Drugs

Male pattern baldness is a very common experience in the majority of men by the age of 50 years. It can affect any man from 15 to 85 but typically, those aged 25 to 45 find it most upsetting. Unfortunately, baldness is “ageing” and is associated with a loss of sexual attractiveness, just as a man reaches his social peak.

For many men, particularly those with early hair loss, drug treatment alone may be sufficient. Most patients recognise that at some point, they need to do something about it before it gets too thin and obvious, or they can just learn to accept their baldness. Drugs such as Propecia, can help at that time. Every patient has a “comfort level” of hair loss, where further loss is unacceptable. Drugs can delay, stop or even regrow hair from that point.

Drug treatment for hair loss is a very important factor to consider either before considering hair transplant surgery, as the sole treatment or preferably in combination.

Once male pattern hair loss has started, it is clear that the patient has hair cells which are sensitive to dihydrotestosterone ( DHT ). Hair loss is likely to continue unless medication is used to stop it. Keeping your hair is much easier than replacing it and hair transplantation can then be used to add density or restore hair to completely bald areas.

What Drugs are available?

Although many claims are made, there are only a small number of well proven drugs that do work. These are detailed below.

In addition, there are also a large number of “natural” treatments advertised. These are based on herbal combinations. Unfortunately, although it is possible that some of these are effective, no convincing large studies have been performed. The best known herbal treatment is Saw Palmetto which has some evidence to suggest effectiveness in prostate enlargement. However, although finasteride is also used in prostatism, there is no proof that Saw Palmetto works in the same way i.e. by blocking enzymes that make DHT.

Medication (medical treatments)

Propecia

Propecia is currently the most effective licensed drug for treating hair loss. It slows, stops or regrows hair in 88% of men (regrowth in 37%).
The chemical name for it is Finasteride and has been used in hair loss for more than ten years. It needs to be used for at least a year before you can definitely be sure whether it's working although some people will see improvement before this, even by three months occasionally.
The longer it is used for, the better, as each year after the first twelve months, there continues to be a 2-3% improvement until a plateau is reached after five years.
However, 80-90% of the best achievable result will be reached within 12-18 months.

It is known to be a very safe drug which is very unlikely to interact with any other drugs commonly taken ( alcohol, antibiotics, painkillers or even "recreational drugs"). Although there are no long term studies showing serious side effects or indeed, benefits, Finasteride has been used very safely for twenty years as a 5mg tablet in Prostate disease.

It works by "blocking" the action of 5 Alpha 1 reductase which is an enzyme that makes Dihydrotestosterone (DHT) from Testosterone.( see causes of hair loss). Propecia is not itself a hormone. In practice, crown and vertex hair responds best, temporal hair is unlikely to regrow. Only scalp hair responds to Propecia.

Download Propecia Consent Form ( PDF 66 Kb )

"I personally have taken it for 4 years with no side effects but have achieved slight regrowth of frontal hair and crown hair and definitely arrested the ongoing hair loss."

BEFORE

AFTER

Dutasteride

Dutasteride is a tablet which is still undergoing trials in many countries, including the UK, and is therefore not licensed yet.
However, there is much debate going on across the internet about it's effectiveness. The results so far seen suggest that it is more effective then previous DHT inhibitors but also with more side effects.
Some people may accept this risk but with any new medication, we may not have full knowledge of long term side effects.

Minoxidil (Regaine) solution

Minoxidil was used initially in the treatment of high blood pressure but a side effect of increased hair growth was noticed involving all the body, not just scalp hair.
This is not a problem when Minoxidil is used as a solution instead of tablets.
Unfortunately, Minoxidil is not very effective - users can see benefit from reduced hair loss and even some regrowth but most of the hair tends to remain fine, wispy and pale. The solution also tends to cause skin irritation.
However, Minoxidil is readily available and can be more effective when used with Propecia - the two drugs work in different but synergistic ways.