Is Hair Loss Treatment Lifelong? Here’s What The Data Show.

Article Summary

It can be daunting to think of hair loss treatments as a lifelong commitment. And for most cases of androgenic alopecia, this is true. However, starting treatment does not necessarily mean you must commit to a lifetime of treatment. Studies suggest that after stopping a hair loss treatment, hair loss levels converge with placebo groups (i.e., where you would’ve been having never started treatment). In other words, over the long-haul, starting and stopping hair loss treatments should never make you worse off than had you never started them. Embracing hair loss treatment as a positive aspect of self-care can transform the perception of these treatments from a lifelong burden to a beneficial part of one’s daily routine – even if just for a few years. This article delves into what happens when you quit a hair loss treatment, as well as different perspectives on the lifelong use of treatments.

Full Article

Is hair loss treatment lifelong? It can be daunting to think that’s the case, as it seems quite a commitment. But while it’s true for most cases of androgenic alopecia, lifelong hair loss treatment may not be as scary as it seems. In this article, we will delve into the effects of stopping hair loss treatments and how a shift in perspective can improve how we feel about “lifelong” hair loss treatments. 

Is Hair Loss Treatment Lifelong?

The short answer is yes: hair loss treatments must be continued, or results gained will be lost. This is at least true for most cases of androgenic alopecia (more on this below). The longer answer is that:

• This isn’t true for all hair loss cases. There are plenty of situations where hair loss treatments are only temporary, as the hair regrowth sustains even after quitting. It depends on the type(s) of hair loss.
• “Lifelong” treatments aren’t as scary as they seem. The fact that some treatments might require a lifelong commitment should never be a reason not to try that same treatment, at least today.

Let’s first look at what we know about what happens when you quit a hair loss treatment.

What Happens if I Quit a Hair Loss Treatment?

Luckily, some studies explain what happens when you quit traditional hair loss treatments like minoxidil and finasteride. There is even a study looking at what happens if you stop microneedling.

What Happens if I Quit Minoxidil?

In 1999, a study explored the implications of discontinuing minoxidil after long-term use. The study yielded intriguing results, as the group that ceased minoxidil treatment observed a period of increased hair shedding and a temporary drop in hair counts, falling below their pre-treatment levels.

Four groups of 9 men with AGA were followed over two years, with each group receiving either 2% minoxidil, 5% minoxidil, a placebo, or no treatment. The 2% and 5% minoxidil groups displayed a notable increase in hair counts after three months, which reached a plateau but remained higher than those observed in the placebo and control groups.

Approximately two years into the study, at the 96-week mark, the individuals in the 2% and 5% minoxidil groups stopped their treatments. This discontinuation is evident in the data related to hair weights, which began to decline shortly afterward (see Figure 1). Three months later, around week 108, their hair loss had fallen well below the levels seen in the placebo group, even dipping below their initial hair counts. However, by week 120, three months later, the 2% and 5% minoxidil groups had rebounded and returned to a level comparable to their baseline hair counts before the study began.

It should be noted that any excess hair shedding experienced during this transition phase is usually not a permanent condition. With time, the hair adjusts to a new equilibrium without the presence of the drug, and excessive shedding should subside, returning to pre-treatment levels.

What Happens if I Quit Finasteride?

The informational insert for Propecia, a finasteride brand, indicates that hair loss typically resumes within 3 to 12 months after stopping the medication, and hair counts may revert to pre-treatment levels. This conclusion is grounded in the results from Phase II and III clinical trials, which were crucial for the FDA’s approval of finasteride for treating androgenic alopecia.

In these trials, a subset of participants received finasteride for an entire year. Subsequently, they were unknowingly switched to a group that received a placebo (a sugar pill) during the second year, corresponding to months 12-24 of the study. The researchers closely monitored and documented changes in hair counts for these participants from the start (month 0) throughout 24 months. They then compared these changes with those who continued using finasteride throughout the study and those who consistently received the placebo.^[2]Kaufman, K.D., Olsen, E.A., Whiting, D., Savin, R., DeVillez, R., Bergfeld, W., Price, V.H., van Neste, D., Roberts, J.L., Hordinsky, M., Shapiro, J., Binkowitz, B., Gormley, G.J. (1998). Finasteride … Continue reading

What the Findings Say

The study revealed that ceasing finasteride and switching to placebo resulted in hair counts falling back to their initial levels, or even slightly below, within 12 months after stopping the medication (Figure 2).

However, there are also interesting studies that can provide information about taking a break from finasteride.

Biological Effects of Finasteride After Quitting

Because finasteride has a terminal half-life of 5-7 hours, and it takes about 4-5 days for the drug to fully dissociate from tissues, its biological effects on hormone profiles can persist for approximately 30 days after discontinuation.

In practical terms, this means finasteride can continue to have a therapeutic impact in reducing scalp levels of dihydrotestosterone (DHT) even several weeks after discontinuing the medication (see Figure 3).

Exploring Alternative Finasteride Dosing Schedules

A study investigated whether a daily dose of 1 mg was necessary to maintain hair regrowth. Initially, a group of men was placed on a daily 1 mg finasteride regimen for a year. In the second year, the men were divided into two groups: one continued to take finasteride daily, while the other group adopted a 30-days-on, 30-days-off dosing schedule.^[5]Kim, K.H., Park, S.M., Lee, Y.J., Sim, W.Y., Lew, B.L. (2020). Similar efficacy of maintenance treatment of finasteride 1 mg every other month compared with finasteride 1 mg daily in Korean men with … Continue reading

The second group used finasteride for only half the time (i.e., 6 months as opposed to 12 months), yet both groups experienced similar improvements in hair parameters during the second year.

The underlying hypothesis for this result was that finasteride’s pharmacokinetics might allow for dosing schedules that alternate monthly. This approach could potentially accommodate those who wish to reduce their drug exposure or take breaks from the medication without significantly compromising their hair gains.

What If I Need To Stop Taking Finasteride For Any Other Reason?

When pausing finasteride use for an extended period exceeding 30 days, there is a higher risk of hair loss resuming due to the dissipation of the drug’s effects on scalp DHT levels. Both clinical withdrawal studies and anecdotal reports from finasteride users support this phenomenon.

Hair loss may not immediately return for many individuals but might become noticeable around the second or third month after quitting. To maintain the benefits of the drug on hair health, it is advisable to keep the withdrawal period beyond 30 days as short as possible.

If you want to learn more about the pharmacokinetics of finasteride and how you can maximize your treatment usage, you can follow these links:

• Finasteride: How Long Does It Stay In The Bloodstream?
• Finasteride: How Long Does It Stay Active in Scalp Tissue?
• What Happens If I Stop Using Finasteride?

What Happens if I Quit Microneedling?

Currently, there is only one clinical study evaluating the effects of microneedling cessation. This study compared the effects of using minoxidil only, microneedling only, and using both minoxidil and microneedling together.^[6]Bao, L., Zong, H., Fang, S., Zheng, L.i, Y. (2022). Randomized trial of electrodynamic microneedling combined with 5% minoxidil topical solution for treating androgenetic alopecia in Chinese males … Continue reading

The study involved 71 male participants with androgenetic alopecia (AGA), divided into three distinct treatment groups:

1. 5% minoxidil applied twice daily for 24 weeks (23 participants).
2. Microneedling sessions were conducted every 3 weeks, totaling 8 treatments (23 participants).
3. A combination of both treatments over 24 weeks (25 participants).

The researchers assessed changes in hair density and diameter at three-week intervals and conducted a six-month follow-up after the final treatment.

What the Findings Say

All groups exhibited significant increases in non-vellus hair density three weeks post-treatment. Notably, the combination group showed the most substantial increase in non-vellus hair density (56.45±7.82 roots per cm²), outperforming the ~28 increase in the minoxidil group and ~32 in the microneedling group.

These findings align with earlier research, particularly a paper by Dhurat et al., highlighting microneedling’s role in enhancing minoxidil’s effectiveness.

Six-Month Follow-Up Insights

Six months after the completion of the treatments, the study revealed intriguing long-term effects:

• In the minoxidil-only group, 90% of participants lost all newly acquired hair within six months post-treatment cessation, a finding consistent with previous minoxidil research.
• Conversely, in both the microneedling-only and the combination groups, 70% of participants retained some new hair, and 20% maintained all new hair growth (referenced in Figure 4).

Figure 4 illustrates the comparative hair regrowth across the three groups during the initial 24 weeks of treatment and the subsequent 24 weeks post-treatment.

These results suggest that microneedling, alone and in combination with minoxidil, offers more durable effects on hair maintenance, even after treatment discontinuation. The sustained impact in the combination group also indicates that microneedling may enhance minoxidil’s long-term effectiveness.

In summary, while managing hair loss often requires lifelong treatment, there are instances where benefits can continue even after the cessation of certain therapies. Studies have shown that minoxidil and finasteride necessitate ongoing use to maintain hair growth, as discontinuation can reverse benefits. However, treatments such as microneedling, alone or in combination with minoxidil, have demonstrated more enduring effects, offering sustained hair maintenance even after stopping the treatment.

How Can We Change Our Mindset About “Lifelong” Hair Loss Treatments?

Changing our mindset about lifelong hair loss treatment involves embracing it as a part of routine self-care, much like daily exercise or a balanced diet. It’s about viewing these treatments not as burdensome but as an empowering step toward self-confidence and well-being. Recognizing that consistency is key to success, we can integrate these treatments into our daily routines.

Let’s take a look at some ways that we can improve our mindset about long-term treatment.

1. Let hair care become part of a daily self-care routine.

Taking care of our hair is important to our overall health and well-being. We all have a daily skincare routine to maintain our skin’s health and appearance, and we can apply the same principles to our hair care routine.

Hair loss treatments should be viewed as a constructive practice that can help preserve and enhance our natural features. Whether we choose to use topical solutions, medications, or nutritional supplements, these treatments can help us maintain the health and vitality of our hair.

By adopting this mindset, we can reframe hair loss treatment as a positive and nurturing practice that empowers us to take control of our hair’s health, just like how we care for our skin, caring for our hair can be a normal and rewarding part of our daily wellness routine.

Another perspective:

2. Starting treatment today does not mean committing to that treatment forever.

Research shows that when someone quits treatment, their hair loss will resume. Within several months, their hair will return to its state before treatment. As you can see above, minoxidil users typically experience a loss of gains within 3-6 months, with an initial excess shedding period and then a return to baseline. For finasteride users, that timeframe is often 6-12 months (or longer), and quitting microneedling can take over 6 months to lose hair gains. 

Importantly, those same studies show people are never worse off after starting and then quitting hair loss treatments. 

This is critical because it means there is little risk when trying a hair loss treatment and later withdrawing it. By doing so, hair loss is not accelerated; it simply returns to baseline after quitting. In effect, the time spent on the treatment has slowed the progress of future hair loss.

It’s significantly easier to arrest the progression of hair loss than to regrow hair. That means that when fighting hair loss, time is of the essence. We speak about this in our treatment mistakes video series, which is available for members, particularly in the videos about balding speeds.

As such, trying a treatment today does not require a lifelong commitment to that treatment. Just by giving that treatment a shot, the rate of hair loss potentially slows down. If a decision is made later to quit or taper away from that treatment, the data strongly suggest that your efforts should never make things worse in the long-run.

Do Any Hair Loss Treatments Work Permanently, Even After Quitting Them?

For some cases of telogen effluvium and alopecia areata, yes. There may be conditional situations where this might be true for scarring alopecias.

For cases of androgenic alopecia, the clinical data suggests hair loss treatments need to be lifelong. Some studies have indicated that adding microneedling to minoxidil might enhance the staying power of minoxidil’s hair gains by several months,  even 6+ months after quitting both interventions.

We talk about these phenomena in this video. Remember that the data are preliminary, so don’t quit any treatments because of that study. 

So, why not take action now and begin a regrowth protocol to put yourself in the best possible future position? Any progress made will, at the very least, slow down the progression of hair loss over time, providing benefits even without a lifelong commitment to treatment.