Prescription treatments to effectively reduce hair loss

Few men escape male pattern hair loss. While there’s no permanent cure, you can stop the balding process with finasteride (Propecia), a proven and well-tolerated medication trusted by billions of men. 

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Written by Dr Kimberly Langdon, MD

Information last reviewed 06/21/19

About

Hair loss or baldness is extremely common and affects roughly 50% of men over the age of 40. White males have the highest incidence of hair loss with Asians and African Americans second, followed by Eskimos and Native Americans. Balding generally begins at the forehead and progresses towards the back of the head. The earlier in life that it begins, the more severe the degree of baldness.

Causes

Genetics

Male-pattern baldness is genetic, but it is passed from a mother to her son. Therefore, men often do not show the same hair loss pattern as their father. High levels of androgens (male hormones such as testosterone) can lead to hair loss.

Other causes

It is thought that other factors may be involved in hair loss besides high levels of androgens. Hair loss can also be caused by:

  • Old age
  • Toxic chemicals i.e. chemotherapy
  • Low or high levels of thyroid hormones
  • Iron deficiency
  • Skin diseases affecting the scalp
  • High blood pressure
  • Smoking

Symptoms

The pattern of balding can vary from person to person, but the signs of male pattern baldness include:

  • Gradual onset
  • Hairline recedes from the forehead towards the back of the head
  • Thinning of hair around the side of the forehead
  • Increased hair shedding
  • Change from thick pigmented hairs to thinner and shorter hairs, then to short, wispy, colorless hairs
  • Thinning of hair at the top of the head

You may experience male pattern baldness in any of the following patterns. If you are experiencing hair loss in other patterns, patches or clumps, it may be caused by another condition and it is a good idea to speak to your doctor about this. 

 

Diagnosis

Male pattern baldness is generally diagnosed by asking the patient about the development and progression of their hair loss and by looking at the pattern of hair loss itself. Some lab tests can also be done to identify or rule out any underlying causes of hair loss. The tests can involve measuring the following:

  • Blood levels of androgens such as testosterone or dihydrotestosterone (DHT)
  • Iron levels and the total iron-binding capacity, which measures the blood’s capacity to bind iron with transferrin (a protein involved with transporting iron in the blood).
  • Levels of thyrotropin (aka thyroid-stimulating hormone) to assess for thyroid dysfunction

Trichograms may also be carried out to assess the rate of progression of your hair loss. This involves 50-100 hairs being plucked from the scalp and examined under a microscope to measure different types of hair roots and their shapes on the scalp.

Related Conditions

There are a number of conditions and diseases that can cause hair loss:

  • Old age: As you age, your hair follicles start to produce thinner hairs which can lead to the appearance of hair loss.
  • Toxic chemicals: Exposure to toxic chemicals, such as chemotherapy, can damage the hair follicles, leading to hair loss.
  • Low or high levels of thyroid hormones: Thyroid hormones act on every organ or tissue in the body, so changes in the levels of hormones can have a variety of effects. For example, when thyroid hormones are too low, the growth of any tissue can be affected, causing brittle nails, dry skin, fatigue and hair loss. However, if you are being treated for a thyroid problem, it can often be difficult to tell whether the hair loss is caused by the thyroid disorder or by the medication used to treat it.
  • Iron deficiency: Iron (ferritin) helps to produce hair cell protein and is essential for maintaining healthy hair. Therefore, a deficiency in iron can lead to decreased hair quality and hair loss.
  • Skin diseases affecting the scalp: Diseases that affect the scalp can damage the hair follicles leading to hair loss.
  • High blood pressure: There is a strong association between high blood pressure and hair loss, but the nature of this relationship is not fully understood.
  • Smoking: Smoking is thought to cause increased hair loss, but the mechanism by which this occurs is not yet known. Theories include that smoking may damage blood vessels that supply the hair follicle, or that smoking may damage DNA within the hair follicle itself.
  • Inflammation: A study by Kaya Erdogan et al. demonstrated that younger men with early-onset baldness have a higher level of inflammation than those without baldness. Inflammation can cause oxidative stress (an imbalance in chemicals in the body that can cause cell damage). The researchers found the highest levels of oxidative stress in older patients who had had baldness for the longest time, suggesting a link between oxidative stress and baldness.
  • High cholesterol and triglycerides: Cholesterol and triglycerides are types of fat (lipids) found in your blood. High levels of these fats can lead to a range of diseases including heart disease. A study has found a link between high levels of these fats and baldness, although it is not yet known exactly how these factors are related.
  • Stress: We do not know exactly why stress can contribute to hair loss, however it is possible that it is related to the fight or flight response. During periods of stress, your cortisol levels are increased. Cortisol is another androgen and androgens often have a negative effect on hair growth.

Hair loss can also predispose you to other conditions such as:

  • Skin cancer: Men with significant hair loss are at greater risk of their skin being damaged by sunlight, which can lead to skin cancers. It is a good idea to wear a hat or use high factor sunscreen to protect yourself.
  • Prostate enlargement: Balding can be caused by having a high level of certain hormones called androgens. One of these androgens is dihydrotestosterone (DHT), which is also a cause of prostate enlargement.
  • Kidney stones: One study showed that kidney stones are more common in men with male-pattern baldness and the risk gets higher as the hair-loss increases.
  • Other conditions associated with male-pattern baldness are obesity, infertility, insulin resistance, and metabolic syndrome.

Therefore, if you do experience baldness, it is a good idea to be aware of the symptoms of these conditions and to be monitored to prevent the conditions as much as possible.

Treatment

There are two FDA approved medications for male-pattern baldness: Minoxidil and Finasteride.

Finasteride

Finasteride or Propecia is taken orally and can only be used by men. It helps to slow the progression of hair loss and can also cause new growth. Results are usually better towards the back of the head, rather than in the forehead area. It works by reducing the levels of the androgen, dihydrotestosterone (DHT), which is implicated in male pattern baldness. To prevent further hair loss, Finasteride must be continued indefinitely, because stopping it will cause the DHT to rise and hair loss to resume.

Minoxidil

Minoxidil or Rogaine is a topical lotion that stimulates and prolongs hair growth. It is thought to do this by increasing the blood flow to the hair follicles and increasing the size of the follicle and the thickness of individual hairs. Regrowth is better in the back of the head than the forehead and may take up to 4 months to show an effect. To prevent hair loss returning, it is essential to continue the topical treatment indefinitely because stopping it will cause the baldness to return rapidly.

Non-Medicinal Hair Loss Treatments

  • Laser hair loss treatment or a red light hairbrush has had modest success as over-the-counter treatments to regrow hair.
  • Botox injections have been shown to increase blood flow to the scalp, encouraging hair growth.
  • Stem cells, growth factors, herbs, and surgical techniques such as transplantation of hair follicles and micrografting are also available to counter hair loss.

Q&A

Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

  1. Kaya Erdogan H, Bulur I, Kocaturk E, Yildiz B, Saracoglu ZN, Alatas O. The role of oxidative stress in early-onset androgenetic alopecia. J Cosmet Dermatol. 2016 Dec 16. [Medline].
  2. Kim MW, Shin IS, Yoon HS, Cho S, Park HS. Lipid profile in patients with androgenetic alopecia: a meta-analysis. J Eur Acad Dermatol Venereol. 2016 Oct 7. 
  3. Oh BR, Kim SJ, Moon JD, et al. Association of benign prostatic hyperplasia with male pattern baldness. Urology. 1998 May. 51(5):744-8.
  4. Polat EC, Ozcan L, Otunctemur A, Ozbek E. Relation of urinary stone disease with androgenetic alopecia and serum testosterone levels. Urolithiasis. 2016 May 7
  5. Richards KN, Rashid RM. Problems in pattern alopecia. J. Cosmet. Dermatol. 11(2), 131–133(2012).
  6. Tabolli S, Sampogna F, di Pietro C, Mannooranparampil TJ, Ribuffo M, Abeni D. Health status, coping strategies, and alexithymia in subjects with androgenetic alopecia: a questionnaire study. Am. J. Clin. Dermatol. 14(2), 139–145(2013).
  7. Yip L, Rufaut N, Sinclair R. Role of genetics and sex steroid hormones in male androgenetic alopecia and female pattern hair loss: an update of what we now know. Australas. J. Dermatol. 52(2), 81–88(2011).
  8. Sinclair RD, Dawber RP. Androgenetic alopecia in men and women. Clin. Dermatol. 19(2), 167–178(2001).
  9. Yip L, Zaloumis S, Irwin D et al. Gene-wide association study between the aromatase gene (CYP19A1) and female pattern hair loss. Br. J. Dermatol. 161(2), 289–294(2009).
  10. Randall VA. Androgens: the main regulator of human hair growth. In: Hair and Its Disorders: Biology, Pathology, and Management. Camacho FM, Randall VA, Price VH (Eds). Martin Dunitz Ltd, London, UK, 69–82(2000).
  11. Sawaya ME. Differences in the mechanisms of androgen action in hair follicles from women and men with androgenetic alopecia. In: Hair and Its Disorders: Biology, Pathology, and Management. Camacho FM, Randall VA, Price VH (Eds). Martin Dunitz Ltd, London, UK, 153–58(2000).
  12. Ahouansou S, Le Toumelin P, Crickx B, Descamps V. Association of androgenetic alopecia and hypertension. In: Eur J Dermatol. (2007)
  13. Lin-Hui S, Hsiu-Hsi CT. Association of Androgenetic Alopecia With Smoking and Its Prevalence Among Asian Men: A Community Based Survey. Arch Dermatol. (2007)

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