Hair Loss Treatment

Hair loss treatments are available for androgenic alopecia (male pattern balding). All of the following treatments have been approved by the FDA and recommended by the American Hair Loss Association (AHLA).

It should be noted that many additional products or procedures are advertised for the treatment of androgenic alopecia, such as vitamins, trace elements, herbs, amino acids, scalp massage, etc. But, most of these products or procedures have never been verified in sound clinical trials. Treatments can be broken down into two broad categories: medicinal treatments and surgical treatments.

Medicinal Hair Loss Treatment

Only two medications are currently approved by the FDA for treatment of male pattern balding: finasteride (brand name Propecia and Proscar) and minoxidil (brand name Rogaine).

Finasteride (aka Propecia or Proscar)²

Finasteride is a 5-alpha reductase inhibitor. 5-alpha reductase is an enzyme that reduces testosterone into Dihydrotestosterone (DHT). While DHT provides certain benefits, it plays a very important role in the development and progression of prostate enlargement (BPH), and it is the primary cause of male pattern baldness (MPB). Specifically, DHT shrinks the hair follicles causing an eventual loss of hair in a specific pattern.

As a 5-alpha reductase inhibitor, finasteride inhibits the conversion of testosterone into DHT. One milligram of finasteride lowers DHT concentrations by nearly two-thirds. As a result, it treats both benign prostatic enlargement and male pattern baldness. Below are more details^1-2:

• A 5-alpha reductase inhibitor that is taken orally.
• Decreases and/or stops hair loss and may cause regrowth in affected areas.
• More effective at the vertex of the scalp than in the frontal areas.
• Must be used indefinitely (if treatment is stopped, loss of hair will slowly resume).
• One milligram of finasteride was shown in one study to provide better improvements in men greater than 30 years old and in men with worse balding; the efficacy was not reduced with length of baldness.

The AHLA recommends finasteride as the first line of hair loss treatment for all men interested in treating their male pattern baldness.

Minoxidil (aka Rogaine)³

Minoxidil is a vasodilator. That is, it widens blood vessels. Originally, it was used solely as an antihypertensive medication in pill form because of its ability to widen blood vessels and thus reduce blood pressure. Later, it was shown to regrow hair when applied topically. As a result, it became the first drug approved by the FDA for hair loss treatment under the brand name Rogaine. While the exact mechanism of action is unknown, it is thought to stimulate blood vessel dilation and consequently hair growth in affected areas. Now off-patent, it is available over-the-counter. Below are more details^4-8:

• Available as a liquid or foam that is used topically at the area(s) of hair loss.
• Decreases and/or stops hair loss and may cause regrowth in affected areas.
• More effective at the vertex of the scalp than in the frontal areas.
• More effective in younger men than older men.
• Males with < 5 years balding show significantly better effects than those with balding > 21 years.
• Takes at least 4 months for effects to take place.
• Must be used indefinitely (if treatment is stopped, loss will resume rapidly).
• Available in 5% and 2% formulations, with 5% formulation being more effective in men.
• Minimal systemic side effects in men.

The AHLA does not recommend minoxidil as the first line of hair loss treatment for men suffering with male pattern baldness. However, it does recommend the drug for those who have not responded favorably to finasteride treatment or for those who would like to add another product to their regimen.

Other Medical Therapies

Other medical therapies currently under evaluation as potential hair loss treatments include Dutasteride (another 5-alpha reductase inhibitor), Latanoprost 0.1% (a prostaglandin analog used for glaucoma and for stimulating eyelash growth marketed as Latisse), and low-level laser light therapy among others. Some of these therapies have shown promise in treating male pattern baldness.⁹ If you are interested, please discuss these and other potential therapies with your physician or other medical profession prior to initiating treatment.

Surgical Hair Loss Treatment

Surgical hair transplant procedures have been around for over 40 years. During a hair transplant, the patient’s own hair is transplanted from one site on the scalp to the balding site. The donated hair, hair follicles, surrounding tissue, and skin are grafted into tiny slits that the surgeon creates with his or her surgical tools. Newer surgical techniques, known as micrografting procedures, produce a more natural look than older plug transplants. Transplants have become smaller and smaller to the stage that single hairs of follicular units are presently grafted. The goal, of course, is to cover the balding area with enough follicles to effectively produce the appearance, feel, and resilience of naturally growing hair.

For more information on the availability, cost, and appropriateness of a hair transplant, please consult your physician or other medical professional.

External Resources: American Hair Loss Association