Medical Treatments for Hair Loss

Medicines that are claimed to stop hair loss and restore lost hair have been around for a long time. Until scientific research discovered the cause of androgenetic alopecia (see Hormonal Controls of Hair Growth), medical treatments for hair loss were hit-or-miss and sometimes pure quackery. Medical treatments of proven effectiveness began to appear only in recent decades.

As of 2006-2008, there are two medical treatments for hair loss due to androgenetic alopecia approved by the U.S. Food and Drug Administration:

• Minoxidil (brand name Rogaine), and
• Finasteride (brand name Propecia)

Minoxidil
Minoxidil is applied topically (directly to scalp skin) in areas of hair loss. It is available over-the-counter in strengths of 2% and 5%. The 5% strength has been shown to be more effective in both men and women in slowing hair loss and promoting new hair growth. Results of minoxidil's effectiveness in slowing or halting hair loss to some degree in men have ranged from 50% to 80% of men treated, and a lower percentage of men have been reported to experience new hair growth. Minoxidil is ineffective for some men and women who continue to lose hair.

While minoxidil is available without a prescription it is used most effectively in a physician-guided program of hair restoration, after the cause of hair loss has been diagnosed. Treatment with minoxidil is sometimes combined with hair transplantation or other surgical method of hair restoration. In young men under age 30, treatment with minoxidil may be used to slow hair loss until the patient is judged ready to undergo hair transplantation.

Minoxidil's mode of action is not completely understood. It appears to act to prolong the anagen (growth) phase of the hair follicle.

For more information about use of minoxidil in hair restoration, visit the ISHRS website under Medical Hair Restoration for Hair Loss.

Finasteride
Finasteride (brand name Propecia) is a prescribed drug taken orally once a day as a 1 milligram tablet. Its mode of action is well understood, based upon research that documented the hormonal cause of hair loss in androgenetic alopecia. Finasteride inhibits the action of Type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone in the hair follicle. (see Hormonal Controls of Hair Growth).

Dihydrotestosterone is the testosterone metabolite associated with hair loss in androgenetic alopecia. Finasteride should not be taken by women who may become pregnant because of risk for certain kinds of birth defects in the male fetus.

Finasteride has proven highly effective in clinical trials and in medical practice for slowing hair loss in almost all men and stimulating new hair growth in some men. It is used alone, or sometimes in combination with hair transplantation or other surgical hair restoration procedure. For more information, visit the ISHRS website under Medical Hair Restoration for Hair Loss.

A higher-dose form of finasteride (brand name PROSCAR) is approved by the FDA for treatment of benign prostatic hypertrophy (BPH) in men.

Dutasteride (brand name Avodart) is a prescribed drug similar to finasteride, but inhibiting both Type I and Type II 5-alpha reductase. Dutasteride is approved by the U.S. FDA for treatment of BPH in men. It is used in Europe for treatment of hair loss due to androgenetic alopecia. While dutasteride is not approved by the FDA as a hair loss treatment in the U.S., it is sometimes used "off-label" when the use is justified by needs of an individual patient.

Medical treatments for hair loss due to causes other than androgenetic alopecia may require the treatment of an underlying disease such as hyperthyroidism. For more information, visit the ISHRS website under About Your Hair Loss.