The last two years changed how a lot of people start this process. AI photo tools showed up that can tell you your Norwood stage before you’ve even spoken to anyone. Telehealth platforms got cheaper and started offering combinations that used to require a derm visit. And the OTC supplement market ballooned to the point where it’s genuinely hard to tell what’s worth buying. So the old advice, “just ask your doctor,” still holds, but now there’s a lot of ground to cover before you even get to that room.
I went through this myself. My hairline started shifting around the temples about eighteen months ago. What followed was a messy few weeks of browser tabs, contradictory Reddit threads, and one telehealth quiz that felt more like a sales funnel than a medical intake. Here’s how I eventually organized it into a real decision, and the five things that actually moved the needle.
1. Figuring Out Where You Actually Stand: Norwood Staging
Before you spend a dollar, you need to know what you’re dealing with. A Norwood 2 and a Norwood 5 are not the same situation, and the treatment choices differ accordingly. A Norwood 2 might respond well to minoxidil alone. A Norwood 5 is probably having a different conversation.
Getting a professional classification historically meant booking a dermatologist appointment. That’s still the gold standard. But most people don’t do it right away, and I get it. The lag time, the cost, the awkwardness of showing up to talk about your hair.
What I found more useful as a first pass: HairLine AI. It’s a browser tool, no account, no payment. You upload a photo or use your webcam, and it runs your image through a vision model built on Google’s Gemini technology, detecting the shape and recession patterns of your hairline to classify your Norwood stage. It also spits out a rough graft count and transplant cost range if you’re that far along.
It does not prescribe anything. It is not a doctor. But as a neutral starting point, it does something genuinely useful: it takes your vague worry and gives it a name and a number. That alone changes the quality of the conversation you have with any clinician or telehealth provider afterward. You walk in knowing roughly what stage you’re at, which makes it harder for anyone to upsell you.
One honest note: an AI estimate of your Norwood stage is a guide, not a diagnosis. Lighting, photo angle, and hair length all affect it. Confirm with a real clinician before committing to any significant treatment plan.
2. The Two Treatments That Actually Have Evidence Behind Them
Here’s the short version. Finasteride and minoxidil are the two options with real clinical backing for androgenetic alopecia. Everything else is supplementary at best.
Minoxidil started as an oral blood pressure drug. The topical version has been OTC since the 1990s. You can buy generic topical minoxidil for under $15 a bottle at most pharmacies. It works by extending the growth phase of hair follicles. Oral minoxidil, at low doses, is gaining traction as an off-label option and several telehealth platforms now offer it.
Finasteride is prescription-only. It works by blocking DHT, the hormone primarily responsible for pattern hair loss in men. It’s effective, but a minority of users report sexual side effects. That’s a real consideration, not a reason to avoid it automatically, but something to discuss with a clinician honestly.
Both require ongoing use. Stop either one and the hair loss resumes within months. That’s not a flaw in the treatment. It’s just how it works, and anyone who doesn’t tell you that upfront is glossing over something important.
3. Choosing a Telehealth Platform: Hims vs. Keeps
If you’re going the online prescription route, these two come up constantly. They serve the same basic need but differ in meaningful ways.
Hims is the widest option I found. It’s the only major platform currently offering topical finasteride, which appeals to people who want to minimize systemic absorption. It also offers oral finasteride, oral and topical minoxidil, and combination packages. The branding leans lifestyle, which some people find off-putting, but the clinical offerings are genuinely broad.
Keeps is more narrowly focused on hair loss specifically, which shows in how their intake process is structured. Their three-month supply plans tend to come out cheaper than month-to-month, and shipping runs around $5. They offer finasteride and minoxidil in standard forms. Less flashy than Hims, which I personally found reassuring.
Both require a brief clinician review before prescribing. Neither replaces a dermatologist, but for standard androgenetic alopecia in otherwise healthy adults, they’re a practical starting point.
4. When You Need a Custom Prescription Compound
Standard finasteride and minoxidil don’t work for everyone, or some people tolerate one but not the other. Happy Head sits in an interesting niche here. They specialize in custom topical compounds, essentially personalized prescription formulas mixing active ingredients at specific concentrations. That means a clinician there is actually adjusting the formula based on your situation rather than handing you a standard dose.
It costs more than a Keeps or Hims subscription. Expect to pay in the $50 to $80 per month range depending on the formula. Worth it for some people, unnecessary for others starting fresh.
If you want the transplant clinic background behind your Rx service, BosleyRx carries that heritage. Their parent brand built its name in surgical hair restoration, and that context comes through in how they frame treatment.
5. What to Do If You’re a Woman, or If You’re Not Sure Rx Is Right Yet
Women’s hair loss often gets underserved in this conversation. Androgenetic alopecia affects women too, and finasteride is generally not recommended for women of childbearing age. Minoxidil, including the OTC topical version, is FDA-approved for women at 2% concentration.
Keranique is a women-focused OTC line built around 2% minoxidil. It’s not dramatically different from generic minoxidil in its active ingredient, but the formulation and application system are designed for women’s hair and scalp needs.
For anyone, man or woman, not ready to go prescription yet, the honest short list of evidence-adjacent OTC approaches is: topical minoxidil, ketoconazole shampoo (some evidence for DHT-related scalp inflammation), and derma-rolling to improve topical absorption. Supplements like biotin are popular and largely harmless, but there’s limited evidence they do much for pattern hair loss specifically unless you have a documented deficiency.
The Short Version of How I’d Do This
Start with an objective read on your stage, something like HairLine AI gives you, before opening any telehealth intake form. Then decide whether standard finasteride and minoxidil through Keeps or Hims covers your situation. If you want a custom compound, look at Happy Head. If you’re a woman or not going prescription yet, start with OTC minoxidil and see a dermatologist sooner rather than later. The telehealth platforms are convenient, but a real derm visit, especially if you’re not seeing results after six months, is worth scheduling.
Common Questions
Does it matter which Norwood stage you are before choosing between Hims and Keeps?
Not in the way you might expect. Both platforms cover early-to-mid-stage androgenetic alopecia with the same core medications. Where staging matters more is deciding whether you need prescription treatment at all. A Norwood 2 caught early has options a Norwood 5 does not, and knowing your stage before the intake form helps you ask sharper questions.
If HairLine AI gives you a Norwood number, can you just hand that to a Keeps or Hims clinician and skip the intake?
The intake still happens regardless. What the AI estimate does is give you a starting reference point so you’re not going in blind. Telehealth clinicians do their own assessment based on photos you submit through their platform, and they may reach a different classification depending on the images provided.
Why would someone pay $50 to $80 a month for Happy Head when generic minoxidil costs under $15?
Generic minoxidil is a fixed formula at a standard concentration. Happy Head’s compounded topicals let a clinician adjust active ingredient ratios, which matters if you’ve already tried standard doses without results or if you’re reacting poorly to a particular formulation. The price gap is real, and it’s only worth it if you have a specific reason a standard product isn’t working.
Is Keranique actually different from just buying generic 2% minoxidil at a drugstore?
The active ingredient is identical. The difference is in the delivery system, the applicator, and the supporting products in the line, which are formulated for finer hair textures common in women experiencing thinning. Whether that’s worth the price premium over generic depends entirely on how important the application experience is to you personally.
How long do you actually have to use finasteride or minoxidil before knowing if they’re working?
Most clinicians say give it at least six months before drawing conclusions. Hair growth cycles are slow, and shedding in the first few weeks of minoxidil use is normal and temporary. Expecting visible change at the two-month mark is a common reason people quit too early, before the treatment has had a fair run.
Sources
- American Academy of Dermatology, clinical recommendations on treating hair loss (aad.org)
- National Institutes of Health, MedlinePlus: finasteride and minoxidil entries
- Keeps, Hims, Happy Head, BosleyRx, and Keranique official product pages (pricing and formulation details)
- Journal of the American Academy of Dermatology: published studies on oral low-dose minoxidil (publicly indexed via PubMed)
