What are the treatment options for androgenic (male/female pattern) alopecia?

Treatment Options for Androgenic Alopecia

Topical minoxidil 5% and oral finasteride 1mg daily are the first-line treatments for androgenic alopecia, with the strongest evidence for efficacy and safety. 1

First-Line Treatments

For Men:

• Topical minoxidil 5%

  • FDA-approved for male pattern hair loss 2
  • Apply twice daily directly to the scalp
  • Results may be seen as early as 2 months, but may take at least 4 months 2
  • Initial shedding in the first 2 weeks is normal and indicates the treatment is working 2

• Oral finasteride 1mg daily

  • FDA-approved for male pattern hair loss 1, 3
  • More effective than minoxidil alone (80% vs 52% clinical improvement) 4
  • Works by inhibiting 5-alpha-reductase, reducing DHT that causes follicle miniaturization 5
  • Contraindicated in pregnancy due to teratogenicity 1, 3

For Women:

• Topical minoxidil 2%
  • Only FDA-approved treatment for female pattern hair loss 1, 6
  • Apply twice daily
  • Produces significant increase in non-vellus hair count compared to placebo (33 vs 19 hairs) 6

Combination Therapy

• Minoxidil + finasteride
  • Produces higher hair density (+81 hairs/cm² after 6 months)
  • 79% of patients achieve significant visible improvement versus 41% with minoxidil alone 1

Second-Line and Adjunctive Treatments

Platelet-Rich Plasma (PRP)

• Recommended as a series of 3-5 sessions at monthly intervals
• Use manually prepared double-spin PRP injected at 5-7 mL (0.05-0.1 mL/cm²) per session 1

Intralesional Corticosteroids

• Triamcinolone acetonide 5-10 mg/mL administered through monthly injections
• More suitable for patchy hair loss patterns rather than typical androgenetic alopecia 1

Low-Level Laser Light Therapy

• FDA-cleared treatment option
• Demonstrated efficacy in meta-analyses 7

Nutritional Support

• Address deficiencies in:
  • Iron
  • Zinc
  • Vitamin D (target levels of 75 nmol/L or greater) 1
  • Vitamin B12 and folate

Important Monitoring and Safety Considerations

Before Starting Treatment

• Baseline photos for comparison
• For finasteride: consider PSA levels in men (finasteride lowers PSA by 50% after 12 months) 1

Monitoring

• Evaluate at 3 months for initial response
• Critical evaluation at 6 months
• Comprehensive assessment at 12 months to determine continuation 1

Side Effects and Contraindications

• Finasteride

  • Sexual dysfunction that may continue after discontinuation (erectile dysfunction, decreased libido)
  • Breast tenderness/enlargement
  • Depression
  • Contraindicated in pregnancy and women of childbearing potential without reliable contraception 3

• Minoxidil

  • Scalp irritation
  • Temporary increased hair shedding initially
  • Not recommended for pregnant/breastfeeding women or individuals under 18 2

Treatment Expectations

• Hair regrowth is gradual (normal hair grows only 1/2 to 1 inch per month)
• Consistent application is essential for results
• Treatment must be continued indefinitely to maintain results
• Complete hair restoration is unlikely; the goal is to slow progression and achieve modest regrowth 5

Common Pitfalls

1. Discontinuing treatment too early - Results take at least 3-4 months to become visible
2. Inconsistent application - Regular twice-daily application of minoxidil is necessary
3. Unrealistic expectations - Complete hair restoration is rare
4. Ignoring nutritional factors - Address underlying deficiencies
5. Neglecting psychological impact - Hair loss significantly affects quality of life and may require psychological support 1

Androgenic alopecia is a chronic condition requiring long-term treatment commitment. The strongest evidence supports minoxidil and finasteride as the most effective treatments, with combination therapy offering superior results to either treatment alone.