treatment of androgenetic alopecia in men

Last edited 03/2022 and last reviewed 08/2023

Treatment options in male androgenetic alopecia include:

  • wait and see method - some patients prefer not to do anything and accept the cosmetic outcome (1)
  • pharmacotherapy - topical or systemic drugs

    • topical solution - minoxidil 2% or 5% solution
    • mechanism of action is unknown
      • is thought to increase the duration of anagen phase
      • noticeable hairgrowth is seen 4 months after initiation of therapy
      • 5% solution is shown to be more effective than the 2% solution
      • discontinuation of treatment for a few months results shedding of hair slowly
      • transient and self-limiting telogen effluvium may be seen 3 to 5 weeks after initiation of therapy and patients should be adivised to continue therapy despite the effect (1)

    • finasteride
      • selectively inhibits type 2 5 alpha - reductase iso enzyme ( responsible for the conversion of testosterone (T) to dihydrotestosterone (DHT))
      • FDA-approved daily oral dose of 1 mg for the treatment of male pattern baldness has been demonstrated to reduce concentrations of DHT in scalp significantly, where type II 5alpha-reductase is also the predominantly (but not exclusively) expressed isozyme
        • in many, but not all, men, hair loss is halted by finasteride treatment and in some men, there is noticeable hair regrowth within two years of treatment uptake
        • 1 mg daily oral treatment is well tolerated by patients, with rare side effects that may include some loss of libido and erectile function
        • as for minoxidil, cessation of treatment recommences the balding process, indicating that the effects of finasteride are not curative
      • improves the terminal-to-vellus hair ratio in a scalp by inhibiting or reversing miniaturization of hair follicle
      • after discontinuation of therapy the hair loss progresses, therefore should be taken long term on daily basis (1)
      • rare reversible adverse reactions include - erectile dysfunction, loss of libido, a small volume of ejaculate or gynecomastia (2)
    • dutasteride
      • a dual 5alpha-reductase, has been used for the treatment of male androgenetic alopecia
        • evidence shows that dutasteride seems to provide a better efficacy compared with finasteride in treating an drogenetic alopecia. The two drugs appear to show similar rates of adverse reactions, especially in sexual dysfunction (3)

    • hair transplant

    • cosmetic aids
      • wigs and hairpieces

Note:

  • neither minoxidli nor finasteride restores all the lost hair or reverse total baldness (1)
  • analysis of 23 trials indicate 5mg/d oral dutasteride has highest probability of being most efficacious treatment, followed by (in decreasing order of efficacy): 5mg/d oral finasteride (OF), 5mg/d oral minoxidil (OM), 1mg/d OF, 5% topical minoxidil (TM), 2% TM, & 0.25mg/d OM (4)

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