What are the treatment options for male pattern baldness?

Treatment Options for Male Pattern Baldness

The most effective treatment options for male pattern baldness include oral finasteride 1 mg daily and topical minoxidil 5% solution applied twice daily, with oral dutasteride 0.5 mg showing superior efficacy particularly for frontal hair loss. 1

First-Line Pharmacological Treatments

Topical Minoxidil

• FDA-approved 5% solution for men with vertex (top of scalp) hair loss 2
• Application protocol: 1 ml applied twice daily directly to scalp 2
• Efficacy timeline:
  • Results may begin at 2 months with consistent twice-daily use
  • Some men require at least 4 months before seeing results 2
  • Initial increased shedding in first 2 weeks is normal and indicates the treatment is working 2
• Effectiveness: Clinical trials show significant increase in non-vellus hair counts compared to placebo (mean increase of 37.6 vs 8.8 hairs per reference area) 3
• Maintenance: Continued use necessary to maintain results; hair loss will resume if treatment is discontinued 2
• Best candidates: Men with recent onset of hair loss or minimal thinning at the vertex 2

5-Alpha Reductase Inhibitors

• Finasteride (1 mg daily): FDA-approved oral medication 1
• Dutasteride (0.5 mg daily): More effective than finasteride, especially for frontal hair loss 1
• Mechanism: Blocks conversion of testosterone to dihydrotestosterone (DHT)
• Side effects: Potential sexual adverse effects (main patient concern) 1

Topical Alternatives

• Topical finasteride 0.25%: Effective with less systemic DHT reduction than oral formulation 1
• Mesotherapy with dutasteride: Emerging option with limited evidence from retrospective studies 1

Second-Line and Adjunctive Treatments

Oral Minoxidil

• Dosage: Starting at 2.5 mg daily, may increase to 5 mg daily 1
• Not FDA-approved for male pattern baldness but supported by clinical studies
• Main side effect: Hypertrichosis (unwanted hair growth elsewhere on body) 1

Platelet-Rich Plasma (PRP)

• Protocol: Treatment every 4 weeks for 3 months initially 1
• Evidence: Clinical trials show improvement in hair count after several months 1
• Limitations: Heterogeneous procedures make comparing efficacy difficult 1
• Preparation recommendations from Indian Association of Dermatologists 4:
  • Manual double-spin method
  • 3-5 sessions with 1-month intervals
  • 5-7 mL PRP (0.05-0.1 mL/cm²)
  • Target concentration: 1-1.5 million platelets per μL

Low-Level Laser Therapy

• Wavelength: 630-660 nm devices 1
• Usage: 15-30 minutes daily home treatment 1
• Evidence: Limited number of clinical trials showing efficacy 1

Combination Approaches

• Complex therapy (minoxidil with finasteride) shows better results than monotherapy 4
• PRP with microneedling plus background therapy of minoxidil, finasteride, and multivitamins shows promising results 4
• PRF (Platelet-Rich Fibrin) appears promising as both standalone treatment and adjuvant to hair transplant surgery 4

Surgical Options

Hair Transplantation

• Follicular Unit Extraction (FUE) with PRF pre-treatment shows substantial early hair regrowth by month 6 4
• PRF treatment during hair transplantation shows beneficial effect on hair follicle numbers 4

Monitoring and Expectations

• Documentation: Take excellent before and after photos to track progress 4
• Timeline expectations: Normal hair grows only 1/2 to 1 inch per month; regrowth takes time 2
• Initial appearance: New growth often begins as soft, downy, colorless hairs before developing normal thickness and color 2
• Discontinuation: If no results after 4 months of consistent use, consider stopping minoxidil 2

Pitfalls and Caveats

1. Treatment limitations:

   • Minoxidil is only effective for vertex baldness, not frontal baldness or receding hairline 2
   • Results vary significantly between individuals 2

2. Diagnostic considerations:

   • Rule out other causes of hair loss (nutritional deficiencies, thyroid disorders, medications) before treatment 5
   • Perform proper assessment including pull test, trichoscopy, and hair count 5

3. Maintenance requirements:

   • Twice-daily application of minoxidil maintains results better than once-daily application 6
   • Discontinuation leads to reversal of gains within months 2

4. Patient selection:

   • Women should not use 5% minoxidil (2% formulation recommended) 2
   • Not for use in children under 18 years 2
   • Not effective for scarring alopecia or hair loss due to tight hairstyles 2

Male pattern baldness treatment requires consistent long-term application of therapies, with combination approaches often yielding the best results for maintaining and regrowing hair.