Hair Loss Treatment and Male Pattern Baldness Medicine | Dermatology Education Hair Loss Treatment and Male Pattern Baldness Medicine Video
December 14, 2018

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Hair Loss Treatment and Male Pattern Baldness Medicine

There are two FDA-approved medical therapies for male AGA. The first to be approved was minoxidil, first as a 2% solution and subsequently as a 5% solution. In my experience, 2% minoxidil is ineffective in men and 5% minoxidil grows cosmetically acceptable hair in only a small subset of males (< 10%). These responders are likely to be young men, with recent onset of male AGA and only mild thinning. A typical patient with response to 5% minoxidil would be a college-age man with mild recent vertex thinning. In this typical responding patient the response to 5% minoxidil may be short lived, lasting for only a few years. A 1 mg tablet of Finasteride, brand name Propecia, taken daily is an effective oral therapy for androgenetic alopecia in men. Finasteride blocks 5 (alpha)-reductase type II which inhibits the conversion of testosterone to dihydrotestosterone and decreases serum and cutaneous dihydrotestosterone concentrations. This slows further hair loss, inhibits androgen-dependent miniaturization of hair follicles and improves hair growth and hair weight in men with androgenetic alopecia.

Efficacy is usually evident within 6-8 months months of therapy. Response can be defined as either no further hair loss of hair regrowth. In the 2 year data, approximately 65% of patients had no disease progression and 15% of patients had improvement. The drug produces progressive increases in hair counts at 6 and 12 months. Therapy leads to slowing of further hair loss. Finasteride is effective in men with vertex male pattern hair loss and hair loss in the anterior/mid area of the scalp. It may not be effective for men who are over 60 years of age because type 2 5(alpha)-reductase activity in the scalp may not be as high as in younger men.

Approximately 20% of men do not respond at the end of one year and therapy should be discontinued. Treatment must be continued indefinitely to maintain the benefit. In the first year, under 2% of men report side effects related to sexual dysfunction, which resolved both after discontinuation and spontaneously in many men who chose to remain on drug treatment. Serum prostate-specific antigen levels are not effected by the 1 mg dose of finasteride in men under 40. Finasteride decreases serum prostate-specific antigen levels by about 50% in older men.