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

Treatment Options for Androgenetic Alopecia (Hair Loss)

Topical minoxidil is the first-line treatment for androgenetic alopecia, with 5% solution recommended for men and 2% solution for women, showing significant improvement in hair density with response rates of approximately 80%. 1

First-Line Treatments

Topical Minoxidil

• Men: 5% solution applied twice daily (morning and night)
• Women: 2% solution recommended
• Application method: Apply 1mL directly to scalp in the hair loss area, ensuring even distribution 2
• Timeline for results:
  • Initial results may appear at 2-4 months
  • Some patients may need at least 4 months before seeing results
  • Maximum results typically seen by 6-12 months 1, 2
• Efficacy: 5% minoxidil demonstrates 45% more hair regrowth than 2% formulation at 48 weeks 1
• Common side effects: Scalp irritation, pruritus, burning sensation 2

Oral Finasteride (Men Only)

• Dosage: 1mg daily
• Efficacy: Proven effective for promoting hair regrowth and preventing further hair loss
• Cautions: May cause sexual dysfunction and gynecomastia in some patients
• Contraindications: Absolutely contraindicated in women who are pregnant or may become pregnant due to teratogenicity 1

Second-Line and Combination Therapies

Intralesional Corticosteroids

• Indication: Particularly effective for limited patchy hair loss
• Medication: Triamcinolone acetonide (5-10 mg/mL) or hydrocortisone acetate (25 mg/mL)
• Administration: Injected just beneath the dermis in the upper subcutis
• Results: 62% of patients achieved full regrowth with monthly injections in one study
• Side effect: Skin atrophy at injection site 3

Combination Therapies

• Minoxidil + topical finasteride: Produces higher hair density increases (+81 hairs/cm² after 6 months) with 79% of patients achieving significant visible improvement versus 41% with minoxidil alone 1
• Minoxidil + PRP: Higher efficacy than minoxidil alone, particularly beneficial for poor responders to conventional therapy 1

Low-Dose Oral Minoxidil

• Dosage: 1-2.5mg daily
• Evidence: Recent studies show comparable efficacy to topical minoxidil with potentially better compliance
• Side effects: Hypertrichosis (unwanted hair growth), dizziness, lower limb edema (less common) 4, 5, 6

Physical Therapies

Low-Level Laser Therapy (LLLT)

• FDA-cleared for androgenetic alopecia
• Usage: Devices can be used at home daily for 15-30 minutes
• Evidence: Meta-analysis shows superiority to placebo (P < .00001) 7, 8

Platelet-Rich Plasma (PRP)

• Protocol: Typically involves intradermal PRP injections combined with daily topical minoxidil application
• Regimen: Treatment every 4 weeks for 3 months initially to assess individual response 1, 4

Important Considerations

• Realistic expectations: Maintenance of existing hair and modest regrowth is considered a successful outcome; complete hair restoration is unlikely 1
• Consistent application: For topical minoxidil, twice daily application is essential for optimal results 2
• Initial shedding: Temporary increase in hair loss during the first 2 weeks of minoxidil treatment is normal and expected 2
• Contraindications:
  • Pregnant or breastfeeding women should avoid minoxidil and finasteride
  • Not recommended for individuals under 18 years of age
  • Caution in patients with scalp conditions that may increase absorption 1, 2

Treatment Algorithm

1. Initial treatment:

   • Men: Topical minoxidil 5% twice daily
   • Women: Topical minoxidil 2% twice daily

2. After 4-6 months of inadequate response:

   • Men: Consider adding oral finasteride 1mg daily or PRP therapy
   • Women: Consider PRP therapy or low-dose oral minoxidil (off-label)

3. For treatment-resistant cases:

   • Consider combination therapies
   • Evaluate for potential underlying causes (nutritional deficiencies, hormonal issues)

4. For extensive hair loss:

   • Consider hair systems (wigs) as a non-medical solution, particularly for women with extensive hair loss 3

Remember that consistent application and patience are key, as visible results typically take several months to appear.