What is the best treatment for male androgenetic alopecia (male pattern baldness)?

Best Treatment for Male Hair Loss (Androgenetic Alopecia)

For male pattern baldness, start with oral finasteride 1 mg daily combined with topical minoxidil 5% twice daily, as these are the only FDA-approved medications proven to arrest hair loss progression and stimulate regrowth in men. 1, 2

First-Line Medical Treatment

Combination therapy with finasteride plus minoxidil provides superior results compared to either agent alone and should be the standard approach for men seeking maximal hair regrowth. 2, 3

Oral Finasteride

• Start with finasteride 1 mg daily (FDA-approved dose) as the cornerstone of treatment, as it directly blocks DHT production and prevents further miniaturization of hair follicles. 2, 3
• Dutasteride 0.5 mg daily demonstrates superior efficacy compared to finasteride, particularly in the frontal scalp region, though it lacks FDA approval for this indication. 3
• Expect results at 4-6 months minimum; treatment must continue indefinitely as discontinuation reverses all benefits. 4, 5
• Sexual side effects are the primary concern among patients, though clinical trials demonstrate safety. 3

Topical Minoxidil 5%

• Apply 1 mL of minoxidil 5% solution twice daily directly to the scalp in areas of thinning. 1, 2
• Results may appear as early as 2 months, but most men require at least 4 months of consistent use before seeing improvement. 1
• Initial increased shedding for up to 2 weeks is expected and indicates the medication is working by replacing old hairs with new growth. 1
• New hair initially appears as soft, downy, colorless "peach fuzz" that gradually thickens over time. 1
• Minoxidil 5% is significantly more effective than the 2% formulation in men and should be the preferred concentration. 1, 2

Alternative Medical Options

Topical Finasteride

• Consider topical finasteride 0.25% daily for men concerned about systemic side effects, as it produces less dramatic decreases in serum DHT while maintaining efficacy. 3
• This option has gained popularity as an alternative to oral therapy with demonstrated effectiveness in clinical trials. 3

Oral Minoxidil (Off-Label)

• Start with oral minoxidil 2.5 mg daily, potentially increasing to 5 mg daily based on response, for men who cannot tolerate or comply with topical application. 3
• Hypertrichosis (unwanted body hair growth) is the most common side effect, with dizziness and lower limb edema occurring less frequently. 3
• This route lacks FDA approval but multiple clinical studies support its effectiveness. 3

Advanced Treatment Options

Platelet-Rich Plasma (PRP)

• Reserve PRP therapy for men who fail to respond adequately to medical treatment after 6-12 months, using a protocol of monthly sessions for 3 months initially. 4, 3
• PRP demonstrates improvement in hair count in clinical trials, though heterogeneity in protocols limits direct comparison of efficacy. 3
• Combining PRP with topical minoxidil produces superior results compared to either treatment alone. 6

Low-Level Laser Therapy (LLLT)

• LLLT devices (630-660 nm wavelength) used for 15-30 minutes daily represent the only FDA-cleared non-pharmaceutical option for androgenetic alopecia. 2, 7, 3
• Meta-analysis confirms LLLT is superior to placebo (P < .00001) for promoting hair growth in men. 2
• Evidence supporting LLLT is more robust than other physical therapies, though direct comparisons with medical treatments are lacking. 7, 3

Treatment Algorithm

Follow this stepwise approach:

1. Begin all men with oral finasteride 1 mg daily plus topical minoxidil 5% twice daily immediately upon diagnosis. 2, 3
2. Evaluate response at 4 months minimum; continue treatment if any stabilization or improvement is noted. 1, 5
3. If inadequate response at 6-12 months, consider switching to dutasteride 0.5 mg daily or adding PRP therapy monthly for 3 sessions. 3
4. For men intolerant of oral finasteride, substitute topical finasteride 0.25% daily or add oral minoxidil 2.5-5 mg daily. 3
5. Consider LLLT as adjunctive therapy at any stage for men seeking additional benefit. 2, 7
6. Refer for hair transplant surgery combined with continued medical therapy for advanced cases or those desiring immediate cosmetic improvement. 5

Critical Pitfalls to Avoid

• Never discontinue treatment once results are achieved, as all benefits reverse completely within months of stopping medication. 1, 5
• Do not wait to see "how bad it gets" before starting treatment—early intervention produces optimal outcomes as miniaturized follicles become irreversibly damaged over time. 5
• Avoid stopping treatment during the initial 2-week shedding phase with minoxidil, as this temporary increase in hair loss is expected and necessary for regrowth. 1
• Do not use minoxidil 2% in men, as the 5% concentration is significantly more effective. 1, 2
• Recognize that androgenetic alopecia is progressive—current treatments arrest progression and allow partial regrowth at best, not complete restoration. 5

Important Limitations

The provided guidelines 8 address alopecia areata (an autoimmune condition causing patchy hair loss), not androgenetic alopecia (male pattern baldness), and therefore their recommendations regarding intralesional corticosteroids and contact immunotherapy do not apply to this question. 8

Treatment works best for men with recent onset hair loss and less extensive balding; those with complete baldness or hair loss for many years are less likely to respond. 1, 5