- The two most effective and the only FDA-approved medical treatment methods for hair loss are Finasteride tablet and topical Minoxidil solution or foam.
Finasteride:
- Finasteride is a blocker of 5-alpha-reductase enzyme in hair follicles. Finasteride is a generic name and sold as 1 or 5 mg orally applied tablets under different names from various companies.
- Common brand names of Finasteride are Propecia (1 mg) and Proscar (5 mg).
- Finasteride has been scientifically proved to stimulate the resting and dormant hair follicles to produce thicker hair. It increases hair number and hair shaft diameter all over the scalp. It is the most effective form of medical treatment.
- Finasteride can stop or significantly slow down the rate of hair loss in 80% of the patients for 2-5 years. Improvement in hair density is observed in 50% of the patients within one year, and in 70% within two years.
- Treatment dosage is 1 mg (Propecia, one tablet) or 1.25 mg (Proscar, quarter of a 5 mg tablet) daily. Treatment dosage should be followed for the first 4-6 months after the beginning of its use. Then the dosage may be lowered to half as a long-term maintenance dosage (Propecia half a pill daily or Proscar quarter of a pill every other day).
- Even daily dosages of 0.25 – 0.30 mg is proved effective to keep the hair healthy and prevents further hair loss. Lower doses place less of a burden for cost and also decrease the risk of side effects.
- Possible side effects: Sometimes, it may cause a decrease in sexual libido. In fact, its very rare and reported in less than 3% of the patients who use 1 mg over 1 year. Anyway, exaggerated claims and scaremongering on the internet worries the patients and many of them feared to use finasteride.
- Rationally, finasteride offers great potential benefits compared with a relatively slight risk of side effects.
Finasteride must not be used by women, -it is teratogenic for newborns and ineffective in postmenopausal women.
Minoxidil:
- Minoxidil (generic name) is a drug used as a pill for high blood pressure treatment. The exact mechanism of action on hair loss is unknown, but possibly due to its vessels dilating effect. It may increase the blood supply of the vertex area which already receives diminished blood supply.
- Topical minoxidil leads to an increased hair count and an increase in the hair shaft diameter within a few months. Increased optical density can be achieved in 40% of the patients within one year.
- Topical liquid or foam form of Minoxidil is used for hair loss treatment. Positive effect is generally restricted to the vertex area. Anyway, it may also be used for the other parts of the scalp.
- Rogaine (most common brand name), 5% liquid or foam, is applied directly to the vertex area of the scalp twice a day to achieve a positive effect. A few minutes of effective massaging over the application area is necessary to increase the skin penetration.
- Recommended concentration of both liquid and foam forms is 5% for men. Women may use 2% Minoxidil.
- Possible side effects: Sometimes signs of local irritation (redness, itching, pimples) over the application area. To prevent it, effective massaging/rubbing after application is mandatory. Foam form causes less irritation and may be the first choice, anyway liquid form is generally more effective.
Finasteride or Minoxidil?
- Finasteride is significantly more effective than minoxidil. It is the first choice. Its effective for all areas of the scalp.
- Minoxidil effect is generally restricted to vertex-crown area. It can be used as a sole agent at the beginning stage of progressive thinning of the vertex hair.
- Both drugs can also be used together as a combined therapy or as a supplemantary medical therapy following a hair transplant.