One medication, Propecia (finasteride), is typically prescribed for men only, due to possible side effects when taken by pregnant women. Another, Rogaine (minoxidil), is useful for treating both men and women. The last two, high-estrogen oral contraceptives and aldactone
The single most effective medication proven to treat genetic pattern
hair loss is Propecia. It is prescribed for men with a genetic predisposition
to hair loss (male pattern baldness). Propecia is the brand name for the drug finasteride. Finasteride is a prescription medication
that was first approved by the United States Food and Drug Administration (U.S. FDA) for treating enlarged prostate glands. To the delight of some patients taking finasteride for enlarged prostate glands, a side effect of this medication was decreased hair loss, and often re-growth of hair recently lost.
In 1998, after years of additional testing as a hair loss treatment, finasteride was also approved in pill form, at a lower dosage, as an anti-baldness treatment. It is sold as a prescription prostate medication
in five-milligram tablet form under the brand name Proscar. For treatment of hair loss, it is sold in one-milligram tablets under the brand name Propecia. For treating baldness, the lower dosage is adequate. The hair loss reduction effect of Propecia occurs at a much lower dosage than that needed to treat enlarged prostrate glands.(spironolactone) are generally prescribed for women only, due to the risk of undesirable feminizing side effects in men.
Finasteride effectively blocks one form of the 5-alpha-reductase enzyme that converts testosterone into DHT. By blocking the conversion
of testosterone into DHT, Propecia prevents the “hair loss message”
from getting to hair follicles that are genetically programmed to be sensitive to DHT. This helps stop further hair loss, and in many cases regular Propecia use actually results in significant hair re-growth of recently lost hairs.
Without Propecia, testosterone in the blood is converted freely by the enzyme 5-alpha-reductase into a form of testosterone called dihydrotestosterone (DHT). In men susceptible to pattern hair loss, certain scalp hair follicles are genetically predisposed to respond in a negative ways to elevated levels of DHT in the bloodstream. The most susceptible hair follicles are typically located at the temples, front, and top of the head, but all hair follicles may eventually be influenced to some degree by normal DHT levels. One negative response to DHT is a shortening of the growing phase of the hair follicles, and another is the progressive miniaturization of the hair follicles, which causes miniaturization of the hairs they produce. The end result is shorter and smaller hairs, and fewer and fewer hair follicles
producing hairs.Propecia blocks a form of 5-alpha-reductase found primarily in the prostate gland, called type-II 5-alpha-reductase, from converting testosterone to DHT. The result is lower levels of DHT in the blood. Over many years, DHT in the bloodstream signals hair follicles to shorten their growing phase and to miniaturize. By reducing the amount of DHT in the blood, Propecia reduces the strength of the DHT hormone message, so many of the follicles that would have quit instead continue to produce new hairs.
A single one milligram Propecia tablet taken daily is the usual prescribed dose for hair loss treatment. Propecia is a treatment, not a cure. This means that a pill must be taken every day for the benefits to continue. When Propecia is discontinued, the hair loss process resumes.Propecia is for men only, and is not approved by the FDA as a hair loss treatment for women or children. A woman taking finasteride would have only a small decrease DHT levels because most of the effect of finasteride is on type-II 5-alpha-reductase that is primarily made in prostate glands. Women who take finasteride and become pregnant may cause a male fetus to develop ambiguous genitals, and have female characteristics until puberty (at puberty, the child’s genitals
Research on minoxidil’s potential as an anti-baldness medication
started after some Loniten patients noticed substantial new hair growth, a condition doctors call hypertrichosis. Usually the new hair growth was on the head and was desirable, but in some cases it also occurred on the arms, back, chest, and other areas. So researchers worked on a lotion form of the medication that could be applied to the scalp or face to direct new hair growth only where it was wanted.
Starting in 1988, Rogaine lotion was available only by prescription,
and only in a two percent concentration. In 1995, the FDA decided minoxidil lotion was adequately safe for use without a prescription
and Rogaine was soon available over-the-counter in pharmacies
and grocery stores. Generic versions of Rogaine became available when the patent on minoxidil expired, and the range of concentrations
increased up to five percent. Most people using minoxidil lotion choose the five percent strength lotion, because it produces slightly faster results than the two percent concentration.
Researchers are not certain exactly how minoxidil works to stop hair loss or increase hair growth. It is known that it does not affect DHT levels in the blood. Minoxidil is a vasodilator, meaning it helps blood vessels enlarge. Other vasodilators, however, do not stop hair loss or increase hair growth.
Minoxidil lotion seems to work only on active hair follicles still capable of producing some hair, even if the hair produced is just “peach fuzz.” One symptom of people with genetic pattern hair loss is the progressive miniaturization of hair follicles at the end of each growth cycle, resulting in finer and finer hairs being produced.Minoxidil lotion is applied on the scalp two times each day. The lotion form of the drug causes the hair-growing effect to take place on the scalp only, and not on other parts of the body. There is no effect on blood pressure when applied as directed. Rogaine is a treatment, not a cure. This means that the lotion must be applied to the scalp twice a day for the benefits to continue. Skipping a day or two occasionally
is not likely to cause any measurable difference in the effectiveness
of minoxidil treatment. After several months of discontinued use, however the regrown hairs are likely to be shed.The most common side effect when used as directed is minor scalp irritation. In clinical studies involving 6,000 men and women about seven percent of those using two percent strength Rogaine lotion experienced some degree of scalp itching, inflammation, dryness, or flaking. A smaller percentage of patients experience an increased pulse rate.
HIGH ESTROGEN ORAL CONTRACEPTIVES
Women inherit a tendency for pattern hair loss just as men do. But in women the DHT message is usually blocked by relatively high levels of estrogens circulating in the blood. Estrogen levels begin to decline as women begin perimenopause around age forty, and by age fifty-five to fifty-eight most women are in menopause. While testosterone
levels usually decline along with progesterone and estrogen, the DHT message may finally start to get through, and thinning hair can result.
Birth control pills contain a combination of synthetic estrogen and progesterone hormones. Since they were first introduced in 1960, the estrogen component of oral contraceptives has been reduced from
After years of testing and clinical trials, in 1988, Rogaine topical lotion became the first medication approved by the FDA for treating genetic hair loss. The medication is a colorless and odorless liquid applied to the scalp. Rogaine is the brand name for the drug minoxidil
when used as a hair loss treatment in lotion form. Before 1988, minoxidil had already been FDA approved in pill form as a prescription
medication for treating high blood pressure. The brand name for minoxidil pills is Loniten. .150 milligrams per pill to .020-.035 milligrams. A birth control pill with .035 milligrams of estrogen is considered a “high-estrogen” oral contraceptive. And for reference, the estrogen level in oral contraceptives
is several times higher than that of most estrogen replacement medications prescribed for certain women after menopause.
The risks of taking oral contraceptives include elevated risk of endometrial (uterine) cancer, and, for older women, an increased risk of cardiovascular complications such as heart attacks and strokes. There may also be a slightly elevated risk of breast cancer.
Aldactone is the brand name for spironolactone, a prescription medication used in pill form for treating women with three common problems seen by dermatologists: acne, hirsutism (too much hair, especially on the face), and androgenetic alopecia. The March 2005 British Journal of Dermatology reported on a study that showed eighty percent of women receiving oral antiandrogens (spironolcatone) could expect to see no progression of their female pattern hair loss, improved chance of stopping their hair loss, or getting some hair back, after taking the medication for a year at 200 milligrams per day.
Spironolactone is for women what Propecia is for men in preventing
hair loss with about the same success rate. A potent anti-androgen, spironolactone binds to DHT receptor sites on hair follicles, thereby blocking DHT from getting its hair loss message to the follicles. This medication is used only for women with androgenetic alopecia (genetic pattern hair loss), because it can produce undesirable side effects in men.
When used as a hair loss treatment, spironolactone is taken as a pill or made into a lotion that is applied directly to the scalp, usually along with minoxidil.
One disadvantage to spironolactone lotion is a disagreeable smell, which is made worse when combined in the same container with Rogaine.