What are the treatment options for male androgenetic alopecia (male hair loss)?

From the Guidelines

Treatment for male androgenetic alopecia should prioritize a combination of FDA-approved medications, such as finasteride and topical minoxidil, alongside other interventions like platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) for optimal outcomes. The two primary FDA-approved treatments are finasteride (Propecia) 1mg daily, which blocks DHT conversion and can slow hair loss and promote regrowth in about 66% of men, and topical minoxidil (Rogaine) 5% solution or foam applied twice daily, which improves blood flow to hair follicles and stimulates growth in approximately 40% of users 1. Both medications require continuous use to maintain results, with visible improvements typically appearing after 3-6 months.

Other options include low-level laser therapy devices used 3 times weekly, and hair transplantation surgery for permanent results. Platelet-rich plasma injections administered every 3-6 months have shown significant increase in hair density, follicle diameter, and terminal hair density, with higher concentrations of platelets having a greater effect 1. However, the effectiveness of PRP can be variable, and factors such as the number of platelets, volume of PRP injected, and frequency of treatment can influence outcomes 1.

Recent studies suggest that PRF may be a promising treatment for androgenetic alopecia, with some theoretical advantages over PRP, including a longer release of growth factors and potential as a scaffold and reservoir of growth factors 1. A split-scalp study showed that using liquid-PRF during hair transplantation produced a greater retention of follicles, with a clear statistical difference after 6 months 1.

Key Considerations

• Combination therapy often yields better outcomes than monotherapy.
• Newer treatments include topical dutasteride, oral minoxidil at low doses (2.5-5mg daily), and anti-androgen medications.
• Hair loss occurs when DHT (dihydrotestosterone) binds to hair follicle receptors, causing miniaturization and eventual follicle death, which is why treatments targeting this pathway are effective for many men.
• The optimal number of PRP treatments, interval between treatment, and the amount of PRP injected per treatment still need to be assessed, with recommendations including a manual double-spin method for preparation of PRP, performing a minimum of 3–5 sessions, and using 5–7 mL PRP with 0.05 to 0.1 mL/cm2 1.

Recommendations for PRP Treatment

• Use a manual double-spin method for preparation of PRP for AGA.
• Perform a minimum of 3–5 sessions of PRP.
• 1 month interval between sessions.
• Recommended dose is; 5–7 mL PRP, using 0.05 to 0.1 mL/cm2.
• Activation of PRP is not required when it is used for AGA.
• About 1 to 1.5 million platelets per uL is the recommended concentration of platelets in PRP 1.

Given the current evidence, a combination of finasteride, topical minoxidil, and PRP or PRF injections, tailored to the individual patient's needs and response, is likely to provide the best outcomes for male androgenetic alopecia 1.

From the FDA Drug Label

Minoxidil topical solution 5% is a clear, light amber liquid medication containing 5% minoxidil for use only on the scalp to help regrow hair in men. Minoxidil topical solution 5% is for use only by men Minoxidil topical solution 5% may be appropriate for you if you are a male at least 18 years old and experiencing gradually thinning hair or gradual hair loss on the top of the scalp (vertex only, as shown). Minoxidil topical solution 5% is more likely to regrow hair in men with hair loss in the range shown.

The treatment option for male androgenetic alopecia (male hair loss) is minoxidil topical solution 5%. It is a medication that helps regrow hair on the scalp, specifically for men with gradually thinning hair or hair loss on the top of the scalp (vertex only). Key points to consider:

• Age restriction: Minoxidil topical solution 5% is for men at least 18 years old.
• Application: Apply the solution directly to the scalp, twice a day, every day.
• Results: Results may be seen as early as 2 months with twice daily use, but it may take at least 4 months for results to be seen 2.
• Effectiveness: The amount of hair regrowth is different for each person, and it is unlikely that anyone will be able to grow back all their hair 2.

From the Research

Treatment Options for Male Androgenetic Alopecia

The treatment options for male androgenetic alopecia include:

• Minoxidil: a topical or oral medication that promotes hair growth and slows down hair loss 3, 4, 5, 6
• Finasteride: an oral medication that inhibits the production of dihydrotestosterone (DHT), a hormone that contributes to hair loss 3, 4, 5, 6, 7
• Low-level laser therapy (LLLT): a non-invasive treatment that uses low-level laser or light-emitting diodes to stimulate hair growth 3, 4, 5
• Platelet-rich plasma (PRP) therapy: a non-surgical treatment that involves injecting platelet-rich plasma into the scalp to stimulate hair growth 4, 5
• Dutasteride: an oral medication that inhibits the production of DHT, similar to finasteride 4, 5, 6
• Topical finasteride: a topical formulation of finasteride that can be applied directly to the scalp 4
• Mesotherapy with dutasteride: a treatment that involves injecting dutasteride into the scalp to stimulate hair growth 4
• Botulinum toxin: a treatment that involves injecting botulinum toxin into the scalp to improve hair growth 4
• Scalp threading: a treatment that involves implanting threads into the scalp to stimulate hair growth 4

Comparison of Treatment Options

The efficacy of these treatment options varies, with some studies suggesting that:

• Dutasteride may be more effective than finasteride in promoting hair growth 4, 6
• Minoxidil may be effective in promoting hair growth, but can cause hypertrichosis and cardiovascular side effects 4, 6
• LLLT may be effective in promoting hair growth, but the evidence is limited 3, 4, 5
• PRP therapy may be effective in promoting hair growth, but the evidence is limited and the quality of the studies is generally low 4, 5

Safety and Side Effects

The safety and side effects of these treatment options also vary, with some studies suggesting that:

• Finasteride and dutasteride can cause sexual dysfunction and neuropsychiatric side effects 4, 6
• Minoxidil can cause hypertrichosis and cardiovascular side effects 4, 6
• LLLT is generally considered safe, but can cause skin irritation and other side effects 3, 4, 5
• PRP therapy is generally considered safe, but can cause pain, swelling, and other side effects 4, 5