Medical Therapy
Medical Treatments
Minoxidil is an FDA-approved direct stimulator of hair growth. Minoxidil comes in oral and topical formulations. It works in 88-90% of individuals with androgenetic alopecia to slow down the progression of hair loss, rethicken hairs that have thinned, and regrow hairs hat have not been permanently lost. We recommend using the 5% foam once daily for both men and women. The solution is just as effective; however, it contains a potential irritant and some complain that it is too greasy. More effective if used with microneedling or dermaroller, which increases the absorption of minoxidil and increases circulation and collagen production in the area. Low-dose oral minoxidil is given as ¼ of a 2.5 mg tablet to start. It may be more effective than the topical formulation in some individuals. Originally used to treat high blood pressure, it has the side effect of increasing hair growth, which led to the topical formulation. Because topical minoxidil can cause dryness, irritation, and difficulty with compliance, oral minoxidil is a good alternative.
The risk of side effects is low and dose-dependent. Low blood pressure, increased heart rate, and fluid retention can be experienced. Other side effects include increased body hair, chest pain/shortness of breath.
Finasteride or Dutasteride (brand name Propecia or Avodart) is FDA-approved in men alone. However, it may be indicated in post-menopausal women with androgenetic alopecia. It blocks the conversion of testosterone to dihydrotestosterone around the hair follicle. It works in up to 92% of users to stop the progression of hair loss and can also rethicken and regrow hair. 1-2% of men may experience sexual side effects.
Spironolactone is a diuretic that functions as an anti-androgen medication in women. At high doses, it can block hormonal influences of hair loss in women. It is not typically used as monotherapy for hair loss but is usually an adjunct to minoxidil. At higher doses, women can experience irregular periods, muscle cramps, increased potassium, and lightheadedness. Therefore, we typically start at lower doses to gauge tolerability. Dosing typically starts at 50 mg and is slowly titrated up to 200 mg.
Bicalutamide is a newer potent anti-androgen that has been commonly used as a chemotherapy medication. It blocks the hormonal influences of hair loss in men and women. Dosing starts at ¼-½ of a 50 mg tablet and can be slowly titrated up to 1 full tablet.
Low-level laser light stimulation devices, such as the HairMax laser comb/band (we need an associate link for this) can also stimulate hair thickening and regrowth. There are many devices on the market. I typically recommend it as an adjunct to other more well-studied treatments, such as minoxidil and finasteride. It is a good alternative for women trying to conceive and those wanting more natural treatments.
Nutraceutical Supplements Nutrafol and Xtresse are supplements that contain important ingredients for hair growth such as vitamins A, C, E, collagen, turmeric, ashwaganda, and resveratrol. It addresses vitamin and mineral deficiencies as well as inflammation. It is usually taken to decrease shedding in addition to other medical therapies.
Hair Transplant Steps
