Pharmaceutical advances for hair loss have helped a number of both male and female patients. Our office offers these medications in place of or in conjunction with surgical hair transplants, but as you will see from reading about these drugs, they are not as effective or long-term as surgical hair restoration.
This is probably the most well-known medication for hair loss. Also called Loniten, it originated as an oral drug for high blood pressure. It caused serious side effects, however, when taken orally, including heart failure. But studies showed that the drug also caused hair growth on the body, often in places like the backs of the hands.
So, they began to develop a topical solution of the medication to see if it would create hair growth on the scalp without the serious side effects. The result was successful, and Minoxidil was released on the market with the brand name of Rogaine.
The medication works best during the first five to 24 months of use in at least a 5% solution, and results do not usually begin to show before several months of use. It must be used twice per day in order to be effective. It also works best in the back portion of the scalp and only on areas that have some remaining hair. It does not grow hair in areas of the scalp where baldness already exists. The 5% solution is sticky, so many patients prefer to use the 2% solution during the day and save the 5% formula for evening when they are not in public.
Minoxidil is effective in both men and women, but it is not as effective in post-menopausal women or in men who already have a significant amount of hair loss.
The drug also does not produce permanent results. If you read about the causes of hair loss in men, you will learn about the effects of testosterone production. Generally, Minoxidil becomes gradually less effective after about two years of use, as testosterone production overpowers it.
Retin-A is sometimes used topically to increase absorption of Minoxidil, but the use of Retin-A can also increase the chances of developing scalp irritation. For this reason, Upjohn, the maker of Rogaine, says that the medication should not be used with Retin-A or other topical formulas like retinoids, corticosteroids, and petrolatum.
Finasteride inhibits the 5-alpha reductase enzyme so that it blocks testosterone from converting into dihydrotestosterone (DHT), the hormone that causes male pattern baldness. As a result, DHT is reduced in the blood and on the scalp, while maintaining normal levels of testosterone in the body.
The drug was first approved for hair growth in 1998. After two years of use, 83% of the men in the studies either grew more hair or did not suffer further hair loss. The majority of hair growth was in the crown of the head (vertex) rather than the front of the head. The hair that grew was also less fine than the miniaturized hair that balding men frequently see.
Like Minoxidil, Finasteride only works in areas where there is existing hair. The medication has to be continued in order to maintain the results. It is sometimes used as an adjunct treatment to Minoxidil and surgical hair restoration.
In a small number of men who take Finasteride, decreased libido and ejaculate volume are potential side effects. In studies, the percentage of men who experienced sexual dysfunction from the drug has been less than 4%. This dysfunction was reversible, however, within a few weeks after the drug was discontinued. For those men who continued with the drug, the side effects eventually stopped in many of them. Luckily, for men who had to cease using the medication, they only lost the hair that was gained from using it; none of the hair that they had prior to beginning the medication was lost.
An even smaller number of men – less than .05% – developed gynecomastia, a condition that causes the formation of male breasts. Again, the condition went away in the majority of these men after they stopped using Finasteride. It is believed that this occurs in some men because the drug’s blockage of testosterone may cause some of the hormone to be converted into estrogen.
There is some belief, although not proven, that Finasteride might decrease the risk of prostate disease, but it might also hide prostate cancer in screening tests. This is because it reduces PSA (prostate specific antigen), which is measured to determine the presence of cancer. Men who visit a doctor for prostate cancer screening should let their doctor know of their Finasteride use. Men over 40 or with any history of prostate disease should consult with their doctor before beginning Finasteride.
What about Finasteride for women? There is mixed data on this. There have been a few studies supporting the drug’s use, but there are more suggesting that there is no benefit. This drug is only FDA-approved for men at this time. For women of childbearing age, it cannot be used because there is a concern that it could cause birth defects in male babies. In fact, pregnant women are told not to even handle crushed tablets of the drug, although there has been no reported incident of birth defects caused by this. So, the risk is probably not great. In short, although there are some physicians prescribing this medication for women, Dr. Lewis does not recommend it.
Dutasteride is another medication similar to finasteride. This is a stronger 5-alpha reductase inhibitor. It is also a very effective medication to stop and reverse male pattern baldness. There is evidence that it is more effective than finasteride at preventing hair loss.
Unfortunately, this comes at a cost – the side effect profile is not as good. There are higher risks of sexual dysfunction, including impotence (4.7%), decreased libido (3%), ejaculation disorders (1.4%), and gynecomastia (0.5). This medication also has a much longer half-life than finasteride and is detectable in the blood for up to 6 months after stopping the medication.
Both finasteride and dutasteride do affect your risk of prostate cancer. There is a decrease in risk of overall prostate cancer but an increase in risk of high grade prostate cancer. There has been no change in survival rates in patients taking finasteride.