Androgenetic alopecia—also called male pattern hair loss or female pattern hair loss—is the most common type of hair loss in Canada, affecting 40–50% of men and women by age 50. For the first time, a panel of Canadian expertshas released consensus guidelines on how to manage this widespread condition, published in J Cutan Med Surg (2025)【Landells et al.】.
These Canadian consensus recommendations address treatment options, preferred sequences, and what does (and doesn’t) work for managing androgenetic alopecia in adult men and women.
🔎 What is Androgenetic Alopecia?
- In men, androgenetic alopecia usually presents with a receding frontal hairline and hair loss at the crown, sometimes starting as early as the teenage years.
- In women, it typically appears as hair thinning at the mid‑scalp and crown, often accelerating after menopause.
Although largely driven by genetics and hormones, other factors—such as inflammation, diet, stress, and environmental triggers—can contribute.
Hair loss can negatively affect mental health, leading to anxiety, depression, and social or professional challenges.
🇨🇦 Why These Guidelines Matter
Until now, there were no Canadian guidelines for managing male and female pattern hair loss.
Patients often turn to over‑the‑counter products, but conflicting information and a lack of high‑quality data make it hard for clinicians to give evidence‑based advice.
This new Delphi‑based consensus—developed by experts from all regions of Canada—fills that gap with practical, expert‑endorsed recommendations.
💊 Recommended Interventions for Androgenetic Alopecia
The panel reviewed 45 interventions. Treatments with >75% consensus are strongly recommended:
- Oral dutasteride
- Oral finasteride
- Oral minoxidil
- Topical minoxidil
- Platelet‑rich plasma (PRP)
- Topical finasteride
- Microneedling
Near‑Consensus (55–74%)
- Ketoconazole shampoo
- Intralesional dutasteride (must be compounded by a pharmacist)
- Low‑level laser therapy
- Aminexil (2,4‑diaminopyrimidine 3‑N‑oxide)
Not Recommended
- Adenosine
- Cetirizine
- Carboxytherapy
- Amla syrup
- Microfilament thread
- Nourkrin (cosmetic)
- Injectable minoxidil
- Caffeine
- Ceramide
- Topical herbal formulations
- Piroctone olamine shampoo/leave‑on
- Rosemary oil
- Shampoos and lotions with fermented papaya/mangosteen/caffeine
- Basic Fibroblast Growth Factor (bFGF)
- Flutamide
🧑⚕️ Preferred Treatments for
Male Pattern Hair Loss
First‑Line Therapies
- 5% minoxidil foam (twice daily)
- Oral finasteride 1 mg (once daily)
Second‑Line Therapies
- Topical 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 therapy
- Platelet‑rich plasma (PRP)
Third‑Line
- Saw palmetto
- Aminexil
- Ketoconazole topical
- Topical caffeine, botulinum toxin, topical cetirizine, mesotherapy with dutasteride
👩⚕️ Preferred Treatments for
Female Pattern Hair Loss
First‑Line Therapies
- 5% minoxidil topical
Second‑Line Therapies
- Oral spironolactone ± oral minoxidil
- Oral finasteride (or oral dutasteride) ± spironolactone
- ⚠️ Oral finasteride and dutasteride are not recommended in females of child‑bearing age.
- ⚠️ Oral finasteride may increase breast cancer risk; avoid in women with hormone‑dependent breast cancer.
Third‑Line Therapies
- Platelet‑rich plasma (PRP)
- Low‑level laser therapy
- Mesotherapy
Other options: cosmetics such as aminexil, nutraceuticals, herbal products.
📝 Key Strengths and Limitations
- ✅ Strength: A diverse, multidisciplinary panel representing all Canadian regions
- ⚠️ Limitation: Delphi consensus relies on expert opinion, which 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).