What are the available treatments for a male patient with genetic alopecia (male pattern baldness)?

Treatment of Male Pattern Baldness (Androgenetic Alopecia)

Start with topical minoxidil 5% twice daily as your baseline treatment, and add oral finasteride 1 mg daily if you want faster and more complete results, particularly for crown hair loss. 1, 2

First-Line Medical Treatments

Topical Minoxidil 5%

• Apply 1 mL directly to the scalp twice daily, every day, ensuring the medication reaches the scalp surface 2
• You must continue this treatment indefinitely—all hair regrowth will be lost if you stop 3, 1
• Expect initial results at 2-3 months, but some men require 4 months to see visible improvement 2
• During the first 2 weeks, you may experience increased hair shedding—this is normal and indicates old hairs are being replaced by new growth 2
• Minoxidil 5% provides superior hair regrowth compared to the 2% formulation 4, 2
• This is the only FDA-approved topical treatment for male pattern baldness 5

Oral Finasteride 1 mg Daily

• Finasteride demonstrates superior efficacy compared to minoxidil alone in head-to-head trials 1
• This is FDA-approved and blocks the conversion of testosterone to dihydrotestosterone (DHT), the hormone that causes hair follicle miniaturization 6, 7
• If response is inadequate after 4 months on minoxidil alone, add finasteride to your regimen 1
• Early treatment produces better outcomes than waiting until extensive hair loss has occurred 6, 7

Low-Level Laser Therapy (LLLT)

• Use 655-nm wavelength devices 3 times per week at home for 15-30 minutes 4, 3
• This is FDA-cleared and proven effective in meta-analyses 5
• Can be used as adjunctive therapy alongside minoxidil and finasteride 8

Advanced Treatment: Platelet-Rich Plasma (PRP)

Add PRP therapy if first-line treatments produce suboptimal results after 6-12 months, but always continue topical minoxidil alongside PRP. 1, 9

PRP Treatment Protocol

• Use nonactivated PRP only—activation reduces efficacy by 31% 1, 9
• Initial treatment phase: 3-5 sessions spaced exactly 1 month apart 4, 1, 9
• Dose: 5-7 mL PRP per session at 0.05-0.1 mL/cm² 4, 9
• Injection technique: 90-degree angle, 2-4 mm depth, injections spaced 1 cm apart using 30-gauge × 4 mm needles 4, 9
• Target platelet concentration: 1.0-1.5 million platelets per microliter 4, 9
• Apply pharmaceutical-grade topical anesthetic cream before injection due to significant pain 4, 3, 9
• Maintenance phase: 1 session every 6 months after initial treatment to sustain results 4, 1, 9

Expected PRP Outcomes

• Initial improvements visible at 2-3 months, with 25% improvement at 2 months predicting sustained response at 6 months 9
• At 6 months: hair density increases 1.74 times, hair diameter increases 14.3 times, telogen phase hair decreases 9.3 times 9
• Combination PRP plus minoxidil 5% produces 57% median increase in terminal hair density versus 48% with minoxidil alone at 32 weeks 3
• 83% of patients achieve negative hair pull test (reduced hair fragility) with combination therapy 3

PRP Preparation Requirements

• Use manual double-spin centrifugation method 4, 9
• Process autologous blood immediately after collection 9
• Do NOT activate the PRP—nonactivated PRP shows 31% greater improvement in hair density 1, 9

Patient Preparation for PRP

• Shampoo and detangle hair before session with no styling products applied 4
• Map out areas of hair loss before injection 4
• Take standardized before-and-after photographs for monitoring 4, 3

Emerging Alternative: Platelet-Rich Fibrin (PRF)

• PRF shows promise as a potentially superior alternative to PRP with theoretical advantages including lower cost and easier preparation 1, 9
• Similar efficacy and safety profile to PRP 9
• Same treatment protocol as PRP can be applied 4

Treatment Algorithm

1. Start immediately with topical minoxidil 5% (1 mL twice daily) 1, 2
2. Consider adding oral finasteride 1 mg daily from the start for superior results, or add after 4 months if minoxidil response is inadequate 1
3. If response remains suboptimal after 6-12 months of combination medical therapy, add PRP injections while continuing minoxidil 1, 9
4. Consider LLLT as adjunctive therapy at any stage (3 times weekly) 4, 3

Monitoring Treatment Response

Evaluate efficacy using multiple methods: 3

• Standardized before-and-after photographs at consistent angles and lighting 4, 3
• Trichoscopy to measure hair density and diameter 3
• Hair pull test to assess hair fragility 3
• Patient self-assessment questionnaires for subjective improvement 3
• Terminal versus vellus hair ratio as indicator of treatment success 3

Critical Pitfalls to Avoid

• Never discontinue minoxidil once started—all gains will be lost within months 3, 1
• Never activate PRP—activation reduces efficacy by 31% 1, 9
• Never use PRP as monotherapy—always combine with topical minoxidil for optimal outcomes 1, 9
• Do not delay treatment—early intervention produces superior results before extensive follicle miniaturization occurs 6, 7
• Insufficient treatment duration leads to suboptimal outcomes—some patients require extended therapy beyond initial 6 months 3

Treatment Efficacy by Severity

• Mild to moderate androgenetic alopecia responds most favorably to all treatments 9
• More severe grades show variable results, particularly with PRP 9
• Treatment works best for vertex (crown) hair loss rather than frontal baldness or receding hairline 2

Available in Your Location

All treatments discussed (topical minoxidil 5%, oral finasteride 1 mg, LLLT devices, and PRP therapy) are widely available internationally. Consult a dermatologist or hair restoration specialist in your area to access PRP therapy, as this requires specialized preparation and administration. Minoxidil 5% and finasteride 1 mg can typically be obtained through prescription or over-the-counter depending on local regulations.