From the Guidelines
For androgenetic alopecia, the recommended treatment regimen combines oral finasteride 1mg daily with topical minoxidil 5% solution applied twice daily, as this combination has been shown to be safe and effective in promoting hair growth and preventing further hair loss 1. The treatment regimen should be continued long-term, as benefits typically begin after 3-6 months and will reverse upon discontinuation. Finasteride works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), which miniaturizes hair follicles, while minoxidil promotes vasodilation and extends the growth phase of hair follicles. Some key points to consider when using this treatment regimen include:
- Men should use finasteride 1mg daily, while women of non-childbearing potential may use it at the same dose (though it's off-label for women)
- Apply 1ml of minoxidil 5% solution to the affected scalp areas twice daily, ensuring the scalp is dry before application
- Side effects of finasteride may include sexual dysfunction in men, while minoxidil can cause scalp irritation or unwanted hair growth elsewhere
- Consistency is crucial for maintaining results, and patients should be advised that these medications prevent further hair loss and promote regrowth but do not completely restore lost hair To assess the response to treatment, various methods can be used, including:
- Photography: Before-and-After Photos
- Trichoscopy: involves using a specialized magnifying device called a trichoscope/folliscope to examine the scalp and hair follicles in detail
- Hair Counts: involve counting the number of hairs in a specific area of the scalp before and after treatment
- Hair Diameter Measurement: A micrometer or specialized tools can be used to measure the diameter of individual hair shafts
- Patient Self-Assessment Questionnaire: Patients may be asked to assess their own hair growth and overall satisfaction with treatment using standardized questionnaires 1.
From the Research
Treatment Regimen for Androgenetic Alopecia
The recommended treatment regimen for androgenetic alopecia using finasteride (1mg) and minoxidil (2% or 5% solution) involves a combination of these two medications.
- Finasteride, an oral medication, is taken once daily to slow down hair loss and stimulate hair growth by blocking the production of dihydrotestosterone (DHT) 2, 3.
- Minoxidil, a topical solution, is applied to the scalp to stimulate hair growth and slow down hair loss. The 5% solution is considered more effective than the 2% solution, and it can be applied once daily 4, 5.
Efficacy of Combination Therapy
Studies have shown that combination therapy with finasteride and minoxidil can be more effective than monotherapy in treating androgenetic alopecia 4, 6.
- A systematic review found that combination therapy with PRP and minoxidil resulted in increased hair growth and improved patient satisfaction compared to monotherapy 4.
- Another review found that combination therapy with finasteride and minoxidil can be more effective than monotherapy in treating androgenetic alopecia, but more studies are needed to confirm this 6.
Dosage and Application
The recommended dosage for finasteride is 1mg once daily, while the recommended dosage for minoxidil is 2% or 5% solution applied to the scalp once or twice daily.
- A study found that once-daily application of 5% minoxidil foam was noninferior to twice-daily application of 2% minoxidil solution in women with androgenetic alopecia 5.
- Another study found that combination therapy with finasteride and minoxidil can be effective in treating androgenetic alopecia, but the optimal dosage and application schedule are not well established 3.