What medications are used to promote hair growth?

Medications for Hair Growth

Topical minoxidil 5% is the primary FDA-approved medication for promoting hair growth in men with androgenetic alopecia, with oral finasteride 1 mg daily as the other FDA-approved option, and combination therapy providing superior outcomes to either agent alone. 1, 2

First-Line Pharmacologic Options

Topical Minoxidil

• Minoxidil 5% topical solution applied twice daily directly to the scalp is FDA-approved and clinically proven to stimulate hair regrowth by reactivating hair follicles. 1, 2
• Initial improvements typically become visible at 2-3 months, though some patients require 4 months of continuous twice-daily use before seeing results. 1
• The medication works through multiple mechanisms including vasodilation, anti-inflammatory effects, Wnt/β-catenin signaling induction, and antiandrogen activity. 3
• Continuous lifelong treatment is mandatory—discontinuation results in loss of all gains within months. 1
• Hypertrichosis (unwanted facial hair growth) affects approximately 15% of patients, representing the most common adverse effect. 4

Oral Finasteride

• Finasteride 1 mg daily blocks conversion of testosterone to dihydrotestosterone (DHT), the androgen responsible for male pattern hair loss. 5
• At 2 years, 66% of men show improvement in hair growth on global photographs versus 7% with placebo, and 83% have no further hair loss versus 28% with placebo. 5
• Sexual dysfunction (decreased libido, ejaculation disorder, erectile dysfunction) occurs in 3.8% versus 2.1% with placebo, with most cases resolving despite continued therapy. 5
• Finasteride is contraindicated in women of childbearing potential due to risk of hypospadias in male fetuses. 5

Combination Therapy Strategy

The combination of finasteride plus minoxidil provides superior efficacy compared to either monotherapy, with 94.1% showing improvement versus 80.5% with finasteride alone and 59% with minoxidil alone at 12 months. 6

• Topical finasteride 0.25% combined with minoxidil 5% demonstrates 86.7% efficacy versus 69.1% for minoxidil alone. 7
• Initial improvements become visible at 2-3 months with combination therapy. 8

Advanced Treatment: Platelet-Rich Plasma (PRP)

Adding PRP to minoxidil-finasteride combination provides the most effective evidence-based approach for androgenetic alopecia. 8, 9

PRP Protocol

• Administer three intradermal scalp injections spaced exactly one month apart, combined with topical minoxidil 5% twice daily. 9
• Use nonactivated PRP, which demonstrates 31% greater increases in hair count and density compared to activated PRP. 9
• Maintenance injections every 6 months are required to sustain results long-term. 8, 9
• At 6 months, hair density increases by 1.74 times, hair diameter by 14.3 times, and telogen phase hair decreases by 9.3 times. 9
• Pain during injection is the primary complaint, though generally well tolerated. 9

Alternative Oral Agents (Off-Label)

Oral dutasteride 0.5 mg daily (approved in Japan and South Korea) provides superior efficacy to finasteride, with probable ranking: dutasteride 0.5 mg > finasteride 5 mg > minoxidil 5 mg > finasteride 1 mg. 3

• Dutasteride inhibits both 5α-reductase type I and II isoenzymes versus finasteride's type II only, suppressing DHT levels more effectively. 3
• Oral minoxidil 5 mg daily causes hypertrichosis and cardiovascular symptoms in a dose-dependent manner. 3
• Dutasteride has a plasma half-life of approximately 5 weeks versus 4.5 hours for finasteride, requiring longer washout periods. 3

Low-Level Laser Light Therapy

• FDA-cleared HairMax LaserComb is superior to placebo (P < .00001) for promoting hair growth in men with androgenetic alopecia. 2

Adjunctive Considerations (Limited Evidence)

• Check TSH, vitamin D, zinc, and ferritin levels and correct deficiencies before initiating treatment. 10
• Biotin (2.5-2500 mg daily) or orthosilicic acid (10 mg daily) may stimulate hair growth but are not generally recommended due to weak evidence. 10
• Spironolactone is not recommended because the risk-benefit analysis does not justify routine use. 10

Critical Clinical Pitfalls

• Women should not use minoxidil 5% solution—it works no better than 2% formulation in women and may cause unwanted facial hair growth. 1
• Minoxidil 5% is not intended for frontal baldness or receding hairline—only vertex (crown) hair loss. 1
• Temporary increase in hair shedding during the first 2 weeks of minoxidil treatment is expected and indicates the medication is working by shedding old hairs to make room for new growth. 1
• Individual response to minoxidil varies based on genetic factors and sulfotransferase enzyme activity in the scalp. 4