What are the treatment options for male pattern baldness?

Treatment Options for Male Pattern Baldness

For male pattern baldness, the most effective first-line treatments are oral finasteride 1mg daily and topical minoxidil 5% solution applied twice daily, which can be used separately or in combination for optimal results. 1

First-Line Treatments

Topical Minoxidil 5%

• Mechanism: Reactivates hair follicles to stimulate regrowth
• Efficacy: Clinical trials show significant hair regrowth compared to placebo 2
• Application: Apply 1mL directly to scalp twice daily
• Onset of results: May be seen as early as 2 months, but typically requires at least 4 months 3
• Maintenance: Continuous use is necessary to maintain results; discontinuation leads to reversal of gains within 3-6 months 3
• Best for: Vertex (crown) thinning; less effective for frontal baldness or receding hairline 3
• Side effects: Temporary increased hair shedding in first 2 weeks (a positive sign), scalp irritation, folliculitis 3

Oral Finasteride 1mg

• Mechanism: 5α-reductase inhibitor that decreases scalp DHT by inhibiting conversion of testosterone to DHT
• Efficacy: Clinically significant increases in hair count after 1-2 years of treatment 4
• Dosage: 1mg daily
• Best for: Both vertex and frontal hair loss
• Side effects: Potential sexual dysfunction (erectile dysfunction, decreased libido, ejaculation disorders) that may continue after discontinuation of treatment in rare cases 5
• Contraindications: Not for use by women, especially those pregnant or breastfeeding 5

Second-Line and Adjunctive Treatments

Platelet-Rich Plasma (PRP) Therapy

• Protocol: Recommended regimen is 3-5 sessions at 1-month intervals 6
• Injection technique: 0.05-0.1 mL/cm² injected at 2-4mm depth, 1cm apart 6
• Efficacy: Studies show increased hair density and thickness, particularly when combined with minoxidil 1, 7
• Maintenance: One session every 6 months after initial treatment phase 6

Low-Level Laser Therapy

• Wavelength: 655nm devices used 3 times weekly 1
• Efficacy: Can be combined with topical treatments for enhanced results 1
• Advantage: Non-pharmaceutical option with minimal side effects 7

Dutasteride

• Dosage: 0.5mg daily (not FDA-approved for hair loss)
• Comparison to finasteride: More potent 5α-reductase inhibitor with potentially better response, especially in the frontal area 7
• Side effect profile: Similar to finasteride 7

Treatment Selection Algorithm

1. For early/mild hair loss limited to vertex:

   • Start with topical minoxidil 5% twice daily
   • Evaluate response after 4 months

2. For moderate to severe hair loss or involvement of frontal area:

   • Combination of minoxidil 5% twice daily + finasteride 1mg daily
   • Consider adding PRP therapy if no significant improvement after 6 months

3. For patients concerned about systemic side effects:

   • Consider topical finasteride 0.25% as an alternative to oral finasteride 7
   • Can be combined with minoxidil for enhanced efficacy

4. For treatment-resistant cases:

   • Consider dutasteride 0.5mg daily as a more potent alternative to finasteride 7
   • Add PRP therapy and/or low-level laser therapy

Important Considerations

• Early intervention is crucial: Treatments are more effective at arresting progression than stimulating regrowth 1
• Realistic expectations: Complete regrowth is unlikely; the goal is to slow or stop progression and achieve moderate regrowth 3
• Treatment duration: Continuous treatment is necessary to maintain results; discontinuation leads to reversal of gains 3, 8
• Monitoring: Evaluate efficacy using global photography, hair counts, and patient self-assessment at 4-month intervals 1

Common Pitfalls to Avoid

1. Delayed treatment: Starting treatment too late when significant hair loss has already occurred reduces effectiveness
2. Inconsistent application: Intermittent use of minoxidil significantly reduces efficacy
3. Premature discontinuation: At least 4 months of consistent treatment is needed before evaluating efficacy 3
4. Neglecting combination therapy: Using multiple treatment modalities often yields better results than monotherapy
5. Ignoring underlying conditions: Rule out thyroid dysfunction, iron deficiency, and vitamin D deficiency that may contribute to hair loss 1

Hair transplantation remains a permanent solution for patients with severe or treatment-resistant hair loss, though medical therapy should be continued post-transplant to maintain non-transplanted hair 1.