90% of men will experience hair loss at some point in their lives, often resulting in low self-esteem, anxiety, and depression. Hair loss can mean a shrinking hairline, spreading baldness on the crown of the head, or extremely thin hair that is most noticeable at the hair part.
Few studies have been conducted on which nonsurgical treatments for male-pattern baldness are the most effective, leaving men unsure of the best solution.
A meta-analysis of 23 studies aims to shed light on this topic. The study, published recently in the journal JAMA Dermatology, assessed research on the impact of varying dosages of minoxidil, dutasteride, and finasteride on male hair thinning when used for two to four months.
Dr. Anthony Rossi, a dermatologist at Memorial Sloan Kettering Cancer Center in New York City who was not involved in the study, commented on the findings: “This meta-analysis is important. We don’t have randomized clinical trials that compare these medications for male pattern baldness against one another, which would be ideal”.
#1: The analysis revealed that 0.5 milligrams per day of oral dutasteride had the best odds of preventing hair loss in men.
The U.S. Food and Drug Administration has approved dutasteride for the therapies of enlarged prostate glands in men. It is also used to treat male-pattern baldness, but this is considered “off-label” use because dutasteride is not FDA-approved as a hair loss treatment.
Off-label use is every day in medicine, according to Rossi. “Many medications are used off label, but there’s usually enough evidence out there to explain why we believe those drugs will work,” he mentioned.
Beware – Dutasteride has more severe side effects than other treatments, including decreased sexual desire and the inability to maintain an erection.
#2: The study found that taking 5 milligrams of oral finasteride per day was second in effectiveness. Finasteride, a prescription medication in the same chemical class as dutasteride, is also used to heal enlarged prostate, and the FDA has approved it as a medicine for hair loss.
At 48 weeks, Finasteride also generated a significant increase in total hair count. A total hair count is exactly what it sounds like: a count of all the hair types on a person’s head, including the fine-grained baby hairs or “peach fuzz.”
#3: A medication containing 5 milligrams of oral minoxidil was the third-most effective treatment for male pattern baldness. After two months, this pill produced a significantly more significant uptick in “terminal” hair count than the lower dose.
Rossi stated that this effect is something that many people strive for: “Terminal” hairs are the more mature hairs on the head (as compared to new, fine baby hairs) and are more likely to create that ‘full head of hair.”
#4: The study found that a daily dose of 1 milligram of finasteride ranked fourth in its ability to prevent male pattern baldness. Forty-eight weeks’ worth of tests showed the highest increase in the number of mature hairs.
#5 (and lower): A topical minoxidil solution of 5 percent applied to the scalp ranked fifth in efficacy, accompanied by a 2 percent solution. As per the study, a much smaller dose of oral minoxidil — only 0.25 milligrams per day — was the least effective.
Downsides: While the study ultimately ranked the treatments in descending order, each treatment had various benefits during the 24- and 48-week cycles, and each has its own unique negative impacts.
Professor of dermatology at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, who has not been involved in the research, Dr. Amy McMichael, stated: “In general, topical medications are going to have less systemic side effects than oral drugs, but topical treatments can be more laborious to use. The best medication is the one that the patient will be compliant with since we are still much better at keeping the hair they have than turning back the hands of time”.
Insufficient effective hair loss treatments
Rather than replacing hair with pricey hair plugs and other intrusive surgical techniques, the pinnacle of treatment is to stop hair loss in its tracks. Unfortunately, there is no single optimal option, according to experts.
Minoxidil is the most well-known remedy for both men and women, and it is available without a prescription in liquid, foam, and shampoo form. Minoxidil requires a twice-daily application to the scalp, and some users complain that it leaves their hair sticky and difficult to style.
The scalp may experience itching or burning sensations and dryness, scaling, and flaking. It takes many months for the expected results to show up, and hair loss comes back rapidly once treatment is discontinued.
According to Rossi, Dutasteride can cause severe side effects in particular men, including libido loss, erectile dysfunction, and orthostatic hypotension.
On rare occasions, dutasteride can cause more severe side effects. Experts recommend calling a doctor or going to the emergency room in the event of skin peeling, redness, swelling of the tongue and throat, trouble breathing or swallowing, or breast changes such as enlargement, lumps, pain, or nipple discharge.
Experts recommend that older men discuss their prostate cancer risk with their physicians before beginning dutasteride. The medicine may raise the risk of high-grade prostate cancer, which also grows and develops more rapidly than other types of prostate cancer.
Finasteride can also affect male sexual performance, but it is less impactful than its cousin dutasteride so it may be a better option for some men.
Rossi advised contacting a dermatologist who deals exclusively in hair loss treatment for assistance navigating the confusing maze of hair loss treatment options. Frequently, he stated, your physician will advise you to begin slowly:
“Many people take a stepwise approach. They may start on finasteride and if they’re not improving on finasteride, then go to dutasteride. Or they may start on topical minoxidil and If they’re not doing well then progress to oral minoxidil.”
McMichael emphasized that none of the study’s findings should be utilized by women with hair loss. Approximately 50% of women suffer from hair loss at some point in life:
“The studies of all these medications in women have been much less extensive, and there is no basis to say that the efficacy would be the same. In clinical practice, many of these medications are used off label in women, but there are some very real concerns.”
McMichael stated that none of the oral meds are suitable for women of childbearing age due to the possibility of pregnancy:
“The only medications evaluated here that have been approved for use in women are minoxidil 2% and 5%, and of the two, we know 5% works better than 2%. I would not extrapolate the findings discussed in this paper to women.”
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