You notice that you are beginning to lose hair and you want to halt or reverse hair loss if you can. One of your options is a medical approach to hair restoration—using one of the hair restoration medications that are offered with a claim to stop loss of hair and stimulate hair regrowth. But which one?
Choosing a hair restoration medication can appear to be a forbidding task. Dozens are advertised on the World Wide Web and in magazines or other print media. Some are “herbal”, some are “all natural”, some are pharmaceutical agents, and most are “proven effective”. What criteria should you use to choose among all of the products offered?
The gold standard for making a choice is approval of a hair restoration medication by the U.S. Food and Drug Administration (FDA), for use in treating hair loss. Approval of a product by the FDA for treatment of hair loss means that the product has been rigorously tested for safety and efficacy in clinical trials that meet FDA standards for study design, number of persons enrolled in the trials, and statistical analysis of study data.
When your criterion for product choice is FDA approved, your choice is made clear. Just two products for men and one product for women have been FDA approved for halting hair loss and stimulating hair regrowth:
Minoxidil, a topical agent available over-the-counter, and Finasteride, a drug taken by mouth, available only for men by prescription in most countries. A third drug, dutasteride, has as similar mechanism of action and been approved in some countries outside the United States. Although not formally FDA approved, dutasteride is sometime prescribed “off-label” in many countries. Under the brand name Avodart, dutasteride is approved in the many countries for the treatment of benign prostatic hypertrophy (prostate enlargement) in men.
The most effective use of any hair restoration medication is under the supervision of a physician hair restoration specialist. Treatment of hair loss by medical or surgical means is best carried out after the reason for hair loss is correctly diagnosed (Click on About Your Hair Loss). For some persons, medical hair restoration is most effective when carried out in conjunction with hair transplantation or other surgical means of hair restoration.
What are the important things to know about FDA-approved hair restoration medications? Here is a summary at a glance:
Minoxidil (Brand Name Rogaine)(1)
Topical: applied to the scalp as a liquid or foam.
Minoxidil is offered in 2% and 5% concentrations. Use is twice daily for men. Women can benefit similarly from use of either the 2% or the 5 % formula (2). For many women, the foam formulation is aesthetically more acceptable and offers the advantage of being used once daily. Other minoxidil formulations for women are twice daily.
Over-the-counter. Generic minoxidil is also offered under a variety of trade names; it may also be an ingredient in an over-the-counter product.
Rogaine is the brand name for minoxidil before its patent expired and generic versions could be developed.
Mode of Action
How minoxidil acts to slow hair loss and stimulate hair regrowth is not well understood. Minoxidil was first developed as an oral medication to lower blood pressure by dilating blood vessels. Its activity in stimulating hair growth was noted as a side effect. The side effect on hair growth became the basis for development of the hair restoration product Rogaine. Whether minoxidil’s effect in dilating blood vessels contributes to its effect on hair growth is not known.
Studies have shown that minoxidil slows or halts hair loss and promotes hair regrowth in both men and women, at both 2% and 5% formulations. The 5% formulation is generally more effective for men although both formulations are similarly effective for women. (3)Positive response to minoxidil therapy (reduced hair loss and/or hair regrowth) has been noted in from less to 50% to more than 80% of persons treated in various studies. Overall, about 30 % of users would be expected to get a noticeable improvement. Positive response is lost if minoxidil therapy is discontinued. Minoxidil is more effective when applied to defined areas of hair loss, less effective when applied to large areas of hair loss.
Scalp itching is the most common side effect of minoxidil therapy. Hair shedding can occur in the first 6-8 weeks. Unwanted facial hair can occur even if the medication is not applied to the face. Repeated, large applications of minoxidil have been associated with a drop in blood pressure in a few reported cases.
1. For more information on minoxidil, finasteride and dutasteride, click on Medical Hair Restoration: Minoxidil (Rogaine) & Finasteride. For more information on minoxidil clinical trials, click on Two New Studies Confirm Effectiveness of 5% Minoxidil in Treating Male-Pattern Hair Loss.
2. Using Rogaine as a Hair Loss Treatment in Women
3. Using Rogaine (Minoxidil) as a Hair Loss Treatment.
Finasteride (Brand Name Propecia)(1)
Oral: 1 milligram tablet.
The 1 milligram dose is for treatment of male-pattern hair loss. Under the brand name Proscar, a 5 milligram dose is given to treat benign prostatic hypertrophy (prostate enlargement) in men.
By prescription. Finasteride for hair restoration is available under its brand name Propecia.
Mode of Action
Finasteride inhibits the activity of Type II 5-alpha reductase, an enzyme that converts the male hormone testosterone into a more potent form called dihydrotestosterone (DHT). DHT is believed to act on scalp hair follicles to render them smaller in caliber (miniaturized) and ultimately inactive.(2)
Large, multi-year studies have shown finasteride to reduce hair loss and/or stimulate hair regrowth in a majority of men treated.(3) In a 5-year study, 65% of men with mild to moderate male-pattern hair loss were found to have a positive result (hair loss reduced and/or hair regrowth stimulated). Finasteride therapy must be continued to maintain a positive result. Physician hair restoration specialists may combine minoxidil and finasteride therapy to achieve an optimal result in selected patients. Medical therapy may be combined with surgical hair restoration to achieve and maintain an optimal result.
Finasteride should not be used or handled by a woman who is pregnant or who may become pregnant. The drug can cause abnormal development in a fetus. Reported side effects in men include decreased libido (sex drive), erectile dysfunction, ejactulatory problems, male breast enlargement (called gynecomastia) and psychological depression. The possibility of persistent sexual dysfunction even after stopping the medication has been reported but the exact association remains unclear.
1. For more information on finasteride, click on Medical Hair Restoration: Minoxidil (Rogaine) & Finasteride.
2. About Your Hair Loss and What Causes It.
3. Using Finasteride (Propecia®) as a Hair Loss Treatment.
Dutasteride (Brand Name Avodart)
Oral: 0.5 milligram capsule.
Dutasteride is approved by the US FDA for treatment of hair loss.
Available by prescription. Avodart is approved by the FDA for treatment of benign prostatic hypertrophy (prostatic enlargement) in men. Although dutasteride is not approved for the treatment of hair loss, Physicians in the U.S. sometimes prescribe Avodart “off-label” for treatment of male-pattern hair loss, if characteristics of an individual patient warrant such use of the drug. Dutasteride is approved by the Korean FDA treatment of hair loss.
Mode of Action
Dutasteride, like finasteride, inhibits the activity of the enzyme that converts testosterone into dihydrotestosterone (DHT). Finasteride inhibits Type II of the enzyme 5-alpha reductase; dutasteride inhibits both Type I and Type II of the enzyme.
In clinical trials reported, dutasteride has shown a profile similar to that of finasteride in treatment of male-pattern hair loss.
As with finasteride, dutasteride should not be taken or handled by a women who is pregnant or who may become pregnant because of the drug’s potential for causing abnormal development of a fetus. Side effects of dutasteride are similar to those reported for finasteride—decreased libido (sex drive), erectile dysfunction, male breast enlargement and psychological depression.