How best to combat hair loss in men?

THURSDAY, Feb. 10, 2022 (HealthDay News) — Nearly all men will see their hairline disappear or a bald spot develop at some point in their lives. For those looking to slow down time, a new study is helping to figure out which hair loss medications work best.

The analysis, from 23 previous studies, ranks available hair loss medications from most effective to least.

Experts said the list is helpful. The drugs – dutasteride, finasteride and minoxidil – have been used for a long time, but there is little information about how they compete in effectiveness.

“We don’t have any studies comparing these drugs,” says Dr. Anthony Rossi, a dermatologist who was not involved in the study.

That has left doctors without a solid answer to the inevitable question, which option works best?

The new research will help fill that gap, according to Rossi of Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, both in New York City.

The best treatment was dutasteride (Avodart) capsules, at a dose of 0.5 milligrams per day. On average, it produced the largest increase in total hair count after six months of use. That means men using it can expect to see more hair showing up where there wasn’t, although that includes smaller, “peach-like” hairs.

Next came finasteride (Propecia) pills, which were taken every day at a dose of 5 mg, followed by the same dose of oral minoxidil (Rogaine).

Not surprisingly, dose and administration mattered, the analysis found. A lower dose of finasteride (1 mg per day) came in fourth, followed by two topical formulations of minoxidil, with the higher dose (5%) outperforming the lower (2%).

At the bottom was a low dose of oral minoxidil, taken as 0.25 mg per day.

However, effectiveness is only part of the story, Rossi emphasized.

“Dutasteride may outperform the others, but it may also have more side effects,” he said. “And we have to advise patients about that.”

Dutasteride can cause loss of libido, erectile dysfunction and breast tenderness, as well as a form of low blood pressure called orthostatic hypotension. In rare cases, men may experience severe reactions to the drug that require medical attention, including peeling skin, facial swelling and difficulty breathing.

Finasteride can also dampen libido or cause breast tenderness, but only in a minority of patients, said Dr. Amy McMichael, a professor of dermatology at Wake Forest Baptist Medical Center in Winston-Salem, NC.

When a healthy person has hair loss, the goal is to increase hair density while maintaining that good health, said McMichael, who was not involved in the study.

“In general, topical minoxidil, oral finasteride and oral minoxidil are well tolerated by most patients and do not cause side effects,” she said.

But any oral medication can cause problems like diarrhea or a rash, McMichael noted, and even topical minoxidil has drawbacks: It can be tricky to apply daily and sometimes irritates the scalp, causing flaking or flaking.

Ultimately, both doctors said men should discuss the pros and cons of each option with their dermatologist.

The findings were published online Feb. 2 in JAMA Dermatology. They are based on 23 clinical studies, most of which compared medication to a placebo (an inactive substance).

All three drugs were originally developed for purposes other than hair loss. Oral minoxidil was first used as a blood pressure medicine; the topical formulation was created after doctors realized that men taking the medication showed increased hair growth, according to Dr. Kathie Huang, who wrote an editorial that accompanied the study.

Meanwhile, both dutasteride and finasteride were first used to treat urinary symptoms caused by an enlarged prostate. The drugs block an enzyme that converts testosterone to dihydrotestosterone — the main hormonal cause of male pattern baldness, according to Huang, a dermatologist at Brigham and Women’s Hospital in Boston.

Finasteride is approved by the US Food and Drug Administration to treat hair loss in men; dutasteride is not, but doctors are allowed to prescribe it “off-label” for that.

In the real world, most patients with hair loss eventually need a combination of treatments.

“Usually the backbone of treatment is the combination of finasteride and topical minoxidil 5%,” McMichael said. “But patients often get the best results with even more added to this spine.”

That could be low-level laser light or platelet-rich plasma injected into the scalp. That plasma (the liquid part of blood) is taken from the patient’s own blood sample.

Rossi agreed that finding the best treatment can be a process.

“It’s important to be realistic,” he said. “Often you don’t hit a home run with a single option.”

He also recommended that men seeking help for hair loss see a dermatologist for a “complete workup.” That is, in part, to find out if there is an underlying condition causing the hair loss, such as a thyroid condition or nutritional problem.

More information

The American Academy of Dermatology has more about hair loss in men.

SOURCES: Anthony Rossi, MD, assistant assistant, Memorial Sloan Kettering Cancer Center, and assistant professor, Weill Cornell Medical College, New York City; Amy McMichael, MD, professor and chairman, dermatology, Wake Forest Baptist Medical Center, Winston-Salem, NC; JAMA Dermatology, February 2, 2022, Online

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