What are the best treatments for growing hair in male pattern baldness?

Treatment for Male Pattern Baldness

For male pattern baldness, start with topical minoxidil 5% applied twice daily to the scalp, which is FDA-approved and clinically proven to stimulate hair regrowth by reactivating hair follicles. 1

First-Line Treatment: Topical Minoxidil

• Minoxidil 5% solution is the primary FDA-approved treatment for men with male pattern baldness, applied as 1 mL twice daily directly to the scalp 1
• Results typically appear at 2 months with consistent twice-daily use, though some men may require at least 4 months of treatment before seeing visible regrowth 1
• Clinical studies demonstrate significant efficacy: mean increase of 58.2 nonvellus (terminal) hairs in the vertex area after 4 months of 2% minoxidil treatment 2
• Long-term data shows sustained benefit: men maintained mean increases of 323-335 nonvellus hairs from baseline after 2 years 9 months with twice-daily application 3
• Twice-daily application is superior to once-daily: switching to once-daily dosing results in greater hair loss compared to continued twice-daily use (p = 0.05) 3

Important Treatment Considerations

• Treatment must be continued indefinitely - discontinuation leads to reversal of all hair growth benefits within months 4, 1
• Initial shedding may occur during the first 2 weeks as old hairs are replaced by new growth; this is expected and indicates the medication is working 1
• Early hair regrowth appears as soft, downy, colorless hairs that gradually become thicker and pigmented with continued use 1
• Minoxidil works best for vertex (crown) hair loss, not frontal baldness or receding hairline 1
• Response rates vary: approximately 48% of men show improvement at 1 year, increasing to 66% at 2 years based on global photographs 5

Second-Line Treatment: Oral Finasteride

• Finasteride 1 mg daily is an effective oral alternative that blocks conversion of testosterone to dihydrotestosterone (DHT), the androgen responsible for male pattern baldness 5
• Clinical efficacy data: 48% showed improvement in hair growth at 1 year, increasing to 66% at 2 years; 83% had no further hair loss compared to baseline after 2 years 5
• Sexual side effects occur in 3.8% of patients (vs 2.1% placebo), including decreased libido, ejaculation disorder, and erectile dysfunction - these typically resolve with discontinuation 5
• Contraindicated for use by or around pregnant women due to risk of hypospadias in male fetuses 5

Advanced Combination Therapy

• Platelet-rich plasma (PRP) combined with topical minoxidil 5% shows superior efficacy compared to either treatment alone, with the highest increase in hair density in comparative studies 4
• Recommended protocol: Apply minoxidil 5% (1 mL) twice daily combined with monthly PRP injections for at least 3 sessions spaced one month apart 4
• PRP induces proliferation of dermal papilla cells, increases vascularization of perifollicular tissue, and accelerates telogen-to-anagen transition 4

Common Pitfalls to Avoid

• Inadequate application technique: The medication must reach the scalp directly, not just the hair 1
• Premature discontinuation: Stopping before 4 months prevents assessment of true efficacy 1
• Unrealistic expectations: Complete hair restoration is unlikely; the goal is to slow loss and achieve partial regrowth 1
• Using minoxidil for inappropriate hair loss patterns: It does not work for frontal baldness, receding hairline, or non-androgenetic causes of hair loss 1

Monitoring Treatment Response

• Evaluate response using standardized before-and-after photographs, assessment of hair density and diameter, and patient satisfaction 4
• Key indicators of positive response include increased hair density, increased hair shaft diameter, decreased proportion of telogen hairs, and improved patient satisfaction scores 4
• If no results are seen after 4 months of consistent twice-daily minoxidil use, discontinue treatment as further benefit is unlikely 1