What is the treatment for androgenetic alopecia in adults?

Treatment of Androgenetic Alopecia in Adults

Topical minoxidil 5% is the first-line treatment for androgenetic alopecia in both men and women, with oral finasteride 1mg daily recommended as first-line therapy for men only. 1, 2, 3

First-Line Treatments

For Men:

• Topical minoxidil 5%

  • Apply twice daily directly to the scalp in the affected area 2
  • Allow to dry for 4 hours before washing 2
  • Results may be seen as early as 2 months, but may take up to 4 months 2
  • Must be continued indefinitely to maintain results 1

• Oral finasteride 1mg daily

  • Effective for promoting hair regrowth and preventing further hair loss 1
  • Potential side effects include sexual dysfunction (erectile dysfunction, decreased libido) 4
  • May continue after discontinuation of treatment 4
  • Not for use in women 4

For Women:

• Topical minoxidil 5% once daily 1
  • Goal is to maintain and improve hair density
  • Allow 6-12 months for visible results

Adjunctive Therapies

• Low-level laser therapy

  • Can be used 3 times weekly as a non-pharmaceutical option 1
  • Minimal side effects
  • FDA-cleared for treatment of androgenetic alopecia 3

• Platelet-Rich Plasma (PRP) therapy

  • Recommended as an adjunctive treatment, particularly in mild cases 1
  • Typical regimen: 3-5 sessions at 4-6 week intervals, with maintenance every 6 months

• Low-dose oral minoxidil

  • Alternative for patients who cannot tolerate topical formulation
  • 1mg daily has shown similar efficacy to topical minoxidil in recent studies 5
  • Can be combined with spironolactone 25mg daily in women 1

Nutritional Considerations

• Evaluate for nutritional deficiencies that may contribute to hair loss:
  • Iron (serum ferritin)
  • Zinc (levels below 70 μg/dL may require supplementation)
  • Vitamin D (maintain levels of at least 30 ng/mL)
  • Thyroid function 1

Treatment Monitoring

1. Take baseline photos before starting treatment
2. Document progress with standardized photos at 3,6, and 12 months
3. Initial assessment at 3 months (early signs of improvement may be visible)
4. Critical evaluation at 6 months (significant improvements should be noticeable)
5. Comprehensive evaluation at 12 months to decide on continuing or modifying treatment 1

Important Considerations

• Temporary increased shedding may occur in the first 2 weeks of minoxidil use, which is a normal part of the process 2
• Treatment must be continued indefinitely to maintain results; discontinuation leads to reversal of gains within 3-4 months
• Hair regrowth varies between individuals - not everyone will respond to treatment 2
• The most common side effects of topical minoxidil are scalp irritation and itching 2
• Finasteride may be associated with increased risk of high-grade prostate cancer and rare reports of male breast cancer 4

Treatment Algorithm

1. Initial Assessment: Determine pattern and extent of hair loss
2. First-line therapy:
   • Men: Start with both topical minoxidil 5% twice daily AND oral finasteride 1mg daily
   • Women: Start with topical minoxidil 5% once daily
3. After 6 months: If inadequate response, add adjunctive therapy:
   • Low-level laser therapy
   • PRP therapy
   • Consider low-dose oral minoxidil if topical application is problematic
4. Ongoing management: Continue effective treatments indefinitely with regular monitoring

The evidence strongly suggests that minoxidil and finasteride are the most effective treatments for androgenetic alopecia, with the highest level of evidence supporting their use 3, 6.