What to do about Male Pattern Baldness?

Male pattern baldness (also known as androgenic alopecia) is a common form of hair loss that affects about 80% of all men by the age of 70 and can start as young as your late teens and early 20s.  It is due to an excessive response to testosterone in the body.  You typically start losing hair at the front and crown of your scalp, or you can have general hairline recession. 

The 2 main phases are hair growth are called “anagen” (hair at its healthiest and is constantly growing) and “telogen” (hair is stagnant and not growing, eventually growing weaker and falling off).  Androgenic alopecia occurs when hair spends most of its time in the telogen phase.  Testosterone in our bodies turns into “dihydrotestosterone (DHT),” which shrinks hair follicles and leads to thinner, weaker and finer hair that will eventually fall out.

Current FDA approved medical treatment is geared towards helping your hair stay in the anagen phase of hair growth and avoiding the telogen phase.   The most common medications that we can prescribe for you at CCFP are as follows:

Oral Finasteride:

Finasteride is an FDA approved treatment for androgenic hair loss.  It was initially marketed as a medication to treat enlarged prostate at a 5mg dosed tablet, but at a daily dose of 1mg, it can help treat androgenic alopecia. It works by stopping the body from converting testosterone to DHT (a Type2 5-alpha-reductase enzyme inhibitor), preventing formation of weaker hair that can fall out (prevents the telogen phase).  It can improve hair growth within 1 year of treatment, more effective at regrowing hair at the crown of the scalp and tends to provide better hair growth for men over age 30 when compared to under age 30.  Potential side effects include erectile dysfunction, low libido, breast formation, low blood pressure, and mood changes. Unfortunately, once you stop finasteride, hair loss will resume within a few months.  

There is also a topical form of finasteride, but it has been found to be more effective in maintaining hair only, not regrowing hair.  It also caused skin irritation.

Topical minoxidil:

Topical minoxidil is also an FDA approved treatment for androgenic hair loss.  It is available as a foam (5% concentration) or a solution (2% and 5%).  It works by dilating blood vessels, leading to increased blood flow to hair follicles and increasing the anagen phase for hair, maintaining healthy growing hair.  Hair growth is expected within 4–8 months of treatment and stabilizes after 12–18 months.   Potential side effects include skin irritation, itchiness, and excessive hair growth.  And like finasteride, when stopping minoxidil, hair loss will resume.  

Oral minoxidil:

Oral minoxidil, while not FDA approved for androgenic hair loss, is starting to gain popularity as a treatment.  Initially used to treat high blood pressure, lower doses are now also used to treat androgenic alopecia.  It is available in 2.5mg and 10mg tablets and the typical daily dose is 1.25 to 5mg daily.   Like topical minoxidil, it dilates blood vessels to allow increased blood flow to your hair.   Potential side effects are excessive hair growth on other parts of the body, low blood pressure, elevated heart rate, leg swelling, and pericardial effusion.  And hair loss resumes once you stop using oral minoxidil.

Other treatments are also available, and your provider at CCFP can help direct you to the proper specialist or pharmacy to get them.

Hair Transplant: 

Patients who do not have success with medical treatment can opt for a hair transplant, which is an in office procedure that is typically performed by dermatologists and plastic surgeons.   It entails moving your own healthy scalp hair to an area of your scalp without hair where it will then grow.  Local anesthesia is used to minimize pain, it usually takes several hours and may necessitate multiple doctor visits.

There are two types of hair transplant techniques: follicular unit extraction (FUE) and follicular unit transplantation (FUT).  In FUE, individual hairs are removed throughout the scalp and transplanted onto areas of the scalp without hair, while FUT involves cutting a single strip of scalp hair, usually from the back and then distributing the hair.  FUE is preferred due to a higher choice of hairs, less pain, less recovery time, and less scaring

Potential side effects include adverse reactions to anesthesia, pain, bleeding, swelling, infection, and dissatisfaction.  Hair growth is permanent after the procedure, but the procedure can cost on average anywhere from $4000 to $20000.  The cost is determined by number of hairs used (usually around 3000-5000 hairs) and cost per hair ($2 to $10 per hair) It may be less expensive overseas, however the quality and results of the procedure may vary.

Dutasteride:

Dutasteride is similar to finasteride as it inhibits 2 enzymes that convert testosterone to DHT. It appears to be more effective than finasteride, however it is not FDA approved and generally not covered by insurance.

Nutrafol and Viviscal:

These are over the counter supplements that can help regrow hair but are generally inferior to finasteride and minoxidil in treating androgenic alopecia.

Platelet-rich plasma:  

This procedure has been shown to be effective.  However, it is fairly invasive and may need several treatments.  It is also generally not covered by insurance and can lead to scalp pain, bleeding, headache, and burning of scalp.

Light Therapy: 

This has also been shown to be effective and you can do daily treatments at home.  However, potential side effects include scalp pain and hives.

Studies are still ongoing to discover the root cause of androgenic alopecia and whether it is strongly associated with diseases such as obesity, diabetes, heart disease, and stroke. It is not a disease that requires treatment, but rather a genetically predetermined disorder.  However, studies do show it can lead to adverse psychosocial effects due to feeling embarrassed and self-conscious about your hair loss.  If you are experiencing androgenic alopecia, from a small amount of thinning to full hair loss, you can schedule an appointment with a provider at City Care Family Practice to go over the best treatment option for you!

References:

“Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics;”  Mark S. Nestor MD PhD, Glynis Ablon MD, Anita Gade DO,  Haowei Han DO and Daniel L. Fischer DO MA;  J Cosmet Dermatol. 2021 Dec; 20(12): 3759–3781. Published online 2021 Nov 6. doi: 10.1111/jocd.14537

“Androgenetic Alopecia: Therapy Update;” Shivali Devjani, Ogechi Ezemma, Kristen J. Kelley, Emma Stratton and Maryanne Senna; Drugs. 2023; 83(8): 701–715. Published online 2023 May 11. doi: 10.1007/s40265-023-01880-x

Image from: https://www.bioyoungwellness.com/2022/10/01/hair-loss-prevention/