Medical Treatment

Minoxidil (sold under the names Rogaine and Regaine)

Minoxidil was originally used as a medication for people with high blood pressure, but it was discovered that some people who took the drug grew more hair. Experimentation showed that when applied to the scalp Minoxidil reduced hair loss and could possibly cause hair to regrow. Only minimal to moderate results should be expected with Minoxidil. It may work to some extent on the crown but does not work on receding hair lines.

Minoxidil is available as an 'over the counter' medication under the brand name Rogaine and Regaine. It comes in a 2% or 5% solution. The 5% solution is thought to be approximately 50% more effective than the 2% solution. Maximum benefit is seen from 5 months to 2 years with a decrease in effectiveness after this. Minoxidil does not grow hairs in areas that are bald. In the few case that Minoxidil does grow hair the hair tends to be short, fine and similar in texture to 'peach' hair. Once Minoxidil is stopped it's effects are lost quite quickly and any benefits gained will be lost. Side effects of Minoxidil can include contact dermatitis of the scalp which presents as an irritation of the scalp. This is usually solved by reducing the strength from 5% to 2% or taking a break from the treatment.

In women Minoxidil appears to be more effective, especially in younger, pre-menopausal women. Side effects can include contact dermatitis and facial hirsutism (i.e. hair growth on the face). It is advised that only Minoxidil 2% is used as the 5% solution is more likely to cause side effects. Should these side effects develop the medication should be stopped immediately.

Finasteride (sold under trade names Propecia and Proscar)

In 1997 Finasteride (Propecia) received FDA approval in the USA for the treatment of hair loss. The dose is 1mg per day. Finasteride (Proscar) has been used successfully in the USA and Europe for many years to treat enlargement of the Prostate in older men. Finasteride blocks the conversion of testosterone to Dihydrotestosterone (DHT). Finasteride is only available on prescription and can only be taken by men. It is not to be used by females. Like Minoxidil Finasteride has only been shown to be effective against hair loss at the crown. Also like MInoxidil Finasteride only helps some men and, while some men actually regrow hair, it mostly reduces further hair loss. In studies after 2 years results showed that 83% of men taking Finasteride either kept their hair or grew more. Again as with Minoxidil, if Finasteride is stopped, the patient returns to their previous hair loss pattern and all benefits are lost. This medication has certain side effects. Firstly it may cause a lowering of sexual libido in men. This occurs only in 1.8% of men taking the drug (versus 1.3% on a placebo). This side effect tends to go away if the person continues to take the drug (58% of cases). In resistant cases this side effect stops when the drug is stopped. In rare cases Finasteride may cause skin rashes, other allergic reactions, testicular pain and a reduction in the amount of semen. In clinical tests these side effects went away when the subject stopped taking the drug. Women of child bearing age should not handle or have contact with Finasteride as it may cause damage to a developing foetus (baby) should she become pregnant / be pregnant. Some people have expressed concern about the use of Finasteride in men who are planning to have children. The question has been asked whether the taking of Finasteride by the male would cause any abnormalities in the foetus. Studies on pregnant monkeys have suggested that extremely high doses of Finasteride given to the male monkey resulted in no foetal abnormalities. Therefore practically speaking this is not a concern. However, for peace of mind, to present even the tiny theoretical risk, men who are concerned should either stop taking the drug or use condoms to prevent any possible Finasteride exposure during pregnancy. Finally, Finasteride causes an approximate 1/3 decrease in serum PSA (Prostate Specific Antigen). It may also blunt the rise of PSA levels in patients with prostate enlargement and prostate cancer. Since PSA is used as a screening test for the development of prostate cancer, there is a concern that Finasteride may interfere with the detection of the disease. Therefore it is important that you inform your family doctor or GP that you are taking Finasteride so that he / she can take into account any effects Finasteride may have on your PSA. There is evidence to suggest that Finasteride may reduce the risk of developing prostate cancer by up to 25%. As time goes on our comfort with the side effect profile of Finasteride increases. Finasteride has been shown to be a useful addition to hair restoration for a number of reasons. Finasteride works best in the younger candidate who not yet be a suitable candidate for hair transplantation as his hair loss pattern may not yet be established. Finasteride is less effective on the front of the scalp, the area where hair transplantation may offer the greatest cosmetic improvement. Finasteride can stabilise or regrow hair on the crown where hair transplantation may not always be indicated or where sufficient donor hair may not be available to cover this area. Finally the use of Finasteride will often allow the hair restoration surgeon to concentrate on and create more density in the most cosmetically important areas such as the front of the scalp, thereby keeping donor reserves for future hair loss. It is now estimated that one million men in the USA take Finasteride daily. Patients must commit themselves to taking Finasteride for at least 12 months to achieve any appreciable benefit. Also Finasteride must be taken on an ongoing basis to maintain the benefit.

Dutasteride

Another drug, Dutasteride, is shown to inhibit the conversion of testosterone of Dihydrotestosterone (DHT) by inhibiting the type 1 and type 2 enzymes responsible for this conversion. Dutasteride has been shown to decrease levels of DHT by 90% at 2 weeks and 93% at 2 years. To date it has not been approved for the treatment of male pattern baldness.

There is evidence that the simultaneous use of Minoxidil (Rogaine) and Finasteride (Proscar) has an additive or synergistic affect on the progression of hair loss in men. Therefore it is suggested that using both drugs together has far more beneficial effects than using either drug on it's own.