Treatment Options for Men's Hair Thinning (Androgenetic Alopecia)
For men with androgenetic alopecia, start with oral finasteride 1 mg daily or topical minoxidil 5% twice daily as first-line treatment, with finasteride showing superior efficacy in head-to-head trials. 1, 2
First-Line Medical Treatments
Oral Finasteride (Preferred First-Line)
- Finasteride 1 mg daily demonstrates superior efficacy compared to topical minoxidil 5% in direct comparison studies, with an 80% clinical cure rate versus 52% for minoxidil. 2
- This medication works by inhibiting 5-alpha reductase, reducing dihydrotestosterone levels that cause follicular miniaturization. 3, 4
- Results typically appear at 4 months, though some men may require longer treatment duration to see benefits. 5
- Side effects are minimal, with loss of libido reported in approximately 15% of patients (6 of 40 in controlled studies), which resolves upon discontinuation. 2
- Treatment must be continued indefinitely to maintain results, as discontinuation leads to reversal of benefits. 6
Topical Minoxidil 5% (Alternative First-Line)
- Apply 1 mL twice daily directly to the scalp in areas of thinning. 5
- FDA-approved for male pattern hair loss, with meta-analysis confirming superiority over placebo (P < 0.00001). 3
- 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
- Initial shedding for up to 2 weeks is expected and indicates the medication is working by replacing old hairs with new growth. 5
- Most effective for vertex (crown) hair loss rather than frontal baldness or receding hairline. 5
- Scalp irritation is the primary side effect, occurring rarely. 2
Advanced Treatment: Platelet-Rich Plasma (PRP) Therapy
When to Consider PRP
- Add PRP therapy for enhanced results or when response to first-line treatments is suboptimal. 1
- The combination of PRP with topical minoxidil shows the highest increase in hair density compared to either treatment alone. 1, 6
PRP Treatment Protocol
- Treatment phase: 3-5 sessions spaced 1 month apart, using 5-7 mL of PRP per session at 0.05-0.1 mL/cm². 6
- Inject at 90-degree angle, 2-4 mm depth, with injections 1 cm apart using 30G × 4mm needles. 6
- Maintenance phase: 1 session every 6 months after completing initial treatment series. 1, 6
- Apply pharmaceutical-grade topical anesthetic cream before injection due to significant pain. 6
- PRP does not require activation before injection for androgenetic alopecia. 7, 6
PRP Mechanism and Evidence
- PRP induces proliferation of dermal papilla cells, increases vascularization of perifollicular tissue, and accelerates telogen-to-anagen transition. 1, 6
- Higher platelet concentrations (1 to 1.5 million platelets per microliter) correlate with greater hair density and follicle diameter improvements. 1
- Combined therapy with PRP and minoxidil is significantly more effective than minoxidil monotherapy. 7, 6
Platelet-Rich Fibrin (PRF) as Alternative to PRP
- PRF has theoretical advantages over PRP and is safe, easy, time and cost-effective for managing androgenetic alopecia. 7
- PRF showed clinical efficacy with patient satisfaction scores of 7.42 and is particularly valuable for mild cases. 7
- Protocol: 3-5 sessions at 1-month intervals using 5-7 mL per session, with maintenance of 1 session every 6 months. 6
- PRF does not require activation and provides sustained growth factor release through fibrin scaffold. 1
Emerging and Alternative Treatments
Low-Level Laser Therapy (LLLT)
- FDA-cleared devices using wavelengths of 630-660 nm show efficacy in meta-analysis (P < 0.00001). 3
- Recommended usage: three times per week for 15-30 minutes at home. 6, 8
- Evidence is limited compared to finasteride and minoxidil, but represents a non-pharmacological option. 8
Oral Dutasteride
- Dutasteride 0.5 mg induces better responses than finasteride, especially in the frontal area, though not FDA-approved for this indication. 8
- Consider when finasteride response is inadequate after 12 months of treatment. 8
Oral Minoxidil
- Not FDA-approved for androgenetic alopecia, but clinical studies show effectiveness at 2.5-5 mg daily. 8
- Main adverse effect is hypertrichosis (unwanted body hair growth), followed by dizziness or lower limb edema. 8
Monitoring Treatment Response
Assessment Methods
- Use standardized before-and-after photographs taken under identical lighting conditions. 1, 6
- Perform trichoscopy to evaluate hair density per cm² and hair shaft diameter. 1, 6
- Conduct hair pull tests to assess hair fragility (83% of patients achieve negative pull test with PRP plus minoxidil). 6
- Utilize patient self-assessment questionnaires for satisfaction scores. 1, 6
Key Response Indicators
- Increased hair density per cm². 1
- Increased hair shaft diameter (terminal hair density). 1
- Decreased proportion of telogen (resting phase) hairs. 1
- Improved patient satisfaction scores. 1
Critical Treatment Considerations
Common Pitfalls to Avoid
- Low platelet concentration, inadequate injection volume, or insufficient treatment frequency leads to PRP treatment failure. 1
- Inadequate follow-up to assess treatment response results in suboptimal outcomes. 6
- Discontinuing treatment prematurely (before 4-6 months) prevents accurate assessment of efficacy. 5
- Efficacy decreases with severity and duration of alopecia, so early treatment achieves the best outcomes. 6, 4
Patient Selection
- Finasteride and minoxidil work best for vertex (crown) hair loss, not frontal baldness or receding hairline. 5
- Men with more extensive hair loss than moderate thinning may not respond as well to medical therapy alone. 5
- Individual genetic factors significantly influence response to any platelet concentrate therapy. 1