Medical Therapy for Male Pattern Baldness
Medical therapies are useful in the prevention and treatment of male pattern hair loss, particularly in the early stages of the balding process. These medical therapies work to thicken hair in areas that are thinning (miniaturized hairs). There are currently two FDA-approved medications approved to treat androgenetic alopecia, namely finasteride and a minoxidil topical formulation, and have to be continually used to exert and maintain its effects. Hair loss returns when you stop either of these medicines.
Finasteride works by specifically inhibiting an enzyme known as 5-alpha-reductase, which converts testosterone into a more potent androgen dihydrotestosterone (DHT). It is DHT that shrinks or “miniaturizes” the hair follicle, which eventually leads to baldness known as male pattern baldness or androgenetic alopecia. When finasteride is taken at a dose of 1mg daily, the DHT levels in the scalp are lowered by as much as 60%. This reduction in DHT has been proven to stop the progression of hair loss in 86% of men taking the drug during clinical trials. In addition 65% of trial participants had increased hair growth.
The American Hair Loss Association recommends finasteride as the first line treatment for men interested in treating their male pattern baldness.
Although side effects are generally uncommon, reduced libido or erectile dysfunction have been reported in less than 1 in 50 patients. Your dermatologist may discuss with you the pros and cons and potential side effects before starting such treatment.
Minoxidil 5% in solution or foam can be directly applied to the affected scalp to help stimulate follicles where hairs are thinning and is thought to work through increasing the blood circulation to the applied area of the scalp. It is less effective than oral finasteride but can help to slow hair loss for many men, and some men grow new hairs. For those undergoing hair transplantation, topical minoxidil is helpful for reducing “shock” loss.
Side effects with topical minoxidil are generally uncommon, causing scalp irritation in individuals with a sensitive scalp.