What are the treatment options for hair loss due to androgen resistance?

From the Guidelines

Treatment for hair loss due to androgen resistance should prioritize platelet-rich plasma (PRP) injections combined with topical minoxidil, as this combination has been shown to be the most effective treatment modality 1.

Overview of Treatment Options

Treatment options for hair loss due to androgen resistance include both medical and surgical approaches.

• Finasteride (1mg daily) and minoxidil (5% solution applied twice daily) are first-line medications.
• Finasteride works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), which is responsible for hair follicle miniaturization, while minoxidil promotes blood flow to the scalp and extends the growth phase of hair follicles.
• For women, spironolactone (50-200mg daily) can be effective as it blocks androgen receptors.
• Low-level laser therapy devices used 3-4 times weekly may stimulate hair follicles.
• Platelet-rich plasma injections administered every 3-6 months can promote growth factors in the scalp.
• For more permanent results, hair transplantation surgery relocates DHT-resistant follicles from the back of the scalp to thinning areas.

Efficacy of PRP and PRF

Studies have shown that PRP combined with topical minoxidil is the most effective treatment modality, while PRP alone and topical minoxidil alone are more effective than placebo 1.

• PRP monotherapy was more effective than minoxidil monotherapy in most studies, although some studies found them to be equally effective.
• Minoxidil was shown to be better tolerated than PRP, due to the pain incurred during PRP injections.
• Platelet-rich fibrin (PRF) has also been proposed as a treatment option, with some studies suggesting it may have a greater potential to regenerate hair than PRP due to its longer release of growth factors 1.

Recommendations

It is recommended to start treatment early, as these interventions are more effective at preventing further loss than regrowing hair.

• Consistency is crucial, and most treatments require 6-12 months before noticeable improvement occurs.
• Regular follow-ups with a dermatologist are recommended to monitor progress and adjust treatment as needed.
• The choice of treatment should be individualized based on the patient's specific needs and medical history.
• Further research is needed to fully understand the efficacy and safety of PRF compared to PRP.

From the FDA Drug Label

Minoxidil topical solution 5% will not improve hair loss due to: • damage from the use of hair care products which cause scarring or deep burns of the scalp. • hair grooming methods such as cornrowing or ponytails which require pulling the hair tightly back from the scalp.

The treatment options for hair loss due to androgen resistance are not explicitly mentioned in the provided drug labels. However, minoxidil topical solution 5% may be used to treat hair loss in men, but its effectiveness for androgen resistance is not directly stated.

• Key points:
  • Minoxidil topical solution 5% is for use only by men.
  • It is used to help regrow hair on the scalp.
  • Results may be seen as early as 2 months with twice daily use.
  • It is unlikely to grow back all hair.
  • It may not work for everyone. 2

From the Research

Treatment Options for Hair Loss due to Androgen Resistance

• The treatment options for hair loss due to androgen resistance include medications such as finasteride and minoxidil, which have been scientifically shown to be useful in the treatment of hair loss 3.
• Low-level laser light therapy is also an effective treatment for promoting hair growth in men with androgenetic alopecia, and minoxidil is effective in women with androgenetic alopecia 4.
• Platelet-rich plasma (PRP) is a promising treatment for hair restoration in patients with androgenic alopecia, and can be used alone or in conjunction with topical and oral therapies 5, 6.
• Phototherapy with low-level energy lasers is also available as a treatment option for androgenetic alopecia 6.
• Subcutaneous injections of autologous platelet-rich plasma into the scalp represent an interesting alternative treatment for androgenetic alopecia, as monotherapy or as an adjuvant treatment 6.

Efficacy of Treatment Options

• A systematic review and meta-analysis found that minoxidil, finasteride, and low-level laser light therapy are effective for promoting hair growth in men with androgenetic alopecia, and that minoxidil is effective in women with androgenetic alopecia 4.
• A randomized controlled trial found that low-level laser therapy combined with topical 5% minoxidil was not significantly more effective than topical 5% minoxidil alone in improving hair density in patients with androgenetic alopecia 7.
• Most studies of hair restoration with PRP report positive outcomes, but further research is needed to optimize PRP preparation and administration procedures and to identify patient populations that benefit most from this treatment 5.