What are the treatment options for hair loss?

Hair Loss Treatment Options

For androgenetic alopecia (pattern hair loss), start with topical minoxidil 5% applied twice daily, which is the FDA-approved first-line treatment with proven efficacy in both men and women. 1, 2

First-Line Treatment: Topical Minoxidil

For Men

• Apply minoxidil 5% topical solution 1 mL twice daily directly to the scalp 1
• Treatment works best for vertex (crown) hair loss, not frontal baldness or receding hairline 1
• Results typically appear at 2 months, but may require 4 months of consistent use before visible improvement 1
• Initial temporary increase in hair shedding for up to 2 weeks is expected and indicates the medication is working 1
• Treatment must be continued indefinitely—discontinuation reverses all benefits 2

For Women

• Use minoxidil 5% foam once daily OR minoxidil 2% solution twice daily 3, 4
• The 5% concentration demonstrates superior efficacy compared to 2% in controlled trials, with greater improvement in hair count and patient satisfaction 4
• Women should avoid the 5% solution formulation marketed for men, as the 5% foam is specifically FDA-approved for female pattern hair loss 3
• Both concentrations improve psychosocial perceptions and quality of life even when hair regrowth is modest 4

Important Caveats with Minoxidil

• Efficacy ranges from 17-70% depending on concentration and individual response 5
• Common side effects include scalp pruritus, local irritation, and unwanted facial hair growth (hypertrichosis), particularly with 5% concentration 4
• Does NOT work for hair loss caused by medications, nutritional deficiencies, thyroid disease, scarring alopecia, or tight hairstyles 1

Advanced Treatment: Platelet-Rich Plasma (PRP)

For patients seeking enhanced results or those with inadequate response to minoxidil alone, add PRP injections using a specific protocol. 2

PRP Treatment Protocol

• Preparation method: Manual double-spin technique targeting 1-1.5 million platelets/µL; activation is NOT required 2
• Initial phase: 3-5 treatment sessions spaced 1 month apart 2
• Dosing: 5-7 mL total PRP volume, injecting 0.05-0.1 mL/cm² at 1 cm intervals 2
• Injection technique: 90-degree angle, 2-4 mm depth, using 30G × 4mm needles 2
• Maintenance phase: Single session every 6 months after initial treatment series 2
• Pain management: Apply pharmaceutical-grade topical anesthetic cream before injection—this is strongly recommended as the procedure causes significant discomfort 2

Combination Therapy Superiority

• PRP combined with topical minoxidil 5% demonstrates superior efficacy compared to either treatment alone, with the highest increase in hair density in comparative studies 2, 6
• This combination is significantly more effective than minoxidil monotherapy 2
• PRP monotherapy shows greater effectiveness than minoxidil monotherapy in most studies 6

PRP Evidence Considerations

• Higher platelet concentrations produce greater effects on hair density, follicle diameter, and terminal hair density 6
• Microneedling application may be superior to injection technique for some parameters 6
• Some studies report ineffectiveness, possibly due to low platelet concentration, inadequate volume, insufficient treatment frequency, or individual genetic factors 6

Additional Treatment Options

Low-Level Laser Therapy (LLLT)

• 655-nm laser devices used 3 times per week demonstrate efficacy for androgenetic alopecia 6, 2
• Requires continuous use similar to minoxidil 6

Oral Minoxidil (Off-Label)

• Low-dose oral minoxidil 1 mg daily shows comparable efficacy to topical 5% solution in recent trials 7
• May be considered for patients with poor adherence to topical application or scalp irritation 7
• Both formulations show >60% patient satisfaction with no significant difference in outcomes 7

Other Modalities

• Hormonal therapies, nutraceuticals, exosome treatments, and hair transplantation are available but beyond first-line recommendations 6

Treatment Monitoring

Evaluate treatment response using multiple objective measures at regular intervals. 2

Assessment Methods

• Standardized before-and-after photographs for visual comparison 6, 2
• Trichoscopy to examine hair follicles, identify miniaturization, and assess vellus hair presence 6
• Hair counts in specific scalp areas before and after treatment 6
• Hair diameter measurements using micrometer—increased shaft diameter indicates positive response 6
• Patient self-assessment questionnaires for satisfaction and perceived improvement 6, 2
• Pull test to assess hair fragility—fewer hairs removed indicates improved strength 6

Timeline for Evaluation

• Initial assessment at 2-4 months for minoxidil 1
• Comprehensive evaluation after one year for PRP combination therapy 2
• Treatment efficacy may decrease with greater severity and longer duration of alopecia 2

Alopecia Areata: Different Treatment Approach

For patchy autoimmune hair loss (alopecia areata), the treatment algorithm differs completely from androgenetic alopecia. 8

Limited Patchy Alopecia Areata

• First-line: Intralesional corticosteroids (triamcinolone acetonide 5-10 mg/mL) injected monthly 8, 6
• Success rates up to 62% with monthly injections 8
• Most suitable for fewer than 5 patches <3 cm diameter and cosmetically sensitive areas like eyebrows 6
• Monitor for skin atrophy, a consistent side effect 8

Extensive Patchy Alopecia Areata

• First-line: Contact immunotherapy with diphenylcyclopropenone (DPCP) 8
• Stimulates cosmetically worthwhile regrowth in <50% of patients 8
• Requires specialized protocols with sensitization followed by weekly applications at increasing concentrations 6

Important Distinction

• Minoxidil is NOT first-line therapy for alopecia areata, showing limited efficacy with variable response rates of only 32-33% 8, 6
• For limited disease <1 year duration, observation without treatment is legitimate as spontaneous remission occurs in up to 80% of cases 8