What are the treatment options for androgenetic alopecia causing a receding hairline?

From the Guidelines

Treatment for androgenetic alopecia causing a receding hairline should prioritize a combination of FDA-approved medications, such as minoxidil and finasteride, alongside newer treatments like platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) injections, with the goal of maintaining existing hair and potentially regrowing lost hair, as evidenced by recent studies 1.

Medication Options

• Minoxidil (Rogaine) is applied topically as a 5% solution or foam once or twice daily to the affected areas, working by prolonging the growth phase of hair follicles and increasing blood flow.
• Finasteride (Propecia) is taken orally at 1mg daily and works by blocking the conversion of testosterone to dihydrotestosterone (DHT), which is responsible for miniaturizing hair follicles.

Procedure Options

• Hair transplantation surgery can permanently restore hair by moving DHT-resistant follicles from the back of the scalp to the receding areas.
• Low-level laser therapy devices used for 15-30 minutes several times weekly may provide modest benefits by stimulating cellular metabolism in follicles.
• PRP or PRF injections administered every 3-6 months have shown promise in treating androgenetic alopecia, with PRF potentially offering a safer and more effective alternative to PRP, as suggested by recent research 1.

Assessment and Monitoring

• Treatment response can be assessed using various methods, including photography, trichoscopy, hair counts, hair diameter measurement, pull test, patient self-assessment questionnaire, trichogram, and global physician assessment, as outlined in studies 1.
• Regular monitoring and adjustments to the treatment plan can help optimize outcomes and minimize side effects.

Side Effects and Considerations

• Side effects vary by treatment: minoxidil may cause scalp irritation, finasteride can potentially cause sexual side effects in some men, while surgical options carry risks of infection or scarring.
• Newer treatments like PRP and PRF injections have shown promise, but more research is needed to fully understand their efficacy and potential side effects, as noted in studies 1.

From the FDA Drug Label

Minoxidil topical solution 5% is not intended for frontal baldness or a receding hairline.

The FDA drug label does not answer the question.

From the Research

Treatment Options for Androgenetic Alopecia

The treatment options for androgenetic alopecia causing a receding hairline include:

• Medical treatments:
  • Topical minoxidil 2, 3, 4, 5
  • Oral finasteride 2, 3, 4
• Surgical treatments:
  • Follicular unit transplantation 4
  • Follicular unit extraction 4
• Low-Level Light Therapy (LLLT) 2, 3
• Alternative treatments:
  • Biotin 6
  • Caffeine 6
  • Melatonin 6
  • Marine extract 6
  • Zinc 6

Efficacy of Treatments

Studies have shown that:

• Minoxidil, finasteride, and low-level laser light therapy are effective for promoting hair growth in men with androgenetic alopecia 3
• Minoxidil is effective in women with androgenetic alopecia 3
• Combination therapy of LLLT and minoxidil may be more effective than individual treatments 2
• Medical treatment should be used in conjunction with surgery to achieve a synergistic effect 4

Mechanism of Action

The mechanism of action of minoxidil in the treatment of androgenetic alopecia is likely mediated by mitochondrial adenosine triphosphate synthase-induced stem cell differentiation 5