What are the treatment guidelines for male pattern hair loss?

Treatment Guidelines for Male Pattern Hair Loss

The first-line treatments for male pattern hair loss are oral finasteride 1 mg daily, oral dutasteride 0.5 mg daily, and topical 5% minoxidil applied twice daily. 1

First-Line Pharmacological Treatments

• Topical Minoxidil 5%: FDA-approved for male pattern hair loss, applied twice daily directly to the scalp. Results may be seen as early as 2 months but may take at least 4 months for some men 2
• Oral Finasteride 1 mg daily: Blocks conversion of testosterone to dihydrotestosterone (DHT), promoting hair growth and preventing further hair loss in a significant proportion of men 3
• Oral Dutasteride 0.5 mg daily: More potent 5α-reductase inhibitor than finasteride, recommended as a first-line treatment for male pattern hair loss 1

Treatment Efficacy and Expectations

• Hair regrowth with minoxidil takes time, with results potentially visible after 2 months but may require at least 4 months of consistent twice-daily use 2
• In clinical trials with finasteride, global photographs showed improvement in hair growth in 48% of recipients at 1 year and 66% at 2 years 3
• When beginning minoxidil treatment, temporary increased hair shedding may occur for up to 2 weeks, which is a normal part of the process 2
• Hair regrowth with minoxidil has not been shown to last longer than 48 weeks in large clinical trials with continuous treatment 2

Advanced Treatment Options

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

• PRP/PRF therapy is recommended with a protocol of 3-5 sessions at 1-month intervals 4
• Recommended dose is 5-7 mL PRP, using 0.05 to 0.1 mL/cm² injected at a depth of 2-4 mm 4
• Maintenance phase consists of 1 session every 6 months after initial treatment 4
• Local anesthesia with pharmaceutical-grade numbing cream is strongly recommended to manage injection-related pain 4

Hair Transplantation

• Self-hair transplantation is recommended for appropriate candidates with stable hair loss 1
• PRF can be used as an adjunct to hair transplantation, with studies showing substantial early hair regrowth by month 6 post-procedure 4

Light Therapy

• Irradiation by light-emitting diodes and low-level lasers is recommended as an adjunctive treatment 1

Treatment Combinations

• Combination therapy with PRP and topical minoxidil shows superior efficacy compared to either treatment alone 5
• Topical application of finasteride may be an alternative for those concerned about systemic side effects of oral finasteride, with similar efficacy to oral formulations 6

Important Considerations and Side Effects

• Oral finasteride may cause sexual function disorders (decreased libido, ejaculation disorder, erectile dysfunction) in approximately 3.8% of patients 3
• Sexual adverse events typically reverse upon discontinuation of therapy and many resolve even with continued treatment 3
• Minoxidil may initially increase hair shedding temporarily for up to 2 weeks, which is expected and indicates the treatment is working 2
• Oral finasteride is contraindicated in pregnant women due to risk of hypospadias in male fetuses 3

Monitoring Treatment Response

• Evaluate treatment response using standardized before-and-after photographs, trichoscopy, and patient self-assessment questionnaires 5
• Continue treatment for at least 4 months before evaluating efficacy; if no results are seen after 4 months with minoxidil, consider discontinuing 2
• Key indicators of positive response include increased hair density, increased hair shaft diameter, and decreased proportion of telogen hairs 5

Treatment Algorithm

1. Initial Assessment: Determine pattern and extent of hair loss
2. First-Line Treatment: Begin with either:
   • Topical minoxidil 5% twice daily, OR
   • Oral finasteride 1 mg daily, OR
   • Combination of both for potentially enhanced results
3. Evaluation: Assess response after 4-6 months
4. For Suboptimal Response: Consider adding PRP/PRF therapy (3-5 sessions at 1-month intervals)
5. For Non-Responders: Consider dutasteride 0.5 mg daily or hair transplantation
6. Maintenance: Continue effective treatment indefinitely, as discontinuation leads to reversal of hair growth benefits