the first year
At least one of these
3.8%2.1%Lower sex drive
1.8%1.3%Erection problems
1.3%0.7%Ejaculation problems
1.2%0.7%Stopped because of them
1.2%0.9%
Percentage of men in each group, from three trials in the US label. One man can appear in more than one row, so the rows do not add up. These are first-year figures, not a lifetime risk, and they say nothing about symptoms that continue after stopping. [8]
Advantages
- More hair than placebo at one year in two trials of 1,553 men, with the benefit maintained in extensions of up to five years. [8, 10]
- One 1 mg tablet a day, with or without food. [8, 9]
- It has been studied together with minoxidil solution on the scalp, although the UK tablet label states that no data are available on using the two together. [11, 9]
Trade-offs
- It needs a prescription, and a proper conversation before starting. [8]
- Regulators warn of depression, suicidal thoughts and sexual problems that can continue after stopping. How often that happens is not known. [12, 13]
- The effect reverses within 12 months of stopping, according to the US label. [8]
- The scalp spray has one placebo-controlled trial of 24 weeks behind it and is not approved in the US. It has not been shown to be safer than the tablet. [14, 15]
How finasteride rates on all eight criteria
- Effectiveness
- Benefit shown against placeboThe 1 mg tablet showed a benefit against placebo, as documented in the product label: 107 more hairs at one year in a 5.1 cm² area of scalp. That does not set an order against topical minoxidil, and it does not mean every form of finasteride works equally well.
- Evidence strength
- Broader clinical supportThe evidence for the tablet and its continuing use as an official reference support a core place. It is a provisional description: the original tablet trials have not had a completed appraisal of bias and certainty in our review, and our appraisal of the scalp spray does not cover them.
- Risks and tolerability
- Sexual and psychiatric warningsIn the first year, sexual side effects attributed to treatment were reported by 36 of 945 men on the tablet and 20 of 934 on placebo (3.8% against 2.1%). Persistent sexual symptoms and psychiatric warnings need a separate discussion: those percentages do not measure how often persistent problems occur.
- Time
- Three months or more before benefitThe US tablet label describes three months or more before a benefit, and the comparison cited here was made at one year. Follow the product's own guidance rather than one review date applied to every medicine.
- Cost
- Depends on country and providerDated price observations, for generic tablets in the UK and a subscription in the US, lead to different comparisons. No global price or value-for-money order is supported, and the price of an unidentified scalp blend says nothing about the price of finasteride alone.
- Routine
- One tablet a day, on prescriptionOne 1 mg tablet a day, with or without food. An easy routine does not remove the prescribing decision, the question of tolerability or the label's precautions on handling and reproduction.
- Maintenance
- Benefit lasts only with continued useContinued use keeps the benefit. The US label describes the effect reversing within 12 months of stopping. That does not support taking it on and off, or tapering.
- Access
- Tablet approved (US and UK checked); spray variesThe US and UK tablet labels we checked support use in adult men. The scalp spray is different: Spain has a specific labelled product, while the US regulator reports no approved topical finasteride product.
3. Dutasteride
Conditional alternativeMedicine · Position based on the 0.5 mg capsule
Dutasteride is third, one tier below, and not because it works less well. In a 24-week trial of 917 men, a 0.5 mg capsule once a day raised total hair count more than finasteride 1 mg and more than placebo. [16] It sits lower because of the rest of the picture: it stays in the body for months, long-term comparisons of its benefits and risks are incomplete, and in the US and UK it has no hair-loss label. [17, 18, 19]
- Dose in the trial
- Once a day0.5 mg. Not an approved hair-loss dose in the US or UK.
- Approved for hair loss
- In JapanThe US and UK labels are for an enlarged prostate.
- Stays in the body
- For monthsDetectable 4 to 6 months after the last capsule.
One trial carries most of the weight. Hairs were counted inside a circle 2.54 cm across at the crown. When only the thicker "terminal" hairs were counted, dutasteride was not shown to be better than finasteride. [16] The page on finasteride and dutasteride looks at that trial more closely, along with side effects and approvals.
Change in hair count after 24 weeks
Dutasteride 0.5 mg184 men
+89.6hairs in the measured area
Finasteride 1 mg179 men
+56.5hairs in the measured area
Placebo181 men
−4.9hairs in the measured area
Average change in total hair count inside a circle 2.54 cm across. These are hairs in that circle, not hairs per square centimetre and not growth over the whole head. The trial was funded by GSK. [16]
Advantages
Trade-offs
- The US and UK labels are for an enlarged prostate, so using it for hair loss there is a decision for a prescriber. [17, 18]
- Half of the medicine is still in the blood about five weeks after the last capsule, and it can be detected for four to six months. [17]
- Sexual side effects were recorded in trials, and the US label says they may continue after stopping. A precautionary warning about mood was added in the UK in 2026. [17, 12]
- It is an alternative to finasteride to discuss with a prescriber, not something to add to it.
How dutasteride rates on all eight criteria
- Effectiveness
- Greater total hair-count gain than finasteride in one trialThe 0.5 mg capsule beat finasteride 1 mg by an adjusted 33.0 hairs, counting all hairs in a circle 2.54 cm across, at 24 weeks (99.165% confidence interval 6.1 to 60.0). For the thicker terminal hairs alone it was not shown to be better. A conditional place is not a claim that it works less well.
- Evidence strength
- Limited supportA substantial direct randomised comparison supports that result, but this is not a combined certainty assessment of all dutasteride evidence. Our appraisal records concerns about how missing data were filled in, the timing of the baseline photos and the reporting history. The long-term evidence comes from a more selected group.
- Risks and tolerability
- Systemic warnings; stays in the body for a long timeSexual or breast-related events were reported by 19 of 184 men on dutasteride, 24 of 179 on finasteride and 12 of 181 on placebo in the 24-week trial. That does not prove equal safety, or that dutasteride is safer. Its long persistence in the body, uncertainty about semen measures and a precautionary warning about mood all weigh on the decision.
- Time
- Compared at 24 weeksThe deciding comparison was made at 24 weeks. That is not a promise of a faster response. The medicine stays detectable for months after stopping, which describes how the body clears it and is not evidence that regrowth is kept.
- Cost
- Only one local price observedOne dated UK price exists for the 0.5 mg capsule as used in the trial, with some additional fees not included. We found no comparable price for a scalp version of dutasteride alone, and no global cost order is established.
- Routine
- One capsule a day; long persistence mattersOne capsule a day, as in the direct trial, is simple to take, but the long persistence matters whenever treatment is reconsidered. A pilot study of taking it a few times a week does not establish equal benefit or lower harm, and it does not support a routine of finasteride plus dutasteride.
- Maintenance
- Data during use; not established after stoppingA selected five-year group describes benefit during continued use. It does not show that the benefit is kept after stopping. The medicine remaining in the blood is not a substitute for a study of what happens to hair.
- Access
- Hair-loss approval varies by countryThe US and UK labels we checked are for an enlarged prostate. Japan's label includes male pattern hair loss. The conditional place has to be reconsidered for the country concerned: it does not mean dutasteride works less well, or that it is off-label everywhere.
4. Saw palmetto
Limited evidenceBotanical supplement · Position based on identified oral extracts
Saw palmetto is the first of the three botanicals on the page. That order is ours: nothing in the evidence puts it above rosemary or pumpkin seed oil. Two named extracts taken by mouth have placebo-controlled trials, one of 60 adults over 180 days and one with about 20 people per group over 16 weeks. [20, 21, 22] A result for one extract does not carry over to another capsule with the same name on the label.
- Amounts in trials
- 100 to 320 mg a dayOf three different extracts. Not a scale of strength.
- Against finasteride
- Fewer improved38% of men, against 68% on finasteride.
- After stopping
- Not knownNo study we reviewed measured what happens next.
The one comparison with a core medicine went against it. In an open-label trial of 100 men, fewer improved on saw palmetto than on finasteride after two years. [23]
Men rated as improved on photographs after 24 months
Finasteride 1 mgPrescription medicine
68%% of men
Saw palmetto 320 mgExtract details not available to us
38%% of men
Share of men judged to have improved, not the amount of hair gained. There was no placebo group, the men were not blinded, and we could read only the published summary. [23]
Advantages
Trade-offs
- The trials are small, and several had company funding or company employees among the authors. [20, 21, 22]
- The 100, 160 and 320 mg used in different studies are amounts of different extracts, not steps on one scale.
- Those trials are too small to rule out rare side effects, and no study we reviewed measured fertility.
- No study we reviewed measured what happens after stopping.
How saw palmetto rates on all eight criteria
- Effectiveness
- Limited signal for specific preparationsOne extract trial in 60 adults, men and women together, reported terminal hair counts over a front and a back area of the scalp combined changing by +18.6 with the extract and −10.1 with placebo at 180 days. That is not a men-only figure or a figure per square centimetre. A second small trial gives another signal, for a different extract. In an open-label study, photographs showed improvement at 24 months in 38% of men on saw palmetto and 68% on finasteride, which is not equivalence.
- Evidence strength
- Limited supportThe 90-day and 180-day reports describe one 60-person trial, registered after it had started. It included 30 men, and its subgroup headings conflict. The second trial is a single four-arm study, not separate confirmations for capsules and scalp use. The comparison with finasteride is known from its abstract, with the extract's standardisation unverified. Company sponsorship of one trial and the involvement of company employees in another are disclosed.
- Risks and tolerability
- Little hair-specific safety dataSmall hair trials cannot establish that the risk is close to zero, that hormones are unaffected, or that it is safe alongside finasteride or dutasteride. No product-related event in one trial is not proof of no events, or of long-term safety. A trial in men with urinary symptoms gives indirect evidence on tolerability. It does not show that the hair extracts are equivalent, or anything about fertility.
- Time
- Study time points onlyOne trial measured results up to 16 weeks, another up to 180 days, and the comparison with finasteride at 24 months. Different extracts, measurements and follow-up do not allow a fastest-response order or a guaranteed onset for one person.
- Cost
- No comparable price yetNo US or UK price has been matched to a studied preparation. Prices of the core medicines are context only: they cannot show that a botanical costs less, or what it costs per extra hair.
- Routine
- Daily capsule; amount depends on the extractThe two extract trials used a daily dose by mouth. That may suit some people, but the weight of a capsule is not the weight of the extract inside it, so a generic number of capsules cannot be given. No advantage over the medicines in keeping to the routine has been shown here.
- Maintenance
- Not established after stoppingThe reports assess use during treatment. They do not establish how long a benefit lasts after stopping, an on-and-off schedule, or the long-term safety of every extract.
- Access
- Studied extract not matched to shop productsFinding the ingredient name on a shelf does not confirm that the studied extracts are available in the US or UK, or that a product is equivalent to them in quality. The trial records do not establish a matched commercial product or a local authorisation as a hair treatment.
5. Rosemary
Limited evidenceBotanical topical · Position based on one studied lotion
Rosemary's position rests on a single trial of a single lotion. In 100 men, that lotion and 2% minoxidil both showed a small rise in hair count after six months, with no significant difference between them. [24] That is not proof that rosemary works as well as minoxidil: there was no placebo group, and the minoxidil was the weaker 2% strength.
- Use in the trial
- Twice a day1 mL of the lotion, about 12 hours apart.
- Change seen
- At 6 monthsNo significant change at 3 months.
- After stopping
- Not knownNo study we reviewed measured what happens next.
The count went up in both groups, by about 7 hairs with rosemary and about 2 with minoxidil, on photographs showing well over a hundred. At three months neither group had changed significantly. [24]
Average hair count at the start and after six months
Rosemary lotion
122.8129.6Minoxidil 2%
138.4140.7
Hairs counted on the study's photographs. The paper does not clearly state the size of the area counted, so these are not hairs per square centimetre. The two groups started from different counts. [24]
Advantages
Trade-offs
- No placebo group, and no comparison with the 5% minoxidil used in men's products. [24]
- The lotion's base and total oil content were not reported, so it cannot be matched to an essential oil, a shampoo or a home mixture.
- Itching increased in both groups, and the paper contradicts itself on which had more. [24]
- We found no repeat of the trial with the same lotion.
How rosemary rates on all eight criteria
- Effectiveness
- Limited signal for specific preparationsOne trial in 100 men compared a specific lotion with 2% minoxidil over six months. A simple difference between the average changes is not an adjusted result showing that one is better, and a difference that is not statistically significant cannot establish that they are equal. The lotion was not compared with 5% minoxidil.
- Evidence strength
- Limited supportOne single-blind trial against an active comparison in the evidence we selected, with no placebo group and unclear details of how the men were assigned to the groups. The area counted and the precision of the comparison are not specified well enough. Academic support and supply of the product by its manufacturer are disclosed.
- Risks and tolerability
- Tolerability versus minoxidil unresolvedItching increased in both groups. The paper's abstract and results disagree with the caption of one of its figures about which group had more itching, so a claim that rosemary is safer or causes no irritation is unsupported. No reliable figure for a lower risk can be given.
- Time
- Study time points onlyAn improvement in hair count was reported at six months. The trial does not show faster action than the core treatments, or a deadline for a personal response.
- Cost
- No comparable price yetNo US or UK price has been matched to a studied preparation. Prices of the core medicines are context only: they cannot show that a botanical costs less, or what it costs per extra hair.
- Routine
- Twice-daily lotion in the trialThe trial used a finished lotion twice a day, about 12 hours apart. That is an application routine, not one shown to be easier to keep up. The percentage of oil, the base and any conversion into drops remain unresolved.
- Maintenance
- Not established after stoppingThis six-month trial does not establish how long results last after stopping, or a tested maintenance schedule.
- Access
- Studied preparation not matched to shop productsThe current manufacturer page we found is a lead on identity, not proof that today's product matches the lot used in the trial: it lists several botanicals and mentions a later change of base. Access in the US or UK to a preparation equivalent to the trial's is unverified.
6. Pumpkin seed oil
Limited evidenceBotanical supplement · Position based on one studied capsule
Pumpkin seed oil is listed last of the three botanicals, an order that is ours. Its place in the tier rests on one trial of one product. In 76 men, a branded capsule supplying 400 mg of pumpkin seed oil a day raised hair count by 40% in the measured area after 24 weeks, against 10% with placebo. [25] The trial was small and funded by the supplier of the capsule, and we found no repeat of it.
- Use in the trial
- 4 capsules a day400 mg of oil: two before breakfast, two before dinner.
- Result in the trial
- +40% against +10%Hair count in the measured area, capsule against placebo.
- After stopping
- Not knownNo study we reviewed measured what happens next.
The headline figure needs care. It means the average hair count in a small, magnified patch of scalp was 40% higher after 24 weeks than at the start. It is not 40% more hair over the whole head, and it is not a prediction for one person.
Average rise in hair count after 24 weeks
Pumpkin seed oil capsule37 men
+40%from the start
Placebo39 men
+10%from the start
Change in the average hair count in the area that was photographed. This is not the change over the whole scalp. The trial was funded by the company that supplied the capsules. [25]
Advantages
Trade-offs
- The complete formula of the capsule was not reported, so the result belongs to that product. It does not carry over to cooking oil or to another capsule.
- Four capsules a day in the trial, two before breakfast and two before dinner. [25]
- We found no trial comparing it with minoxidil or finasteride.
- A trial this size cannot rule out rare problems or say anything about long-term use.
How pumpkin seed oil rates on all eight criteria
- Effectiveness
- Limited signal for specific preparationsIn 76 men, the reported average changes at 24 weeks were +6.2 hairs with the preparation and +1.8 with placebo, per field viewed at 60 times magnification. The 4.4 difference is a subtraction, not a reported adjusted estimate, a figure per square centimetre or a whole-head gain. No head-to-head comparison with a core medicine is established here.
- Evidence strength
- Limited supportA small placebo-controlled trial with five and seven withdrawals, handled by carrying the last measurement forward. The hair count was a secondary measure, and the area counted is not described well enough to compare with other trials. The company that funded the trial also supplied the capsules and held the allocation codes. The authors declared no conflict of interest.
- Risks and tolerability
- Safety data from one small trialItching was reported by one participant in each group and abdominal discomfort by one participant taking the preparation. The data are too limited for a full estimate of how often side effects occur. A small, short trial cannot establish zero risk, or the safety of a different formula.
- Time
- Study time points onlyThe main comparison cited was made at 24 weeks. Nothing supports a faster response than the core medicines or the other botanicals.
- Cost
- No comparable price yetNo US or UK price has been matched to a studied preparation. Prices of the core medicines are context only: they cannot show that a botanical costs less, or what it costs per extra hair.
- Routine
- Four capsules a day in the trialThe trial used four capsules a day, split across two meals. The reported 100 mg of pumpkin seed oil per capsule is not the total weight of the capsule. This routine applies to that preparation, not to any pumpkin seed oil capsule or to cooking oil.
- Maintenance
- Not established after stoppingThe 24-week study does not establish an effect that lasts after stopping, or a long-term safety schedule.
- Access
- Studied preparation not matched to shop productsThe full composition of the trial lot was not reported, and we could not recover it. We found a Korean product registry entry with a matching name and date. It is only a lead on identity and does not connect the trial to a current US or UK product.
Which one fits your situation
A ranking gives an order. It does not know what you have already tried, what you are willing to do every day or whether you want to involve a prescriber. These starting points may help you decide which section to read first.
You would rather use something on the scalp
MinoxidilAfter checking that the product fits your situation, choose one form, solution or foam, and follow its label. The two are alternatives, not two things to stack. Foam and liquid compared.
You are open to a prescription
Finasteride, or dutasterideDiscuss finasteride and its risks with a prescriber. Dutasteride is a possible alternative in the right context. This page does not recommend taking the two together and gives no switching schedule. Finasteride and dutasteride compared.
You are thinking of combining two
Finasteride with minoxidilFinasteride tablets with minoxidil solution on the scalp have direct combination evidence, with limits: foam was not a verified arm of those studies, we could read only the published summary of the main trial, and product labels keep their own rules on combined use. That result does not carry over to every compounded mixture. Minoxidil and finasteride together.
You prefer a botanical
Saw palmetto, rosemary, pumpkin seed oilCompare the exact preparation and the weaker evidence before choosing. A preference for natural options changes what you look at. It does not raise the evidence, and several botanicals together are not a proven stack.
The hair loss is sudden, patchy or painful
An assessment firstThis ranking is not the place to start. See the types of hair loss before any product.
Educational examples, not personal prescriptions.
On combining, the routines page sets out what goes together and what is an alternative.
If you would rather answer a few questions and be pointed to the relevant part, take the hair questionnaire. It does not diagnose hair loss or prescribe anything.
How we rank
Every ingredient is read against the same eight criteria. They answer different questions, so a treatment can do well on one and still need a more careful decision because of another.
- Effectiveness
- What benefit was shownThe benefit shown against a named comparison, in a stated group of people, over a stated time.
- Evidence strength
- How solid that evidence isHow much weight the evidence can carry, and what limits it.
- Risks and tolerability
- What can go wrongSide effects, warnings and unknowns. Counts keep their group size and follow-up.
- Time
- How long it takesWhen studies measured results and what product labels say about reviewing progress.
- Cost
- What it costsDepends on the country, the date and the exact product. Where no comparable price exists, we say so.
- Routine
- What the routine involvesWhat using it involves day to day.
- Maintenance
- What happens if you stopWhat is known about continued use and about stopping.
- Access
- Whether you can get itWhether the exact form is authorised and available, and where.
The same eight criteria for every ingredient. They are read together and never added up into a number.
Cost and convenience cannot make up for missing evidence or hide a risk. Commission, sponsorship and whether we can link to a product are never inputs to the ranking. The full method is on the methodology page.
What could change the order
The order is reopened when new evidence could change the balance of benefit and risk for an ingredient. One more paper on its own is not a reason to reorder.
Minoxidil and finasterideCore option
Evidence that can be compared like for like and shows which of the two works better, or long-term comparisons of the benefits and harms that matter to patients.
DutasterideConditional alternative
Longer-term evidence on how its benefits and risks compare, for the people and the country concerned.
Saw palmetto, rosemary and pumpkin seed oilLimited evidence
An independent, well-controlled trial of the same identified preparation in men with pattern hair loss. A trial against one of the core medicines would say more than percentages taken from unrelated studies.
What this ranking leaves out
It covers six ingredients for adult male pattern hair loss. It is not a ranking for women or children, and it does not cover other kinds of hair loss.
- Procedures and devices
- Listed separatelyMicroneedling, light devices and PRP are not ingredients. Microneedling with minoxidil.
- Vitamins and minerals
- A deficiency questionCorrecting an assessed deficiency is different from treating pattern hair loss. Vitamins for hair loss.
- Hair care and coverage
- A different aimThey address breakage, manageability or appearance, not regrowth. See them in the library.
- Multi-ingredient formulas
- Assessed as a wholeA result belongs to the whole formula, never to one ingredient inside it.
We cover vitamins, iron, zinc and biotin and microneedling on separate pages.
For the wider picture, including what male pattern hair loss is and how to build a routine without adding everything, read the full guide.
