Hair Thinning: How to Identify the Type and What to Ask About Treatment
Hair thinning is common in both men and women, and it has more than one cause. That matters, because an approach suited to one type may be pointless or inappropriate for another. This guide helps you recognize the main patterns, explains how the available options are regulated, and lists what to ask before starting anything. It is educational and does not replace medical advice.
Step one: identify the pattern
Gradual thinning in a predictable pattern
In men, this usually shows as a receding hairline or thinning at the crown. In women, it tends to appear as a widening part or overall thinning on top. This is pattern hair loss, also called androgenetic alopecia. It is hereditary, develops slowly over years, and is the most common type.
Sudden shedding all over
Noticeably more hair in the brush or shower, starting two to three months after a trigger, suggests a condition called telogen effluvium. Triggers include illness, surgery, childbirth, rapid weight loss, major stress, and some medications. It is usually temporary.
Smooth, round patches
Coin-sized bald patches that appear quickly point to alopecia areata, an autoimmune condition. It needs evaluation by a dermatologist.
Thinning along the hairline or where hair is pulled
Tight ponytails, braids, extensions, and similar styles can cause traction alopecia. Changing the style early is important, because long-term tension can lead to permanent loss.
Thinning with an itchy, scaly, or painful scalp
Redness, flaking, soreness, or scarring suggests a scalp condition or infection, which should be examined in person.
Thinning with other symptoms
Hair changes along with fatigue, weight change, or irregular periods may reflect a thyroid problem, low iron, or a hormonal condition. Blood tests can help identify these.
Why the type matters
Products marketed for hair loss are generally aimed at pattern hair loss. They are not designed for shedding caused by illness, patchy autoimmune loss, or scalp disease. A provider's first job is to work out which type you have, and sometimes that requires an in-person examination or lab work.
How the options are regulated
Over-the-counter topical minoxidil. Sold without a prescription as an FDA-approved product.
Oral finasteride. An FDA-approved prescription tablet for men. It is not approved for women.
Compounded topical preparations. Some telehealth services, including Nu Image, prescribe compounded topical formulas that combine several ingredients. Compounded medications are not FDA-approved and are not reviewed by the FDA for safety, effectiveness, or quality.
Supplements, shampoos, and serums. Cosmetic products and dietary supplements are not approved by the FDA, and supplements are not evaluated for effectiveness before sale.
Devices. Some laser caps and combs are FDA-cleared, which is a different standard from drug approval.
What the FDA has said about topical finasteride
In April 2025, the FDA issued an alert about compounded topical finasteride. The agency stated that no topical finasteride product is FDA-approved, alone or in combination, and that it had received reports of adverse events in people using compounded versions.
The FDA also noted that applying finasteride to the skin does not remove the risks described for the oral form, and it raised concern about accidental exposure of other people, particularly women, through contact with the product or treated skin. It advised consumers to discuss the potential risks with their provider before starting.
About NuDew® and NuDew Max®
Nu Image offers two compounded topical preparations by prescription:
- NuDew® is a spray that combines minoxidil, ketoconazole, and finasteride.
- NuDew Max® is a cream that contains those three ingredients plus dutasteride.
Both are provided only after evaluation by a licensed provider. Neither is FDA-approved. Dutasteride is not FDA-approved for hair loss in any form.
Safety points for you and your household
- Pregnancy. Women who are pregnant or may become pregnant should not use or handle products containing finasteride or dutasteride, and should avoid contact with treated skin, because of risk to a developing baby.
- Hand washing. Wash your hands after every application and let the product dry fully before contact with others, pillows, or shared towels.
- Possible side effects. Reported effects of finasteride and dutasteride include changes in sexual function and mood. Topical products can also cause scalp irritation, redness, dryness, or itching. Stop and contact your provider if you notice any of these.
- Pets. Minoxidil is toxic to cats and dogs. Keep the product and treated skin away from pets until dry.
- Other health details. Tell your provider about prostate conditions, liver disease, and all medications you take, and ask about blood donation.
Questions to ask before starting
- Which type of hair loss do I have, and how was that determined?
- Is this product FDA-approved or compounded?
- What are the possible side effects, including with topical use?
- How should I apply it, and how do I protect the people I live with?
- How will we review whether to continue?
- When would you refer me to a dermatologist?
Everyday hair and scalp care
Gentle handling helps whatever the cause. Avoid tight styles, limit high heat and harsh chemical treatments, eat a varied diet with enough protein and iron, and see a provider about sudden or patchy loss instead of waiting.
Getting an evaluation
Nu Image offers online evaluations with licensed providers. A provider reviews your history and hair-loss pattern, decides whether a prescription is appropriate, and tells you when an in-person examination is the better route.
This content is for educational purposes only and is not medical advice, diagnosis, or treatment. NuDew® and NuDew Max® are compounded prescription preparations. Compounded medications are prepared by state-licensed compounding pharmacies and are not reviewed or approved by the FDA for safety, efficacy, or quality. Prescription products require an online consultation with a licensed healthcare provider, who will determine whether a prescription is appropriate.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your physician about the risks and benefits of any treatment. Nu Image Medical may not offer the medications or services mentioned in this article.
