Medical Therapies for Male Pattern Baldness

Male Pattern Baldness Medical Therapies


In the past few decades, medicine has made remarkable strides in the treatment of hair loss. With the discovery of 5-alpha-reductace inhibitors such as Propecia and the development of surgical hair restoration, It is now feasible to stop or reduce the development of hair loss and also to replace loss hair with surgical treatment.


With that in mind, there are still a huge number of hair loss products on the market that we would consider false advertisement. They offer a tremendous solution without any evidence of really working to save you from hair loss. People might spend thousands on “snake oils”. And they are everywhere, online commercials, on the radio, on your TV. And unfortunately most of these so-called “treatments” do not work. Always do your research on a product! If the FDA and or American Hair Loss Association does not approve the product, then it is more than likely going to waste your money and time, and your hair will continue falling out. Who wants that?!


Let's look at a few that really do work.


Finasteride is the generic name for the brand drugs Propecia and Proscar. It was initially developed by Merck and was designed as a medicine to treat enlarged prostate.


As they were going through medical trials, researchers noticed an unexpected result initially considered an adverse effect: hair growth. 

Finasteride passed the trials for treatment of enlarged prostate for men, and was cleared for treatment of BPH, benign prostatic hyperplasia, by the FDA and then was eventually cleared by the FDA and came to market in the United States in December of 1997 for treatment of male pattern baldness (androgenetic alopecia) and is approved for treatment at a dosage of 1mg. Its commercial name is known as Propecia, available as an oral medication. 


Finasteride is the first oral medication with FDA approval to successfully treat male pattern baldness.


Finasteride works because of its ability to inhibit 5-alpha-reductase, the enzyme that converts testosterone right into a more powerful androgen dihydrotestosterone (DHT).

When taken daily, Propecia's 1 mg dosage of finasteride can effectively lower DHT levels in the scalp as much as 60%. DHT is responsible for reducing or shrinking the hair roots, which ultimately results in baldness. And it is this 60% decrease in DHT hitting the scalp hairs that has actually shown to prevent the progression of hair loss. The statistics suggest 86% of men will stop the progression of hair loss and 60% of men had an increase of hair growth.


Lowering DHT levels remains the main truly effective way to prevent hair loss, and propecia remains a first line recommendation by the American Hair Loss Association to treat androgenetic alopecia (male pattern hair loss).


Minoxidil (Rogaine).

If we go back a little further we find Minoxidil was the very first medicine authorized by the FDA for the treatment of male pattern baldness. For years, minoxidil (trademarked Loniten) was a main line treatment for high blood pressure. And with a similar story to finasteride, it was discovered during clinical trials that hair growth was an unexpected adverse reaction to the medication. People were growing hair in areas they did not expect to grow hair such as their cheeks and some people saw hair growth on their temples. Eventually it was tried as a topical solution applied to the head of patients with hair loss and was found to be successful in hair loss prevention and regrowth of hair to varying degrees depending on the degree of hair loss. 


And while minoxidil has been clinically shown to slow the progression of loss of hair as well as regrow some hair, the majority of experts see it as a fairly marginally efficient medicine in the battle against loss of hair. It appears to have a marginal effect due to its inability to really hit at the hormonal process that really causes hair loss.  Its effects are usually therefore disappointing to men using it and the effects last only as long as the medication is applied. It is still a recommendation by the American Hair Loss Association especially if side effects such as erectile dysfunction occur with finasteride, but it is not considered a first line agent as compared to propecia, hence we put it second in our blog here. 

So there ya have it, finasteride is the first line, and minoxidil (rogaine) is considered an effective treatment for a small percentage of its users. In other words, get a hold of your physician and discuss the risks and benefits of propecia and other treatments for hair loss before you really start losing a lot of your hair! Don’t count on rogaine over the counter alone to really make the difference.


Bear in mind that successful therapy of hair loss is significantly dependent on early intervention. It is essential to begin treatment with a reliable product as soon as you observe the onset of loss of hair. And we really encourage you to only use FDA approved medications for hair loss!


Paul Pearce M.D.

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