What medication can help a patient with hair loss grow hair?

Medication for Hair Growth

Start with topical minoxidil 5% applied twice daily as first-line therapy, and consider adding platelet-rich plasma (PRP) injections for enhanced results if monotherapy proves insufficient after 4-6 months. 1, 2

First-Line Treatment: Topical Minoxidil

Topical minoxidil 5% is the FDA-approved first-line pharmacologic treatment for androgenetic alopecia and must be continued indefinitely to maintain results. 1, 2

Dosing and Application

• Apply 1 mL of 5% minoxidil solution twice daily directly to the scalp 2
• For women, 5% minoxidil foam once daily is also effective and FDA-approved 3
• Hair must be shampooed and detangled before application, with no hair products present 1

Expected Timeline

• Initial results may appear as early as 2 months with consistent twice-daily use 2
• Most patients require at least 4 months before seeing visible results 2
• Temporary increased hair shedding for up to 2 weeks is expected initially as old hairs are replaced by new growth 2
• If no improvement after 4 months, discontinue and consider alternative therapy 2

Efficacy Data

• In women with female pattern hair loss, 5% minoxidil demonstrated superiority over 2% formulation in patient-assessed treatment benefit at 48 weeks 4
• 80% clinical cure rate (increased hair intensity) has been documented in comparative trials 5
• Increases both hair count and hair diameter significantly after 6 months of treatment 6

Alternative: Oral Minoxidil

Low-dose oral minoxidil (1 mg daily) represents an effective alternative for patients with poor compliance to topical formulations, though topical remains preferred first-line. 7, 6

When to Consider

• Patients experiencing scalp irritation from topical formulation 7
• Poor adherence to twice-daily topical application 7
• Difficulty applying topical medication due to hair texture concerns 7

Dosing

• 1 mg daily oral minoxidil shows comparable efficacy to topical 5% solution 6
• Both formulations show significant improvement in hair diameter after 6 months (p < 0.001) 6
• Over 60% patient satisfaction in both oral and topical groups 6

Important Caveat

Topical minoxidil demonstrated better photographic improvement in hair density at multiple scalp locations compared to 1 mg oral formulation, though the difference was not statistically significant 6

Advanced Combination Therapy: PRP with Minoxidil

For patients requiring enhanced results beyond minoxidil monotherapy, combination therapy with PRP injections provides superior outcomes. 1, 8

When to Add PRP

• Poor response to minoxidil monotherapy after 4-6 months 1
• Patients seeking maximal hair density improvement 8
• More severe grades of androgenetic alopecia 8

PRP Protocol

• 3-5 treatment sessions spaced 1 month apart during initial phase 1
• Use 5-7 mL of nonactivated PRP per session 1
• Inject at 0.05 to 0.1 mL/cm² at 1 cm intervals 1
• 90-degree angle, 2-4 mm depth using 30G × 4 mm needles 1
• Maintenance: 1 session every 6 months after initial treatment phase 1

Anesthesia Requirement

Apply pharmaceutical-grade topical anesthetic cream before PRP injection due to significant pain associated with the procedure. 1

Combination Therapy Outcomes

• PRP combined with topical minoxidil 5% is the most effective treatment modality, superior to either treatment alone 8
• Combination therapy achieves 57% median increase in terminal hair density versus 48% with minoxidil alone at 32 weeks 1
• 83% of patients achieve negative hair pull test (reduced hair fragility) with combination therapy 1
• Hair density increased 1.74 times and hair diameter increased 14.3 times in combination therapy groups 8

PRP Technical Details

• Nonactivated PRP shows 31% greater improvement in hair density compared to activated PRP 1
• Target platelet concentration: 1 to 1.5 million platelets per µL 1
• 25% improvement in hair density at 2 months predicts sustained response at 6 months 1

Monitoring Treatment Response

Assessment Methods

• Standardized before-and-after photographs at baseline and follow-up 1
• Trichoscopy to evaluate hair density and diameter 1
• Hair pull test to assess hair fragility 1
• Patient self-assessment questionnaires for subjective improvement 1
• Monitor terminal versus vellus hair ratio as key efficacy indicator 1

Follow-Up Schedule

• Evaluate response at 2,4, and 6 months for minoxidil monotherapy 2
• For combination therapy, assess at 6 months and 1 year 1
• Maximum response typically achieved by 6 months 1

Critical Warnings and Contraindications

Who Should NOT Use Minoxidil 5%

• Women should not use 5% minoxidil solution (use 5% foam or 2% solution instead) as studies show it works no better than 2% in women and may cause facial hair growth 2
• Pregnant or breastfeeding women - minoxidil may be harmful 2
• Children under 18 years old 2
• Patients with hair loss from medications, nutritional deficiencies, hypothyroidism, chemotherapy, or scarring conditions 2

Common Pitfall

Discontinuing minoxidil leads to reversal of all hair growth benefits - patients must understand this is lifelong therapy if effective 1, 2

Alternative Medication: Finasteride (Men Only)

Oral finasteride 1 mg daily demonstrates superior efficacy to topical minoxidil in male androgenetic alopecia, with 80% clinical cure rate versus 52% for minoxidil. 5

Key Points

• More effective than topical minoxidil 5% in head-to-head comparison (p < 0.05) 5
• Side effects include loss of libido in 15% of patients, which resolve upon discontinuation 5
• Not appropriate for women of childbearing potential due to teratogenic effects

Treatment Algorithm Summary

1. Start all patients with topical minoxidil 5% (1 mL twice daily) 1, 2
2. Assess response at 4 months - if no improvement, consider discontinuing 2
3. If partial response or inadequate improvement at 6 months, add PRP therapy (3 monthly sessions) 1
4. For men with poor minoxidil response, consider switching to oral finasteride 1 mg daily 5
5. For patients intolerant of topical formulation, switch to oral minoxidil 1 mg daily 7, 6
6. Maintenance: Continue minoxidil indefinitely + PRP every 6 months if using combination therapy 1, 2