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, with platelet-rich plasma (PRP) injections showing promising results as an adjunctive therapy. These treatments have demonstrated significant efficacy in promoting hair regrowth and preventing further hair loss.

First-Line Pharmacological Options

Minoxidil (Topical Solution)

• Mechanism: Vasodilator that increases blood flow to hair follicles and prolongs the growth phase
• Dosage: 5% solution applied twice daily to dry scalp
• Efficacy:
  • Clinically proven to help regrow hair by reactivating hair follicles 1
  • Results may be seen as early as 2 months, but may take up to 4 months for visible improvement 1
  • Studies show significant increases in hair count compared to placebo (mean increase of 58.2 hairs in a 1-inch diameter area) 2
• Important considerations:
  • Requires continuous use; hair loss will resume if treatment is discontinued 1
  • May cause temporary increased shedding during first 2 weeks of use 1
  • Side effects include scalp irritation

Finasteride (Oral)

• Mechanism: 5α-reductase inhibitor that blocks conversion of testosterone to DHT
• Dosage: 1mg daily
• Efficacy:
  • Clinical trials showed significant increases in hair count (107 and 138 hairs vs placebo at 1 and 2 years) 3
  • Slows progression of hair loss and increases hair growth 3
• Important considerations:
  • Prescription-only medication
  • Potential sexual side effects (though minimal in clinical trials) 3
  • Not for use by women, especially those who are pregnant or may become pregnant

Advanced Treatment Options

Platelet-Rich Plasma (PRP) Injections

• Protocol based on recent guidelines:
  • Manual double-spin method for preparation
  • 3-5 treatment sessions at 1-month intervals
  • 5-7 mL PRP injected (0.05-0.1 mL/cm²)
  • Maintenance: one session every 6 months 4
• Efficacy:
  • Increases hair density and thickness
  • Studies show positive clinical results with statistical significance 4
  • More effective when combined with other treatments like minoxidil 4
• Practical considerations:
  • Requires proper anesthesia due to injection pain
  • Injections performed 1 cm apart at 2-4 mm depth 4
  • Patient should shampoo before treatment but avoid hair products 4

Dutasteride

• Mechanism: Dual 5α-reductase inhibitor (types I and II)
• Efficacy: Superior to finasteride, especially for frontal area regrowth 5
• Dosage: 0.5mg daily (though not FDA-approved specifically for hair loss)
• Considerations: Similar side effect profile to finasteride but potentially more potent

Combination Approaches

1. Minoxidil + Finasteride: Most effective combination, with synergistic effects 5
2. Topical Finasteride (0.25%): Alternative for those concerned about systemic side effects 5
3. PRP + Minoxidil: Enhanced efficacy compared to either treatment alone 4

Treatment Selection Algorithm

1. For early/mild hair loss:

   • Start with topical minoxidil 5% twice daily
   • Add oral finasteride 1mg daily if no contraindications exist

2. For moderate to severe hair loss:

   • Combination of minoxidil 5% + finasteride 1mg daily
   • Consider adding PRP treatments (3-5 sessions at monthly intervals)

3. For non-responders after 6-12 months:

   • Consider switching to dutasteride 0.5mg daily
   • Intensify PRP protocol
   • Evaluate for hair transplantation if appropriate

Important Caveats

• Treatment expectations: Results take time (minimum 3-6 months) and require consistent application
• Continuous therapy: All treatments require ongoing use to maintain results
• Monitoring: Photograph baseline and follow-up at 3-6 month intervals to objectively assess response
• Non-responders: If no improvement after 4 months of minoxidil or 12 months of finasteride, consider alternative or additional treatments

Remember that early intervention typically yields better results, and combining treatments often provides superior outcomes compared to monotherapy.