Thousands of pages have been written about magic hair loss products which will not only stop your hair loss but will also regrow hair.
However, most of those magic products have very little to none scientific proof and the positive cases are anecdotal. Over here, we would like to create a list of the medications that are proven to work by slowing down or stabilising the hair loss or promoting hair growth.
Firstly, we would like to make a big distinction between DHT blockers/antiandrogen medication and what we call Hair Growth Stimulant therapies.
DHT blockers/antiandrogen medication
There are several antiandrogen medications that are in different trial stages which are showing very promising results, but at this point in time, none of these medications have been approved by the FDA for their usage to treat male pattern baldness.
When we say antiandrogen medication, we are referring to medication that acts by blocking the androgen receptor.
On the other hand, when we speak about DHT Blockers, we are referring to medications that are 5α-reductase inhibitors, hence reducing the production of DHT hormone, which is the hormone that causes male pattern baldness.
Finasteride
Finasteride was patented in 1984 and approved for medical use in 1992. It is available as a generic medication.
It works by decreasing the production of dihydrotestosterone (DHT) by about 70%, including in the prostate gland and the scalp.
Each patient is assessed individually as the usage of medication depends on the patient’s age, type of hair loss, whether the hair loss is stable or not, etc.
In most of the cases, the usage of Finasteride and Minoxidil (see below) is recommended and in some cases is compulsory before undergoing a hair transplant surgery.
The results of finasteride can be seen 3-6 months after starting the treatment, but the maximum efficiency of the treatment is generally achieved 18-24 months after having started the treatment.
Adverse effects from finasteride are rare, however, some men experience sexual dysfunction, depression, and breast enlargement.
The most efficient dosage is 1mg/day, however many patients use lower dosages and still observe a remarkable decrease in hair loss. In the last few years, topical versions of finasteride are widely used, however, the efficiency of the topical version is normally lower than the oral version.
Dutasteride
Dutasteride inhibits around 90-95% of the DHT in the body whereas Finasteride does around 70%. The reason for this difference is that Dutasteride inhibits the 5 alfa reductase type I and II, and finasteride only inhibits type II.
5 alfa reductase exists in two forms: type 1 and 2. Type 1 is predominant in sebaceous glands and liver, whereas type 2 is in the prostate, seminal vesicle, and hair follicle.
Dutasteride has not been approved by the FDA for its use against male pattern baldness but it has been used by millions of patients for years.
For hair loss, the recommended dosage is 0.5mg/day. Like in finasteride, side effects are rare. In the last few years, topical versions of dutasteride are widely used, however, the efficiency of the topical version is normally lower than the oral version.
Saw Palmetto - Serenoa Rapens
Theoretically, Serenoa Rapens acts as a DHT blocker in a similar way that Finasteride does. However, the studies carried out to prove its effectiveness haven´t shown the results claimed by the manufacturers.
Hair Growth Stimulant therapies
At the beginning of this page, we spoke about hair growth stimulant therapies. Before we explain in detail some of the most common therapies used nowadays, it is very important to understand that all the therapies listed below do not reduce the levels of DHT in the body; hence, they don´t act against the progression of the male pattern baldness.
Minoxidil
Minoxidil is a medication used for the treatment of high blood pressure and pattern hair loss. It is an antihypertensive vasodilator. It is available as a generic medication by prescription in oral tablet form and over the counter as a topical liquid or foam.
Thanks to its vasodilation properties, it is effective in helping promote hair growth in people with androgenic alopecia regardless of gender.
In recent years, the oral version of minoxidil has become very popular as its efficiency seems to be greater than the topical formulation. A medical prescription is needed in most of the countries to get this medication.
Applied topically, minoxidil is generally well tolerated, but common side effects include itching of the eye, itching, and irritation on the treated area. In most cases, this irritation happens because of the presence of propylene glycol (PG) as a conductor. Formulations without PG can also be found.
In the oral version, side effects are uncommon at the low doses used to treat hair loss. It is important to report side effects to your doctor. These side effects may be: a rapid increase in pulse rate, palpitations, feeling dizzy, shortness of breath, chest pain and fainting.
PRP (platelet-rich plasma)
The treatment with Platelet-rich Plasma is a novel technique that allows to isolate and use the growth factors present in the blood of the patient to boost, accelerate and stimulate the regeneration of tissues.
Surely you have heard about this treatment in sports medicine since it is very common in the treatment of bone, muscle, and joint injuries of elite athletes.
Its application at the capillary level stimulates the formation of collagen, elastin, and hyaluronic acid, also increasing vascularization at the level of the hair follicle, which is why it is indicated to slow hair loss and promote regeneration in patients with moderate hair loss.
LLLT (Low Level Laser Therapy)
Low-intensity light is called low-level laser therapy (LLLT) which stimulates cellular activity in tissues. It is associated with a range of wavelengths from red through to infrared laser light that promotes tissue repair and regeneration.
LLLT has been reported to stimulate hair growth in men and women in androgenetic alopecia (AGA) and was approved by the US FDA in 2007. It is assumed to stimulate anagen phase re-entry in telogen hair follicles (HFs), prolong the duration of anagen phase, and increase rates of proliferation in active anagen HFs.
Based on the study of Pillai and Mysore (2021) LLLT represents a non-invasive, safe, and potentially effective treatment option for patients with AGA who do not respond or are not tolerant to standard treatment of AGA. Moreover, combining LLLT with topical minoxidil solution and oral finasteride may act synergistically to enhance hair regrowth.
LLLT was US FDA approved in 2007 and since then the devices (hats, caps, combs, etc) have gained some popularity. This therapy requires a very consistent usage and as mentioned above, it works very well along with other therapies such as oral finasteride and minoxidil.
Dermarolling
Dermarollers in all their versions (dermapen, dermastamp, etc) work by causing micro-wounds to the skin without significantly damaging the skin barrier. These micro-wounds heal quickly, leading to stimulation of collagen and elastin fiber production, which can improve the appearance of the skin.
These products may also help improve how medication reaches the skin, as micro-injuries allow medications to penetrate the skin barrier more easily.
This collagen, elastin fiber product, increase of blood supply, and growth factors may stimulate the growth of the hair in the areas where the treatment takes place.
One of the more common questions is the right length of the needle for each patient. The shortest answer would be that the target area of the skin is between 1-1.5mm under the skin. Also, it is important to note that many users will experience a temporary shed in the areas treated. Twice or three times a week, it will be the very maximum recommended.
Based on the study from Dhurat et al. (2013) Dermaroller along with the Minoxidil-treated group was statistically superior to Minoxidil-treated group in promoting hair growth in men with AGA for all 3 primary efficacy measures of hair growth. Microneedling is a safe and promising tool in hair stimulation and is also useful to treat hair loss refractory to Minoxidil therapy.
After going through the most common medications and therapies used against male pattern baldness, as a final note, it is paramount to understand that a hair transplant surgery is the last resource within a hair restoration process. It is utterly important to achieve hair loss stabilisation prior to the surgery to achieve the best and longest lasting result with the procedure.