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Hair Loss Medications

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Hair Loss Medications

Medications serve an essential role in preventing and treating. They are particularly useful in the early stages of the balding process. The FDA approves two medicines for common hair loss (androgenetic alopecia). These are the oral medication Propecia (which contains finasteride 1mg) and the topical medication Rogaine (which contains minoxidil).
Both medications reverse or slow miniaturisation, a hormone-driven process in which hair follicles shrink over time until they eventually disappear. Although both drugs help treat male pattern hair loss, finasteride is far more effective than minoxidil.
Finasteride inhibits dihydrotestosterone (DHT), the hormone directly responsible for miniaturisation. By inhibiting DHT, finasteride increases the length and thickness of miniaturised hair. Finasteride requires a prescription but is available in a generic 1mg dose and a less expensive 5mg dose. Often, patients purchase the 5mg pill and divide it into 1.25mg doses using a pill cutter.
Minoxidil increases the duration of the growth (anagen) phase of the hair follicle growth cycle and can also induce a new anagen phase. This improves the quality of the hair by increasing the diameter and length of the miniaturising hairs. Regaine and generic minoxidil are available in a variety of over-the-counter formulations. The standard doses are the 5% solution, 5% foam (men and women), and 2% solution for women.

How To Use

Medical treatment works best when it is started early because once a follicle completely disappears, the medication cannot regenerate new hair. Therefore, the early diagnosis of male pattern hair loss is important, and, if medical treatment is contemplated, it should be started sooner rather than later.
Medications usually take six months to a year before you can see the results. In the first few months, they may cause shedding, so one needs to be patient to achieve the best outcome. Medications are also most effective when used consistently over the long term. Stopping and starting treatment is not recommended because when you stop, the effects of the medication will wear off, and some of the hairs that are shed may not regrow. If you start again, you may be continuing at a lower baseline.
Propecia is significantly more effective than Regaine in treating hair loss, but they have additive effects when used together. Over 1/3 of patients can expect visible hair regrowth when both are used. In addition, in over 90% of patients, these medications can significantly slow down further hair loss.

Effectiveness on the Front of the Scalp

Since the FDA approved finasteride and minoxidil for use in the crown (the back of the scalp), there is a common misconception that the drugs only work in this area. The fact is that finasteride and minoxidil also work in the front and top parts of the scalp.
The crown usually has hair in the thinning phase for more extended periods than the front part of the scalp, so there is often a longer window of time for the medications to be helpful in re-growing hair in this location. This helps to explain the relatively better response to medication in the back part of the scalp (the crown) compared to the front. That said, medications are equally important in all parts of the scalp to prevent further hair loss.

Medicine vs Surgery

Medications can be used alone or as part of a hair loss treatment plan that includes hair transplantation. Medical therapy works well with hair transplant surgery since they serve different purposes; medical treatments prevent further hair loss, whereas surgery regains lost hair. A hair transplant does not prevent the progression of the balding process like medications do, but it is the only treatment that can restore hair to a very thin or completely bald area.

Side Effects

While side effects from medications and finasteride, in particular, are rare, this is a matter of great interest to hair restoration physicians who have many patients using (and benefitting from) these medications. Therefore, this topic is taken very seriously at HTG clinics, for Hair Restoration.

Oral Minoxidil

Minoxidil is an oral medication that was initially FDA-approved in the 1970s to treat severe and treatment-resistant hypertension (high blood pressure). Doses used for the treatment of hypertension range between 10mg and 40mg daily. At these doses, patients taking minoxidil for blood pressure control were noted to have “hypertrichosis” or increased hair growth (as well as many other side effects). Minoxidil works to increase hair growth by causing a shortening of the telogen (resting) phase and lengthening the anagen (growth) phase of the hair cycle, increasing the hair follicle diameter and length.
Topical versions of minoxidil have been used for decades to help slow genetic thinning, but daily compliance with the application is a barrier to continued use and benefit. In addition, many patients experience scalp irritation from the topical medication. More recently, low doses of oral minoxidil have been used “off-label” to help patients with androgenetic alopecia who prefer daily oral administration over topical application. The oral form should be more effective, but this has not yet been proven in controlled scientific studies.
Clinical experience suggests that oral minoxidil can effectively treat male and female patients with androgenetic alopecia. Minoxidil doses used for hair loss are significantly lower than those used previously to treat hypertension. Most patients will tolerate the medication without significant side effects.
The main reasons to consider oral minoxidil are:
  • 1. It is probably more effective than the topical formulation.
  • 2. When both forms of topical medication irritate the scalp and cannot be tolerated (i.e., the solution and occasionally the foam).
  • 3. When using the topical version is inconvenient or too messy. This is particularly important for women who wash their hair infrequently.
Women
For genetic thinning in women, we prescribe minoxidil in doses of 0.625mg (1/4 pill) or 1.25mg (1/2 pillWomen who are pregnant, or are planning to get pregnant, should not take minoxidil or spironolactone.
Men
In men, we treat genetic thinning with 1.25mg (1/2 pill), 2.5mg (1 capsule) or 5mg (2 tablets) of oral minoxidil daily.
The most common side effect experienced with low-dose oral minoxidil is hypertrichosis (excess hair around the face and body). This hypertrichosis is often mild and manageable by most patients. Other less common side effects include dizziness or fainting (postural hypotension), lower limb swelling/oedema, puffiness around the eyes, blood pressure and EKG changes. A rare complication, more likely seen at the higher doses used to control blood pressure, is fluid accumulation around the heart (pericardial effusion) or lungs. This may present as chest pain, tightness, or shortness of breath. The risk of side effects increases as the dose increases.
All patients taking oral minoxidil should tell the doctor if they have heart disease or blood pressure problems and if they are taking any medication for these conditions.
If the doctor recommends doing so, you should take oral minoxidil with topical minoxidil to increase efficacy.
It takes oral minoxidil from 1 to 3 months to begin to work. Shedding may be noted during the first few months after starting therapy; therefore, you may not see any improvement for six months or more after beginning treatment. It is important not to discontinue the medication for this reason. The benefits of minoxidil will stop if the medication is discontinued. Over the two to six months following stopping, the hair loss pattern will return to the state it would have been if the medication had never been used.

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