Almost everything with good evidence for male pattern hair loss is either over the counter and cheap, or prescription-only. The large market in between is mostly unregulated and mostly unproven.
What Works and Needs No Prescription
Topical minoxidil 5%
The only over-the-counter treatment with a strong evidence base for androgenetic alopecia. A Pharmacy medicine, so sold from a pharmacy without a prescription. Solution or foam, same active ingredient; foam irritates less because it usually omits propylene glycol.
Needs four to six months before judging, and works only while used.
Ketoconazole shampoo
Primarily an antifungal for dandruff and seborrhoeic dermatitis, available over the counter at 1%. There is some evidence of benefit in androgenetic alopecia, and it genuinely treats scalp inflammation, which does not help hair. Reasonable as an adjunct, not as a primary treatment.
What Is Plausible but Thin
- Caffeine shampoo — laboratory evidence that caffeine counteracts some DHT effects, a long way from a shampoo left on for a minute. Unlikely to harm.
- Rosemary oil — a small number of limited studies compared it with minoxidil with broadly similar results. Interesting, heavily oversold, can irritate. Fine alongside proven treatment, not instead of it.
- Microneedling — among the better-evidenced adjuncts, particularly combined with minoxidil, but technique and hygiene matter and it increases absorption.
What Is Mostly Decoration
- Biotin — useful only if you are deficient, which is uncommon. High doses also interfere with laboratory tests including thyroid function and troponin, so tell any doctor arranging blood tests.
- Collagen — hair is keratin, and ingested collagen is digested like any protein. No good evidence in androgenetic alopecia.
- Saw palmetto — marketed as a natural DHT blocker. Weak evidence, unregulated dose, and if it works it works by the same mechanism as finasteride with less data on both efficacy and safety.
- "Hair vitamins" bundled into subscriptions — the largest share of what people spend and the smallest share of what works.
What Needs a Prescription
Finasteride and dutasteride are prescription-only, and for good reason — the MHRA introduced a patient alert card in 2024 and strengthened the warnings again in 2026 over psychiatric and sexual side effects, including that sexual dysfunction may persist after stopping.
For severe alopecia areata — an autoimmune condition, not pattern loss — JAK inhibitors such as ritlecitinib are now available, with NICE recommending NHS use. That is a specialist route via a GP referral, not something to buy online.
Where to Spend
If your budget is limited, in this order: a focused blood test to rule out a reversible cause such as low ferritin or thyroid disease; then generic minoxidil 5%; then a conversation about finasteride if you want to address the mechanism.
That is the whole evidence-based list. Everything else is optional, and most of it is optional in the way a nicer bottle is optional.