What are the treatment options for male pattern hair loss?

Treatment Options for Male Pattern Hair Loss

Topical minoxidil 5% and oral finasteride 1mg daily are the first-line treatments for male pattern hair loss, with clinical studies showing finasteride achieving an 80% clinical cure rate versus 52% with topical minoxidil. 1

First-Line Treatment Options

Topical Minoxidil 5%

• Applied twice daily directly to the scalp 2
• Results may appear as early as 2 months, but may take up to 4 months to show efficacy 2
• Demonstrated 45% more hair regrowth than 2% formulation at 48 weeks 1
• Mechanism: Reactivates hair follicles to stimulate regrowth 2
• Most effective for vertex (crown) hair loss 2
• FDA-approved for men 18 years and older 2

Oral Finasteride 1mg

• Blocks conversion of testosterone to dihydrotestosterone (DHT) 1, 3
• Significantly increases hair count in both vertex and frontal scalp regions 4, 5
• Long-term studies show durable improvements over 5 years of treatment 6
• In clinical trials:
  • 83% of finasteride users had no further hair loss after 2 years (vs 28% with placebo) 1
  • Global photographs showed improvement in 48% of users at 1 year and 66% at 2 years 3
  • Increases hair count in a 1-inch diameter circular area by 107 hairs at 1 year and 138 hairs at 2 years compared to placebo 7

Combination Therapy

• Combined minoxidil and finasteride produces higher hair density increases (+81 hairs/cm² after 6 months) 1
• 79% of patients achieved significant visible improvement with combination therapy versus 41% with minoxidil alone 1

Treatment Considerations and Monitoring

Patient Selection

• Most effective for men with:
  • Gradual thinning hair or hair loss on the top of the scalp (vertex) 2
  • Hair loss that has begun recently 2
  • Hair loss pattern within the range shown on product packaging 2
  • Family history of gradual thinning hair 2

Monitoring

• Take baseline photos before starting treatment 1
• Evaluate at 3 months for initial response 1
• Critical evaluation at 6 months 1
• Comprehensive assessment at 12 months to determine continuation 1
• Note: Temporary increased hair shedding may occur in the first 2 weeks of minoxidil use, which is expected and part of the process 2

Side Effects

• Finasteride:
  • Sexual function disorders (decreased libido, ejaculation disorder, erectile dysfunction) in 3.8% vs 2.1% with placebo 3
  • Sexual adverse events typically reverse upon discontinuation 3
  • Contraindicated in pregnant women due to risk of hypospadias in male fetuses 3
• Minoxidil: Generally well-tolerated when used as directed 2

Important Caveats

• Minoxidil is less effective for frontal baldness or receding hairline 2
• Complete hair restoration is unlikely; maintenance of existing hair and modest regrowth is considered a successful outcome 1
• Both treatments require continuous use to maintain results; hair loss will resume if treatment is discontinued 2, 6
• Women should not use 5% minoxidil as studies show it works no better than 2% formulation in women 2
• Neither treatment will work for hair loss due to:
  • Medications
  • Nutritional problems
  • Thyroid issues
  • Chemotherapy
  • Scarring of the scalp 2

For optimal results, patients should apply the medication directly to the scalp as directed and maintain consistent daily use. Results take time to develop, with the full benefit typically seen after 12 months of continuous treatment.