What is the best treatment approach for a 68-year-old with androgenetic alopecia (male/female pattern baldness)?

Treatment of Hair Thinning at 68 Years Old

For a 68-year-old with androgenetic alopecia (pattern baldness), start with topical minoxidil 5% applied twice daily, which is the first-line treatment for both men and women at this age. 1

Primary Treatment Options

First-Line Pharmacologic Therapy

• Topical minoxidil 2-5% is the cornerstone treatment for both sexes and should be applied continuously to maintain effectiveness 1, 2
• Oral finasteride 1 mg daily (for men only) is FDA-approved and can maintain positive responses for many years 3, 4
• Oral dutasteride 0.5 mg (for men) induces better responses than finasteride, especially in the frontal area, though it requires continuous use 3

Alternative Pharmacologic Options

• Topical finasteride 0.25% daily (for men) is effective with less systemic absorption than oral formulations, reducing serum dihydrotestosterone levels less dramatically 3
• Oral minoxidil 2.5-5 mg daily shows effectiveness in clinical studies, though not FDA-approved for this indication; main side effect is hypertrichosis, with less common dizziness or lower limb edema 3

Adjunctive Physical Treatments

Low-Level Laser Therapy (LLLT)

• 655-660 nm wavelength devices used at home for 15-30 minutes daily are FDA-cleared for androgenetic alopecia 1, 5
• These require use 3 times per week for effectiveness 1
• Evidence is limited compared to pharmacologic options, but can be used as complementary therapy 3, 5

Autologous Platelet Concentrates (PRP)

• Injectable platelet-rich plasma has become increasingly popular, with clinical trials showing increased hair density (hairs per cm²) after treatment 1, 3
• Treatment protocol typically involves sessions every 4 weeks for 3 months initially, then every 6 months for maintenance 1, 3
• Higher platelet concentrations show greater effects on hair density and follicle diameter 1
• Main limitation is heterogeneity in treatment protocols across studies 3

Treatment Algorithm for Age 68

Step 1: Begin with topical minoxidil 5% twice daily as the safest, most established option 1, 2

Step 2 (for men): Add oral finasteride 1 mg daily or consider dutasteride 0.5 mg if frontal involvement is prominent 3

Step 3: If response is inadequate after 6 months, consider adding:

• Low-level laser therapy 3 times weekly 1, 5
• PRP injections every 4 weeks for 3 months, then reassess 1, 3

Step 4: For men with concerns about systemic finasteride, switch to topical finasteride 0.25% daily 3

Critical Caveats at This Age

• All treatments require continuous use to maintain effectiveness; stopping leads to reversal of benefits 1
• Expect 3-6 months minimum before seeing results with any treatment 1, 6
• Sexual side effects with oral finasteride/dutasteride are a widespread concern among patients, though clinical trials show safety 3
• Prognosis varies: Patients with longstanding extensive hair loss have poorer outcomes 1, 6
• No treatment alters the long-term disease course; patients should be warned about possible relapse during or after initially successful treatment 1, 6

Monitoring Response

Assess treatment effectiveness using:

• Before-and-after photography for visual comparison 1
• Trichoscopy to examine hair follicles and identify miniaturization 1
• Hair counts in specific scalp areas 1
• Patient self-assessment questionnaires for satisfaction 1

When to Consider No Active Treatment

Observation without treatment is legitimate if the patient has minimal cosmetic concern, as some treatments can be time-consuming and uncomfortable 1, 6. A wig may be a better option than pursuing treatments unlikely to be effective in longstanding extensive cases 1.