Male Pattern Baldness
Mild to moderate male pattern baldness affects about 50% of men by age 50. Hair loss in men is a physiologic reaction induced my androgens (male hormones) in genetically predisposed men. The mode of inheritance does not follow a predictable pattern, so a person is not necessarily destined to go bald just because their father or grandfather was bald. Male pattern balding specifically refers to recession of hair first in the front above the temples, often accompanied by hair loss in the central part of the frontal hairline. As this progresses, density of hair is then lost at the top of the scalp.
Patients who begin balding at an early age are most distressed and are tempted to consult nonphysician “experts” at hair clinics. These clinics offer a variety of topical preparations, none of which has any value whatsoever. Patients who seek advice for hair loss should be warned not to become involved in these long-term and expensive programs. Selected patients may be referred for hair transplants, plastic surgical rotation flaps, or even wigs or weaves.
Medical Treatments for Male Pattern Baldness
Currently, there are only 2 FDA-approved medical treatments for male pattern baldness: Minoxidil (brand-name Rogaine) and Finasteride (brand-name Propecia). Topical Minoxidil was approved for the treatment of male-pattern baldness in 1988. A month’s supply of the 2% or 5% solution comes with a dropper applicator. The medication is applied to a dry scalp twice a day. The hair should not be wet for at least an hour afterward. Ideal candidates are men under 30 who have been losing hair for less than 5 years. About one-third of these patients grow hair that is long enough to be cut or combed. Minoxidil works best on hair loss on the top of the scalp. Hair growth is evident in 8 to 12 months. The solution must be used continually to preserve growth. Minoxidil may stop or retard the progression of male-pattern baldness. Adverse effects are limited to local intolerance in a few patients and allergic reactions to Minoxidil and the vehicle used.
Finasteride is the first and only FDA-approved oral medication for the treatment of male pattern baldness. Unlike minoxidil, which is sold over-the-counter, finasteride is available only by prescription. It works by blocking the formation of an androgen called DHT that is found in increased levels in a balding scalp. Taking one pill a day for 6-12 months has been shown to increase hair growth both at the top of the scalp and the mid-scalp region. Studies have shown that around 90% of men who take finasteride will stop losing more hair, and around 65% of men will show new hair growth. The drug is most effective in men between the ages of 18 and 41 with mild to moderate male pattern baldness.
Like all prescription products, finasteride may cause side effects. In clinical studies, a very small number of men experienced certain side effects, such as less desire for sex or erectile dysfunction. Each of these side effects occurred in less than 2% of men. These side effects were reversible and went away in men who stopped taking finasteride. They also disappeared in most men (58%) who continued taking finasteride.