There are presently 2 FDA approved Medications for the treatments of Androgenetic Alopecia
Finasteride is the only oral medication that is FDA-approved for the treatment of male pattern hair loss in MEN ONLY. It is only available by prescription, comes in 1mg tablets and is taken once a day. Finasteride has shown efficacy in patients who had hair loss in the vertex and anterior mid-scalp area. Efficacy in the bitemporal areas has not been established. If the patient stops taking Finasteride, any benefits gained on therapy are lost over the next year. Finasteride has an excellent safety profile. Patients should not judge the results of Finasteride until after at least one year of taking the medication. Finasteride directly affects dihydrotestosterone (DHT), a key factor in male pattern hair loss in those with a genetic predisposition. Finasteride specifically inhibits Type II 5a-Reductase, the enzyme that converts testosterone to DHT, thus lowering DHT, mimicking the natural human model that does not show hair loss. Lowering DHT appears to slow further miniaturization of hair follicles and may help to thicken some of the miniaturized hairs.
Initially, 2% Minoxidil was available by prescription only, now both 2% and 5% solutions are available over-the-counter. Minoxidil has shown efficacy in patients who had hair loss in the vertex. Efficacy in the anterior scalp and bitemporal areas has not been established. If the patient stops using Minoxidil, any benefits gained on therapy is lost over the next year. The Minoxidil (in solution form) should be applied twice daily to the scalp. Patients should not judge the results of Minoxidil until after they have used the product for at least one year. It is unknown how Minoxidil causes hair growth. Studies have shown the 5% Minoxidil causes more hair growth than the 2% Minoxidil, but the side effects are also more common with the higher concentration. Side effects are primarily dermatologic: dandruff, irritation and redness of scalp, and less commonly, there may be hair growth in undesired areas.
OFF-LABEL MEDICATIONS FOR THE TREATMENT OF ANDROGENETIC ALOPECIA
- Dutasteride (Avodart)– Dutasteride is FDA approved for BPH (Benign Prostatic Hypertrophy) similar to finasteride. The dose of dutasteride is 0.5mg tablet and taken once a day. The mechanism of action is similar to finasteride in that it inhibits Type II 5a-Reductase. Dutasteride also inhibits Type I 5a-Reductase which we do not fully understand the implications. Dutasteride was approved for androgenetic alopecia in Korea, but the company stopped their studies in the United States for unknown reasons (questions that arose—a) was it no better than finasteride? b) was there side-effects that could have prevented it for approval?)
- Oral minoxidil– Minoxidil was FDA approved for oral use in the treatment of hypertension. Low dose oral minoxidil has been used to treat androgenetic alopecia, however you should discuss the side effect risks with your physician.
- Spironolactone- discuss the risks and benefits with your dermatologist
- Low Level Light Therapy– A lot of claims and very few studies.
- PRP with and without Acell- One double blind study showed no benefit. The field is lacking in studies and we need more studies. Patients should be told this is experimental and we are experimenting on them.
- Topical Finasteride- compounded by a pharmacist. Make theoretical sense it would be of benefit. Need to discuss with your dermatologist the potential side effect of exposing your spouse to the active ingredient.
- Compounded Medications– Occasionally, physicians will have the pharmacist add retinoic acid or azelaic acid to the Minoxidil solution in hopes of increased efficacy. There are no other medications on the market that can claim that their product causes clinically significant hair growth. There are other medications that have been shown to cause hair growth in dermatologic studies, however the side effect profile was too high or the results were not good enough for the companies to seek FDA approval. Be wary of the Gimmick Treatments that try to fool you into thinking that their products cause hair growth.
POTENTIAL FUTURE TREATMENTS OF ANDROGENETIC ALOPECIA
- Prostaglandin Analogs- Bimatoprost, Latanoprost, etc.
- Prostaglandin D2 antagonists
There are other medications that have been shown to cause hair growth in dermatologic studies, however the side effect profile was too high or the results were not good enough for the companies to seek FDA approval. Be wary of the Gimmick Treatments that try to fool you into thinking that their products cause hair growth.
For more in-depth information on the medical treatments for hair loss, please visit our web site at www.HairMeds.com.