Treatment Plateaus Are Normal and Expected
Finasteride and minoxidil typically reach their maximum effect at 12-18 months. After initial improvement, every hair loss treatment eventually levels off. This plateau is not failure. It is your treatment reaching its ceiling, and understanding the difference between a healthy plateau and genuine treatment decline is essential for making good decisions about your protocol.
Step 1: Recognize What a Plateau Looks Like in Tracking Data
The Improvement Phase
During the first 6-18 months of treatment, effective therapy produces measurable changes in your tracking data:
- Finasteride (1mg daily): gradual density stabilization, then modest regrowth in 65% of users
- Minoxidil (5%): 40-60% regrowth, with visible changes starting at 4-6 months
- PRP therapy: 30-40% density increase over 3-6 months after a treatment course
Your AI tracking graph during this phase shows an upward trend or, at minimum, a halt to the previous downward slope.
The Plateau Phase
At some point, the graph flattens. Your density readings hover within a narrow range (typically less than 3% variation) month after month. This is your plateau.
Plateau characteristics in tracking data:
- Flat trend line over 3+ consecutive months
- No significant upward or downward movement
- Minor fluctuations within a consistent range
- Shedding rate stable at your new baseline
What a Plateau Is NOT
A plateau is not:
- A sudden drop in density (this suggests a new problem or treatment interruption)
- Continued gradual decline (this suggests inadequate treatment response)
- Wild swings in readings (this suggests inconsistent tracking conditions or confounding factors)
Step 2: Understand Why Plateaus Happen
Biological Ceiling
Every treatment has a maximum biological effect. Finasteride reduces scalp DHT by approximately 60-70%. Once all DHT-sensitive follicles capable of responding have responded, further improvement is not possible with that single agent. Your genetics, the extent of follicle miniaturization, and how long you have been losing hair all determine where this ceiling sits.
Hair Cycle Dynamics
Active hair growth (anagen) lasts 2-6 years for scalp hair. Once a treatment rescues a follicle, that follicle enters a growth cycle. After the initial wave of rescued follicles enters anagen, you see improvement. Once all treatable follicles have entered their cycle, the improvement phase ends and maintenance begins.
Follicle Exhaustion
Some follicles are too miniaturized to recover with medication alone. If a follicle has been producing only vellus (fine, colorless) hairs for years, medication may not reverse it to terminal hair production. These follicles define the lower boundary of your treatment response.
Step 3: Determine Whether Your Plateau Is Healthy or Problematic
A Healthy Plateau
Your plateau is normal and healthy if:
- It follows a period of measurable improvement
- Density readings are stable (not slowly declining)
- You have been on treatment for 12+ months
- The plateau level is above your pre-treatment baseline
- You are maintaining consistent medication adherence
This type of plateau means your treatment is working as intended. The goal now shifts from improvement to maintenance.
A Concerning Plateau
Your plateau may signal a problem if:
- It occurred very early (before 6 months of treatment)
- Density never improved from your pre-treatment baseline
- You see a slight downward drift within the "plateau" range
- Shedding rate has not decreased from pre-treatment levels
An early or flat plateau may indicate insufficient treatment response and warrants a discussion with your dermatologist about when to update your treatment protocol.
Step 4: Decide on Your Response
Option A: Maintain Your Current Protocol
If your plateau represents meaningful improvement over your baseline, the best response is often to continue exactly what you are doing. Stopping finasteride, for example, reverses its effects within 6-12 months. The plateau is not a sign to stop. It is a sign that maintenance is working.
This is the right choice when:
- You are satisfied with your current density
- The plateau level is above your starting point
- You tolerate your medications well
- Your tracking data shows true stability
Option B: Add Complementary Treatments
If you want further improvement beyond your plateau, discuss adding rather than switching treatments:
Add minoxidil (if only on finasteride): Minoxidil works through a different mechanism (vasodilation and follicle stimulation rather than DHT reduction). Adding 5% minoxidil can push past a finasteride plateau, producing an additional 40-60% improvement in the newly treated follicles.
Add microneedling: Dermarolling (1.0-1.5mm depth, weekly) has been shown to enhance minoxidil absorption and stimulate growth factors. Combined with minoxidil, microneedling can break through plateaus in some patients.
Add PRP therapy: PRP ($500-2,000 per session) delivers concentrated growth factors directly to the scalp. A course of 3-4 sessions may boost density by 30-40% beyond what medication alone achieves.
Add LLLT: Low-level laser therapy (650-670nm) is FDA-cleared and provides modest supplementary benefits. It works best as an addition to an existing protocol rather than a standalone treatment.
Option C: Escalate Medical Therapy
If complementary additions are not sufficient, your dermatologist may consider:
- Switching from finasteride (1mg) to dutasteride (0.5mg), which inhibits more DHT but carries a higher side effect rate
- Adding oral minoxidil at low doses (under medical supervision only)
- Adjusting dosing schedules based on your individual response
Option D: Consider Surgical Options
If you have reached your medical therapy ceiling and want additional density, a hair transplant can address areas that medication cannot recover. FUE procedures place up to 5,000 grafts per session with 90-95% survival rates. The key consideration is donor supply: safe extraction limits cap at about 45% of donor follicles, with an average of 2.2 hairs per graft.
Importantly, surgical options work best alongside continued medical therapy. Transplanted hairs are DHT-resistant, but your existing native hair still needs protection.
Step 5: Continue Tracking Through and After Any Changes
Whether you maintain your current protocol or add new treatments, consistent tracking remains essential. Use your treatment tracking tools to:
- Document the exact date and nature of any protocol change
- Establish a new baseline at the point of change
- Set a new minimum evaluation period (6 months for medication additions)
- Compare post-change trends against the plateau baseline
A plateau is a data point, not an endpoint. It tells you where you are and helps you make informed decisions about where to go next.
Track Your Treatment Response
Identifying a plateau requires consistent, objective data. If you are not currently tracking with AI-powered analysis, you may be in a plateau (or a decline) without knowing it.
Start tracking at myhairline.ai/analyze and build the data foundation you need for confident treatment decisions.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Never add, remove, or change medications without consulting a board-certified dermatologist. Treatment decisions should be made in partnership with your healthcare provider.