What are the most effective treatments for male pattern hair loss, also known as Androgenetic Alopecia?

Most Effective Treatments for Male Pattern Hair Loss

For male pattern hair loss (androgenetic alopecia), start with oral finasteride 1 mg daily or topical minoxidil 5% twice daily as first-line monotherapy, with finasteride demonstrating superior efficacy in head-to-head trials, and consider adding platelet-rich plasma (PRP) therapy for enhanced results or suboptimal response. 1, 2, 3

First-Line Medical Treatments

Oral Finasteride

• Finasteride 1 mg daily is the optimal dose for treating male pattern hair loss, demonstrating superior efficacy compared to lower doses (0.2 mg, 0.01 mg) and placebo in clinical trials 4
• Results typically appear at 2-4 months, with continued improvement over time; treatment must be continued indefinitely to maintain benefits 5, 6
• In direct comparison studies, oral finasteride achieved an 80% clinical cure rate (increased hair intensity) versus 52% for topical minoxidil 5%, making it significantly more effective 3
• The medication works by inhibiting type 2 5α-reductase, thereby decreasing dihydrotestosterone formation from testosterone 4, 6

Topical Minoxidil 5%

• Apply 1 mL twice daily directly to the scalp in areas of thinning; this concentration provides more hair regrowth than minoxidil 2% in men 5
• Hair regrowth may be visible as early as 2 months, but most men require at least 4 months of consistent use to see results 5
• Expect temporary increased hair shedding for up to 2 weeks when starting treatment—this indicates old hairs are being replaced by new growth 5
• Initial regrowth appears as soft, downy, colorless hairs that gradually become thicker and pigmented with continued use 5
• Treatment must continue indefinitely; discontinuation reverses all hair growth benefits 7, 5

Combination Therapy

• Combining finasteride and minoxidil is more effective than either agent alone, though finasteride monotherapy still outperforms minoxidil monotherapy 8, 3
• Meta-analysis confirms both treatments are superior to placebo (P < 0.00001) for promoting hair growth 8

Advanced Treatment: Platelet-Rich Plasma (PRP/PRF)

When to Consider PRP

• Add PRP therapy when first-line treatments produce suboptimal response after 4-6 months 2
• PRP can be used as monotherapy or combined with topical minoxidil for superior efficacy compared to either treatment alone 7, 2
• The combination of PRP with topical minoxidil shows the highest increase in hair density in comparative studies 7

PRP Protocol (Indian Association of Dermatologists Guidelines)

• Treatment phase: 3-5 sessions spaced 1 month apart 1, 2
• Dosing: 5-7 mL PRP per session, using 0.05 to 0.1 mL/cm² 1
• Injection technique: 90-degree angle, 2-4 mm depth, injections spaced 1 cm apart 1, 2
• Preparation: Manual double-spin method with platelet concentration of 1 to 1.5 million platelets per μL 1
• Activation: Not required for androgenetic alopecia treatment 1
• Maintenance phase: 1 session every 6 months after initial treatment series 1, 2
• Pain management: Pharmaceutical-grade topical anesthetic cream is strongly recommended, as injections are associated with pain 1, 7

Mechanism and Evidence

• PRP induces proliferation of dermal papilla cells, increases vascularization of perifollicular tissue, and accelerates the telogen-to-anagen transition 1, 7
• Higher platelet concentrations demonstrate greater effects on hair density, follicle diameter, and terminal hair density 1
• PRF (platelet-rich fibrin) shows promise as a safe and effective treatment with theoretical advantages over PRP, though more standardized research is needed 1

Additional Treatment Options

Low-Level Laser Therapy (LLLT)

• 655-nm laser devices used 3 times per week are FDA-cleared and demonstrate efficacy in meta-analysis 1, 7, 8
• Requires ongoing use every 6 months for maintained effectiveness 1

Hair Transplantation

• Consider for patients with more extensive hair loss than shown in typical treatment response patterns 5
• PRF can be used as an adjunct to hair transplantation, with studies showing substantial early hair regrowth by month 6 post-procedure 2

Treatment Algorithm

1. Initial assessment: Determine pattern and extent of hair loss using Hamilton-Norwood classification 1
2. First-line treatment (choose one or both):
   • Oral finasteride 1 mg daily (preferred for superior efficacy) 4, 3
   • Topical minoxidil 5% twice daily 5, 8
   • Combination of both for maximum medical therapy 8, 3
3. Evaluation at 4-6 months using standardized photographs, trichoscopy, and patient self-assessment 7, 2
4. For suboptimal response: Add PRP therapy (3-5 monthly sessions, then maintenance every 6 months) 1, 2
5. Maintenance: Continue effective treatment indefinitely to preserve results 7, 5

Monitoring Treatment Response

Assessment Methods

• Standardized before-and-after photographs for visual comparison 1, 7, 2
• Trichoscopy to examine scalp and hair follicles, identifying hair miniaturization and vellus hairs 1, 7
• Hair counts in specific scalp areas before and after treatment 1
• Hair diameter measurement using micrometer or specialized tools 1
• Patient self-assessment questionnaires for satisfaction and perceived improvement 1, 7, 2

Key Indicators of Positive Response

• Increased hair density per cm² 1, 7, 2
• Increased hair shaft diameter 1, 7, 2
• Decreased proportion of telogen (resting phase) hairs 7, 2
• Improved patient satisfaction scores 7, 2

Important Caveats

Patient Selection

• Finasteride and minoxidil work best for vertex (crown) hair loss, not frontal baldness or receding hairline 5
• Men with shorter duration of hair loss or less extensive loss respond better to treatment 1, 5
• If hair loss is more extensive than moderate vertex thinning, medical treatments may not work effectively 5

Safety Considerations

• Finasteride side effects: Loss of libido reported in approximately 15% of patients (6 of 40 in one study); effects resolve upon discontinuation 3
• Minoxidil side effects: Scalp irritation possible but uncommon 3
• PRP side effects: Pain during injection (managed with topical anesthesia), minimal other adverse effects 1, 7
• Women should not use minoxidil 5% or finasteride; minoxidil 5% works no better than 2% in women and may cause facial hair growth 5

Treatment Expectations

• No treatment will restore all lost hair; realistic expectations are essential 5
• Hair regrowth has not been shown to last longer than 48 weeks in large clinical trials without continuous treatment 5
• Efficacy decreases with severity and duration of alopecia 7
• If no results are seen after 4 months of minoxidil use, discontinue treatment 5