In the modern age of hair loss treatment, hair transplant surgery is not a solution to all the problems. It solves the issue of the lost hair and restores them at some level, but it is also vital to preserving the existing hair as well. The pattern or frame created during the hair transplant surgery is designed according to a hair loss pattern patient had at that particular moment.
A couple of years later, the patient can be admitted again with a new ongoing hair loss, and the frame created during the first surgery may not be actual anymore. And to preserve the existing hair, keep them away from shedding off can be reached with medical treatment of hair loss.
1mg Finasteride tablet used daily is a potent 5α-reductase type-2 inhibitor. It inhibits the conversion of testosterone to Di-Hydro Testosterone (DHT); in this way, the levels of DHT decreased by about 50 – 65%.
It is the most potent known medications for hair loss, which showed an impressive effect both in blocking further hair loss and inducing re-growth. We see most of the results on the crown area; however, frontal areas benefit from it too. Five-year researches and follow-ups showed that over 85% of men stabilized or improved. It is one of two medications approved by an FDA for male pattern baldness (MPB).
Unlike in males, the FDA did not approve finasteride use in female pattern baldness. Finasteride is contraindicated, especially in women of the child-bearing age, because it may cause fetal abnormalities.
Some recent studies suggest Finasteride may have some benefit in women of both pre and postmenopausal periods. And according to these reports, Propecia was used off label for hair loss in women of these ages.
The most common concerns men have regarding finasteride use are its’ side effects. The possible side effects are; sexual side effects, gynecomastia, and decreased sperm count. Numerous double-blind studies showed that the incidence of sexual side effects is very low and less than 4.5%. The critical point is that these side effects are reversible after usage stopped.
Dutasteride is another 5∞-reductase inhibitor that blocks both types 1 and 2 versions of the 5α-reductase enzyme. The additional blockade of the type 1 enzyme decreases levels of DHT for more than 90% and is more effective than Finasteride. However, it has a very long half-life, and the side effect profile worse than that of Finasteride. It is not released for the treatment of male pattern baldness, yet some hair transplant clinics use it off the label on patients that are not responsive to Finasteride with a warning about the potential side effects. FDA did NOT approve Dutasteride for MPB treatment.
Minoxidil is a topical FDA approved medication for both male and female pattern hair loss. It is currently available as 2% – 5% liquid, and 5% foam.
It is a direct anagen-prolonging agent. It works for both males and females. The packaging insert states it is for the vertex, but it works in both the front and crown areas. Our clinical experience and experience from colleagues suggest, on average, approximately 50% of male patients’ hair loss has slowed or stopped, 20% showed some signs of the re-growth, and 30% had minimal or no effect.
Compliance was a big problem with minoxidil due to irritation, and the original product was oily and messy due to propylene glycol. The new 5% foam products contain no propylene glycol, so it became much easier to use, and compliance is much higher by the patients. FDA recently approved minoxidil for Female Pattern Baldness as a once a day therapy.