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

Treatment Options for Male Androgenetic Alopecia (Hair Loss)

For male androgenetic alopecia, the most effective first-line treatments are topical minoxidil and oral finasteride, with platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) offering additional benefits as adjunctive therapy. 1, 2, 3

First-Line Pharmacological Treatments

Topical Minoxidil

• FDA-approved for male pattern hair loss, available as 5% solution or foam 2
• Mechanism: Vasodilator that prolongs anagen phase and increases hair follicle size 2
• Application: Apply twice daily directly to scalp in affected areas 2
• Efficacy: Results may be seen as early as 2 months, but may take up to 4 months for visible improvement 2
• Temporary increased hair shedding may occur in first 2 weeks of treatment (a positive sign of the treatment working) 2
• Must be used continuously; hair loss will resume if treatment is stopped 2

Oral Finasteride

• FDA-approved at 1mg daily dose for male pattern baldness 4, 3
• Mechanism: 5-alpha reductase inhibitor that blocks conversion of testosterone to dihydrotestosterone (DHT) 4, 5
• Efficacy: 80% clinical improvement rate compared to 52% with minoxidil alone 6
• Side effects: Potential sexual dysfunction (decreased libido, erectile dysfunction) that may persist after discontinuation in some cases 4, 6
• Contraindicated in women who are or may become pregnant due to risk of birth defects 4

Advanced Pharmacological Options

Oral Minoxidil (Off-Label)

• Used at lower doses (2.5-5mg daily) than for hypertension 5, 7
• More potent than topical application but with increased risk of systemic side effects 7
• Main side effects: Hypertrichosis (unwanted hair growth), potential cardiovascular effects (dizziness, edema) 5, 7

Oral Dutasteride (Off-Label)

• More potent 5-alpha reductase inhibitor than finasteride (blocks both type I and II enzymes) 5, 7
• May provide better response, especially in frontal areas 5
• Longer half-life (5 weeks vs. 4.5 hours for finasteride) 7
• Similar side effect profile to finasteride but potentially more pronounced 5

Adjunctive Treatments

Platelet-Rich Plasma (PRP)/Platelet-Rich Fibrin (PRF)

• Recommended protocol: 3-5 sessions at 1-month intervals, followed by maintenance sessions every 6 months 1
• Dosage: 5-7mL PRP using 0.05-0.1mL/cm² with injections 1cm apart at 2-4mm depth 1
• Works by stimulating dermal papilla proliferation and increasing perifollicular vascularization 1
• Combined therapy with minoxidil is more effective than minoxidil alone 1, 8
• PRF may have theoretical advantages over PRP and doesn't require activation before injection 1
• Local anesthesia strongly recommended due to pain during injections 1, 8

Low-Level Laser Therapy (LLLT)

• FDA-cleared for treating androgenetic alopecia 3, 9
• Typically used with wavelengths between 630-660nm 5
• Home devices available for daily use (15-30 minutes) 5
• Works by stimulating hair follicle cells and improving cellular metabolism 9

Monitoring Treatment Response

• Standardized photography before and after treatment to document progress 1, 8
• Trichoscopy to evaluate hair density and diameter changes 1, 8
• Hair pull test to assess hair strength and fragility 8
• Patient self-assessment questionnaires to gauge satisfaction 1, 8
• Response should be evaluated after 4-6 months of consistent treatment 2

Treatment Algorithm

1. Start with first-line therapy:

   • Topical minoxidil 5% twice daily AND/OR oral finasteride 1mg daily 2, 3, 6
   • Continue for at least 4 months before assessing efficacy 2

2. If inadequate response after 4-6 months:

   • Add PRP/PRF treatment (3-5 sessions at monthly intervals) 1
   • Consider switching to or adding oral minoxidil (starting at 2.5mg daily) 5, 7
   • Consider switching from finasteride to dutasteride if frontal hair loss is prominent 5

3. For maintenance:

   • Continue pharmacological therapy indefinitely 2
   • PRP/PRF maintenance sessions every 6 months 1
   • Consider adding LLLT as complementary therapy 9, 5

Important Considerations and Pitfalls

• Treatments must be continued indefinitely; discontinuation will result in reversal of gains within 3-6 months 2
• Manage patient expectations - complete hair regrowth is unlikely; the goal is to slow progression and improve density 2
• Early intervention generally yields better results than treating advanced hair loss 1
• Monitor for sexual side effects with finasteride/dutasteride, which may persist after discontinuation in some cases 4
• For PRP/PRF treatments, ensure standardized protocols are followed for consistent results 1
• Combination therapy (e.g., minoxidil + finasteride + PRP) generally provides better outcomes than monotherapy 1, 6