My hair loss treatment isn't working after 6 months: what to check before switching

Not seeing new hair after 6 months does not mean your treatment has failed. According to the Spanish summaries of product characteristics (SmPCs), finasteride 1 mg needs 3 to 6 months of daily use before hair loss stabilises, and its main aim is to stop hair loss, not to regrow a lot of hair. Topical minoxidil 5% needs at least 4 months, and how well it works differs from person to person. Before switching, a doctor checks four things: how long you have been on treatment, how consistently you have used it, what you expected to achieve and whether the diagnosis is right.

Six months is the point at which most people think about stopping or switching, so it is worth knowing what the evidence says about this stage.

Why 6 months is a tricky point

Androgenetic alopecia is the most common cause of hair loss in both men and women. According to the 2018 European S3 guideline, it affects up to 80% of Caucasian men and 42% of women, and it becomes more common with age. It progresses slowly, and the treatments with evidence behind them also work slowly.

For the two medicines authorised in Spain, the official timeframes end at exactly this point. The finasteride 1 mg SmPC says it takes 3 to 6 months of continuous daily use to see hair loss stabilise. The topical minoxidil 5% SmPC says it must be applied twice a day for at least 4 months before new hair growth is noticeable. If you are 6 months in, you are at the end of the expected window, not past it. To see how progress usually looks, read our month-by-month timeline for hair loss treatment.

First check: what you expected to achieve

Often the treatment is working, just not in the way you expected. The Spanish SmPC says finasteride "stabilises the process of androgenetic alopecia". Its main aim is to stop hair loss. If you have been losing less hair over these months and the affected area has not got worse, that already counts as a response, even if you can't see more hair in the mirror.

The trials show how big the effect is. In the studies by Kaufman and colleagues (1998), involving 1,553 men aged 18 to 41, hairs were counted in a 5.1 cm² area of the crown that started with around 876 hairs. After one year, the finasteride group had 107 more hairs than the placebo group, and after two years it had 138 more. Two points stand out: the difference is real and statistically robust but moderate, and it kept growing in the second year. Judging the result at 6 months means stopping halfway. You can read more about how finasteride works and what results it gives.

In women, the 2016 Cochrane review (47 trials, 5,290 participants) found that more women saw a moderate or marked improvement with minoxidil than with placebo: 157 out of 593 compared with 77 out of 555. This gives a relative risk of 1.93, based on moderate-quality evidence. Minoxidil improves results, but not everyone responds, and those who do don't all respond to the same extent.

Second check: consistency

The timeframes in the SmPCs assume continuous use: finasteride every day and topical minoxidil twice a day. Missing doses often, stopping for a few weeks or applying it only once a day changes the conditions under which the effect was measured. Consistency is one of the first things a doctor asks about at a follow-up appointment.

Finasteride's effect is also lost when you stop taking it. According to its SmPC, the benefit disappears within 6 months of stopping, and after 9 to 12 months you are back where you started. Giving up at 6 months because it "isn't doing anything" can backfire: you may lose what little progress you had made in slowing hair loss.

Third check: the diagnosis and the indication

Androgenetic alopecia is the most common cause, but it is not the only one. Some types of hair loss have a different mechanism and need different treatment, such as alopecia areata and how it differs from common hair loss. If the diagnosis is wrong, the treatment may not suit the problem. That is why the diagnosis is the first thing to check when the response is not what was expected.

The indication matters too. In Spain, finasteride 1 mg is authorised only for men aged 18 to 41 with early-stage androgenetic alopecia, the group studied in the trials. For anyone outside that profile, for example at more advanced stages, there is no evidence that the same results can be expected. The situation is different for women, as explained in our article on which treatments for female androgenetic alopecia have evidence and which are authorised.

If you really do need to switch: the alternatives a doctor considers

If the timeframe, consistency and diagnosis are all right but the response is still not good enough, the doctor has several options. The European S3 guideline reviews 5-alpha-reductase inhibitors (finasteride and dutasteride), minoxidil and other options. Whether to combine or replace treatments is decided case by case.

One option that gets a lot of attention is low-dose oral minoxidil. According to a review from Hospital Ramón y Cajal published in Actas Dermo-Sifiliográficas, it is used off-label, meaning it is not authorised for hair loss. The lowest doses usually need a compounded (extemporaneous) preparation made up on a doctor's prescription. Errors in preparing it are not rare and may explain some serious side effects. The reported rate of side effects in the general population is 20.6%. This is why it is not a switch to make on your own. If you want the comparison, see what trials comparing oral and topical minoxidil have found.

Key points and next steps

At 6 months, a treatment usually hasn't reached its full effect, and its main aim is to stop hair loss rather than regrow hair. Before switching, it is worth reviewing four things: time on treatment, consistency, expectations and diagnosis. In Spain, medical treatment for hair loss is available with a prior assessment, a prescription from a registered doctor where appropriate, and ongoing follow-up to make any adjustments needed. This is what AiON offers. You can:

Find out in a few minutes whether treatment is right for you