What are side effects of alopecia treatments?

Alopecia treatments can help slow hair loss, stimulate new growth, or even reverse bald patches. But like any medical therapy, they carry potential side effects. Understanding these risks—without unnecessary alarm—lets you balance benefits and drawbacks, and talk with your doctor about what’s best for you.

You might also consider doing a free, online “symptom check for Alopecia Areata” to better understand your symptoms and next steps.

1. Topical Minoxidil

Minoxidil (Rogaine) is a first-line, over-the-counter option for many types of hair loss.

Common side effects:

• Skin irritation: redness, itching, burning or dryness at the application site
• Contact dermatitis: an allergic reaction causing rash or swelling
• Unwanted facial/body hair (hypertrichosis) if the solution spreads or drips
• Temporary shedding: some users see a brief increase in hair fall during the first few weeks

Rare systemic effects (when absorbed in higher amounts or via broken skin):

• Rapid heartbeat (tachycardia)
• Dizziness or lightheadedness
• Fluid retention (swelling of hands/feet)

What to do:

• Use only on dry, intact scalp skin.
• Apply as directed—don’t exceed recommended dose.
• If you develop chest pain, faintness, or severe swelling, stop treatment and speak to a doctor immediately.

2. Oral 5α-Reductase Inhibitors: Finasteride and Dutasteride

Finasteride (Propecia) and dutasteride (Avodart) block the conversion of testosterone to dihydrotestosterone (DHT), a key driver of androgenetic alopecia (male-pattern baldness).

Side effects (reported in clinical trials):

• Sexual dysfunction
  • Decreased libido
  • Erectile dysfunction
  • Reduced ejaculatory volume
• Mood changes: depression, anxiety (rare but important to monitor)
• Breast tenderness or enlargement (gynecomastia)
• Changes in prostate-specific antigen (PSA) levels

Comparing finasteride and dutasteride:

• Dutasteride inhibits both type I and II 5α-reductase, making it more potent.
• Studies suggest dutasteride may offer greater hair regrowth, but sexual side effects can be slightly more frequent.
• Both drugs require daily dosing and may take 3–6 months to show visible results.

What to do:

• Discuss personal/family history of prostate cancer or depression with your doctor.
• Report any persistent sexual side effects or mood changes—some men choose to stop treatment if these issues don’t resolve.
• Women (especially pregnant women) should avoid handling oral tablets due to risk of birth defects.

3. Corticosteroids

Steroid treatments are often used for patchy hair loss (alopecia areata) and involve different routes:

Topical steroids (creams/ointments):

• Skin thinning (atrophy)
• Stretch marks (striae)
• Visible blood vessels (telangiectasia)

Intralesional injections:

• Injection-site pain or itching
• Local skin atrophy or discoloration

Oral steroids (prednisone, prednisolone):

• Weight gain, “moon face”
• High blood pressure, fluid retention
• Elevated blood sugar (risk of diabetes)
• Osteoporosis (bone thinning)
• Increased infection risk
• Adrenal suppression (need to taper off slowly)

What to do:

• Use the lowest effective potency and limit duration when possible.
• Monitor blood pressure, blood sugar, and bone density if on long-term oral steroids.
• Never stop oral steroids abruptly—always taper under medical supervision to avoid adrenal crisis.

4. Contact Immunotherapy and Other Topicals

For stubborn patchy alopecia areata, dermatologists sometimes use sensitizing agents:

Diphenylcyclopropenone (DPCP) or squaric acid dibutylester (SADBE):

• Purposeful rash (contact dermatitis) to “distract” the immune system
• Itching, redness, swelling at treated sites
• Swollen lymph nodes in the neck or behind the ears
• Rarely, widespread eczema or blistering

Anthralin (Dritho-Scalp):

• Local irritation, staining of skin and fabrics
• Burning or itching

What to do:

• Follow your provider’s schedule strictly (weekly or biweekly applications).
• Avoid overapplication—stop and call your doctor if you develop severe blistering or widespread rash.

5. Emerging and Off-Label Options: JAK Inhibitors

Janus kinase (JAK) inhibitors such as tofacitinib and ruxolitinib are showing promise, especially for severe alopecia areata. They are not yet approved in all countries for hair loss.

Potential side effects:

• Increased risk of upper respiratory or urinary tract infections
• Headache, nausea
• Elevated liver enzymes, changes in blood counts
• Lipid abnormalities (cholesterol/triglycerides)
• Potential reactivation of latent infections (TB, hepatitis)

What to do:

• JAK inhibitors require regular blood tests (CBC, liver function, lipids).
• Discuss your infection history and vaccination status with your doctor before starting.

6. Surgical Options: Hair Transplantation

Hair transplant surgery moves hair follicles from one area of the scalp to another. It’s more invasive but can yield permanent results.

Risks and side effects:

• Pain or discomfort at donor and recipient sites
• Infection, bleeding, or poor wound healing
• Scarring (linear or dot-like, depending on technique)
• “Shock loss”: temporary shedding of existing hair around transplanted grafts
• Unnatural appearance if not performed by an experienced surgeon

What to do:

• Research board-certified dermatologic surgeons or plastic surgeons with hair restoration expertise.
• Follow all pre- and post-op instructions for wound care and activity restrictions.

Balancing Benefits and Risks

Every therapy involves trade-offs. Here are questions to ask yourself and your doctor:

• How severe is my hair loss, and how much does it bother me?
• What are the chances of meaningful regrowth versus the risk of side effects?
• How long will I need to stay on treatment, and what happens if I stop?
• Are there any medical conditions (heart disease, depression, prostate issues) that make certain treatments less safe for me?

When to Seek Immediate Medical Attention

Most side effects are mild or manageable. But if you experience any of the following, stop treatment and contact a healthcare provider right away:

• Chest pain, rapid heartbeat not related to exercise
• Severe dizziness or fainting
• Signs of serious infection (high fever, severe rash, widespread swelling)
• Mood changes with suicidal thoughts
• Persistent or worsening sexual dysfunction that causes distress
• Cushingoid features or signs of adrenal crisis (weakness, abdominal pain)

Next Steps

• Consider doing a free, online “symptom check for Alopecia Areata” to clarify your symptoms and possible diagnosis.
• Keep a symptom diary—note any new side effects, when they started, and how long they last.
• Talk openly with your dermatologist or primary care doctor about any concerns.

While side effects can be unsettling, they must be weighed against the potential benefits of treating hair loss. Never hesitate to ask questions, request dose adjustments, or switch therapies if you’re not comfortable.

Speak to a doctor about any side effect that could be life-threatening or seriously impacts your daily life. Your health and well-being come first.