What medications can improve a man's physical appearance?

Medications That Enhance Male Physical Appearance

For men seeking to improve their physical appearance through medication, the most evidence-based approaches target specific conditions: testosterone replacement for confirmed hypogonadism, finasteride for male pattern hair loss, isotretinoin for severe acne, and phosphodiesterase-5 inhibitors for erectile dysfunction—each addressing key masculine aesthetic concerns.

Testosterone Replacement for Hypogonadism

Testosterone therapy in men with obesity and confirmed hypogonadism produces favorable aesthetic outcomes including weight loss, increased lean body mass, reduced abdominal fat, and improved waist circumference. 1

Diagnostic Criteria

• Morning total testosterone <300 ng/dL (normal range 300-800 ng/dL) measured between 8-10 AM 1
• Frankly low free testosterone by equilibrium dialysis on at least 2 separate assessments 1
• Measurement of sex hormone-binding globulin to distinguish true deficiency from obesity-related low binding protein 1
• Luteinizing hormone and follicle-stimulating hormone levels to distinguish primary from secondary hypogonadism 1

Physical Appearance Benefits

• Reduction in abdominal fat mass and waist circumference 1
• Increased lean body mass and muscle mass 1
• Improvements in body composition parameters 1
• Enhanced energy levels (addressing fatigue that affects appearance) 1

Administration

• Transdermal preparations (gel, patch) are currently the most common method 1
• Treatment should only be initiated after completing full hypogonadism workup to rule out etiologies unrelated to obesity 1

Finasteride for Hair Preservation

Scalp hair maintenance is a chief aesthetic concern among men, and finasteride directly addresses male pattern baldness. 2

Mechanism and Dosing

• Inhibits 5-alpha-reductase, reducing conversion of testosterone to dihydrotestosterone 3
• Standard dosing for male pattern baldness is lower than the 5 mg dose used for benign prostatic hyperplasia 3

Important Safety Considerations

• Sexual dysfunction (erectile dysfunction, decreased libido, ejaculation disorders) may occur and has been reported to persist after discontinuation in rare cases 3
• Male infertility and poor seminal quality reported rarely; normalization may occur after discontinuation 3
• Depression and orgasm disorders reported in postmarketing surveillance 3
• Patients should be counseled about these potential adverse effects before initiating therapy 3

Isotretinoin for Severe Acne

For men with severe nodular acne affecting facial appearance, isotretinoin provides definitive treatment by inhibiting sebaceous gland function. 4

Mechanism and Efficacy

• Pharmacologic doses of 0.5-1 mg/kg/day reduce sebum secretion and sebaceous gland size 4
• Clinical improvement occurs in association with reduced sebum secretion 4
• Must be taken with food to optimize absorption (bioavailability more than doubles with high-fat meal) 4

Practical Considerations

• The decrease in sebum secretion is temporary and dose/duration-related 4
• Reflects actual reduction in sebaceous gland size and inhibition of gland differentiation 4
• Highly lipophilic medication requiring administration with meals 4

PDE5 Inhibitors for Erectile Function

Erectile function is a significant masculine concern, and phosphodiesterase-5 inhibitors demonstrate 73-88% improvement rates compared to 26-32% with placebo. 5

Sildenafil Dosing and Efficacy

• Improvement is dose-related (50 mg superior to 25 mg), though less additional benefit occurs when increasing from 50 mg to 100 mg 5, 6
• At least 5 separate attempts at maximum dose should be completed before declaring treatment failure 6
• Sexual stimulation is necessary for medication efficacy 5

Special Populations

• Men with testosterone deficiency respond less robustly; combining sildenafil with testosterone therapy may be more effective in confirmed hypogonadism 6
• Patients with diabetes and post-prostatectomy have more severe baseline erectile dysfunction but sildenafil remains effective 6
• Most erectile dysfunction patients, including those with controlled hypertension, mild stable angina, and uncomplicated past MI, can safely receive sildenafil 6

Safety Profile

• Common adverse effects: headache, flushing, rhinitis, dyspepsia 5
• Serious adverse events occur in <2% of patients with no significant difference from placebo 5, 6
• Absolutely contraindicated with nitrate therapy due to risk of potentially fatal hypotension 6
• At least 24 hours should pass since sildenafil intake before administering nitrates in medical emergencies 5

Drug Interactions

• Reduce dose to 25 mg when co-administered with CYP3A4 inhibitors (ritonavir, ketoconazole, erythromycin, cimetidine) 6

Male-Specific Aesthetic Considerations

Men focus on three primary facial areas: hairline, periocular region, and jawline—requiring different treatment approaches than women. 7, 2

Key Masculine Aesthetic Principles

• Male beauty balances masculine and feminine features; hypermasculine faces can have negative associations 7
• Men prefer reduction (not elimination) of facial rhytids to maintain appearance of wisdom without fragility 2
• Strong chin with well-defined jawline is central to male attractiveness 8
• Maintenance of lower brow position and flatter arch (avoiding excessive lifting) 8
• Men present with more severe rhytides in unique patterns and increased periocular aging changes 7

Treatment Goals

• Sharp facial contours with strong nose, significant malar-midface structure, and powerful chin 8
• Taut jawline maintenance 2
• Reduction of under-eye bags and dark circles 2
• Natural-appearing results (major concern for male patients) 9

Critical Communication Considerations

A significant communication gap exists for men regarding aesthetic treatments, with limited information available online or by word of mouth. 9

• Men require education about available treatments, safety profiles, and side effects 9
• Addressing concerns about natural-appearing results is essential 9
• Approaches to consultation should differ from female patients based on fundamental anatomical and aesthetic dissimilarities 9
• The concern of feminization is of significant importance to male patients 2