Prescribed Medications for Hair Loss
There are relatively few prescription medications available for the treatment of hair loss. At the
present time, there is no “miracle” medication that will completely halt the onset and progression
of hair loss. However, some treatments can provide dramatic improvements. In this section we
will discuss these therapies, outlining their advantages, disadvantages, costs and results.
Level Your Expectations
Many people are disappointed with the results they receive from hair loss medications because
their expectations are not realistic. It is normal to desire the best response, but it is important to
know that results are variable between patients. Before starting any medication, it is always
important to familiarize yourself with the general indications of each treatment.
***When pharmaceutical treatments are used, patience is a virtue. It is not unusual for results to
take between 6 months and a year to become visible. Medication must be taken in perpetuity in
order to maintain the results. For this reason, long-term cost and side-effects are major
considerations.
Finasteride (Propecia)
Finasteride-based treatments are best represented by the adage “an ounce of prevention is worth
a pound of cure.” While they can be quite effective in delaying the progression of male pattern
baldness, they do very little for people that already have extensive hair loss. Nevertheless, 5AR
inhibitors like Propecia and Proscar are currently the strongest weapons available in the war on
baldness.
History: In 1992, Finasteride was approved by the FDA for the treatment of Benign Prostatic
Pyperplasia (BPH). In 1997 Merck and Company marketed the product as a hair loss treatment
(although at a different dosage) after noticing its positive effects on hair growth. 13 years later,
Finasteride remains 1 of only 2 FDA approved medications for the treatment of androgenetic
alopecia.
Method of Action: The enzyme 5-alpha-reductase is involved in the conversion of testosterone
into its active form of dihydrotestosterone (DHT – the androgen primarily responsible for male
pattern baldness). Over time, DHT shrinks hair follicles until they no longer produce visible
hairs. Finasteride is a 5AR inhibitor. By reducing circulating levels of DHT, androgen receptors
in the hair follicle are protected from its adverse effects.
Usage: Finasteride is generally administered in the form of once daily pills. Results are not
typically visible for period of about 6 months (with optimal results occurring around 12 months).
After a period of 5-6 years, these results steadily diminish.
How Finasteride Works
Finasteride is primarily designed to halt the progression of hair loss. Finasteride is most
efficacious at the crown and vertex areas of the scalp, and generally does not affect (positively or
negatively) the frontal scalp.
Starting Finasteride early is the key to its success. At the first sign of hair loss, ask your doctor
about starting a regimen that includes Finasteride pills like Propecia or Proscar. Although new
hair growth will not be visible, it is important to remember that Propecia is working actively to
stop hair loss from becoming worse. Many patients quit Finasteride, thinking that it has not
provided any results, only to lose a great amount of hair shortly after discontinuing regular use.
Side-effects of Finasteride
As with other medications, there are several side-effects that can manifest while taking
Finasteride. Most of Finasteride-induced side-effects are temporary and will diminish quickly if
Finasteride use is discontinued. However, recent studies indicate that many side effects, such as
sexual dysfunction may in fact be permanent. This is still a subject of debate among industry
37
professionals. Although only a very small percentage of men experience side-effects while on
Finasteride, it is important to be aware of these possible complications:
- low sex drive
- temporary impotence
- decreased volume in the amount of semen
Some serious side-effects include:
- changes in breasts (lumps, pain, etc.)
- allergic reactions (itching, rash, hives)
- testicular pain
- permanent sexual dysfunction
Proper Dosing of Finasteride
1 mg of Finasteride is the recommended dose for the treatment of Androgenetic Alopecia.
Taking a higher dosage will not result in any additional benefits.
Finasteride is also available in a 5 mg dosage under the brand name Proscar. Some people
purchase Proscar (because it is less expensive) and cut the tablets into several pieces. Others
simply take the entire 5 mg. Once again, there is no scientific proof that this is as effective as the 1 mg dose of Finasteride.
***Pregnant women should not handle Finasteride. Broken or crushed tablets can be absorbed by the skin, leading to several serious complications.
Combining Finasteride and Minoxidil
The combination of minoxidil and finasteride is popular because both treatments can be used in
synergy. Minoxidil and finasteride work in different ways; minoxidil stimulates hair growth and
finasteride blocks the negative effects of DHT. Together, these effects can produce dramatic and
noticeable results.
Both medications must be used regularly, however, and the discontinued use of either product
will adversely affect results.
Minoxidil (Rogaine)
Minoxidil (distributed under brand names Rogaine™ and Regaine™) is perhaps the best-known
treatment for male pattern baldness. Minoxidil is unique because of its topical formulation and
availability to both men and women.
History: Minoxidil was initially used as a treatment for high blood pressure, marketed under the
brand name Loniten. After hair growth was discovered as a common side-effect, Minoxidil was
reformulated by Upjohn Corporation into a 2% topical solution. In 1988, after clinical trials had
concluded, Rogaine became the first treatment approved by the FDA with the indication of
treating androgenetic alopecia.
Method of Action: Although Minoxidil is the oldest existing medication for AGA, its precise
method of action remains unknown. Minoxidil is a potassium channel agonist; meaning that it
facilitates in the movement of ions between cells within the body. How this function relates to
male-pattern baldness is still being investigated.
Usage: Minoxidil is applied twice daily to the scalp, either in foam or liquid form. Patients often
report excessive shedding when they start regimens that include Minoxidil. This shedding period
is mostly temporary, however, and generally ceases once the body becomes accustomed to the
treatment.
Unlike Finasteride, Minoxidil has the ability to regrow new hair, albeit in very small quantities.
It is most effective rejuvenating hairs in the vertex and crown areas of the scalp. Minoxidil has
also been found to be quite effective in patients with diffuse thinning.
It should be noted that results will only be seen after 4 months of continuous application. Hairs
rejuvenated with Minoxidil are generally sparse, weak and often colorless. Once Minoxidil
treatment is stopped, these minimal gains are lost within a period of 6 months.
Cost: Rogaine can be purchased over-the-counter at most local pharmacies. A month’s supply of
treatment costs approximately 30 dollars, but bulk rates and discounts are available.
How Minoxidil Works
Initially, Minoxidil was marketed as an oral medication for blood pressure. But doctors began to
notice hair growth as a popular side-effect.
Researchers developed a topical formulation of Minoxidil that is directly applied to the scalp.
Studies conducted since have supported the notion that Minoxidil can cause moderate hair
growth.
The exact mechanism that makes Minoxidil so effective remains unknown.
Side-effects of Minoxidil
Since Minoxidil (Rogaine) is a topical treatment, it is only used externally. Avoid getting
Minoxidil into your eyes, nose or mouth. Minoxidil should also be used singularily, as other
topical solutions might increase its absorption rate and exacerbate side-effects. Side-effects are
only minor, but be observant and consult your physician if you experience:
- skin irritation
- itching
- contact dermatitis
- dryness or flaking of the scalp (dandruff)
- nausea or lightheadedness
- swelling of the face, ankles, hands or stomach
- difficulty breathing
- rapid heartbeat
- chest pain
Applying Minoxidil Onto the Scalp
Doctors recommend that Minoxidil is applied directly to the scalp twice a day, once in the
morning and once in the evening. The solution should be applied to all the thinning areas to
regain lost hair.
Low-Level Laser Therapy (LLLT) is a new medical approach used to heal soft-tissue and
provide acute and chronic pain relief. The two primary devices that employ this technology in
relation to hair growth are the HairMax Laser Comb and the X5 Laser.
How Laser Therapy Works
Low level laser therapy is a non-invasive, painless treatment option for hair loss. The laser light
decreases inflammation and cellular metabolism. Cells of LLLT, according to further European
studies, increases the blood and lymph to the root of the hair and scalp, stimulating hair growth.
Whether or not laser therapy is truly effective is a common point of debate among industry
professionals.
Low-level Laser Therapy for Hair Loss
History: In 2007, the HairMax Laser Comb received a 501(k) clearance from the U.S. Food and
Drug Administration. It is currently the only medical device approved by the FDA to be
marketed to individuals suffering from certain classes of male pattern baldness (NW1-NW2V).
Method of Action: The HairMax Laser Comb claims to reverse miniaturization and stimulate
dormant hair follicles with laser photo therapy. This approach has been hypothesized to increase
blood circulation, promote cellular activity and reverse apoptosis (natural degradation of cells) in
various tissues throughout the body. Within the follicle this increased circulation fosters a
nutrient-rich environment and eliminates waste, promoting healthier hair overall.
It is also theorized that the concentrated light energy emitted by the HairMax Laser Comb
increases the production of adenosine triphosphate (ATP). This molecule provides cells with
usable energy, increasing their propensity to grow and repair.
Cost: The most popular LLLT device, the HairMax Laser Comb, costs roughly 500 dollars. It
can be purchased via the HairMax website and comes with a two-year warranty. Various
payment options are available.
Handheld Laser for Home Use
Usage: Using the HairMax Laser Comb is quite easy. The device is held at the front of the
hairline and slowly moved backward towards the crown at four-second intervals. This
progression is then repeated in the opposite direction. For best results it is recommended that this
process is performed for 15 minutes, 3 times per week.
Results experienced by the HairMax Laser Comb are minimal at best. There is insufficient data
to suggest definitively that this process works, but a recent clinical study performed by the
company confirmed limited efficacy with no major safety concerns.
Advantages of handheld device:
• Less expensive and more convenient than doctor visits
• may permit the laser better access to the scalp
Disadvantages of handheld device:
• can be easy to forget and tedious to use on a regular basis
• it may be difficult to determine whether or not the treatment is working and when use
should be discontinued.
Potential risks of LLLT
Handheld lasers are considerably safe devices for hair/scalp use. Although there are no scientific
studies that specifically promote their efficacy, handheld lasers can provide results for some
people. No safety issues have ever been reported.
There are relatively few prescription medications available for the treatment of hair loss. At the
present time, there is no “miracle” medication that will completely halt the onset and progression
of hair loss. However, some treatments can provide dramatic improvements. In this section we
will discuss these therapies, outlining their advantages, disadvantages, costs and results.
Level Your Expectations
Many people are disappointed with the results they receive from hair loss medications because
their expectations are not realistic. It is normal to desire the best response, but it is important to
know that results are variable between patients. Before starting any medication, it is always
important to familiarize yourself with the general indications of each treatment.
***When pharmaceutical treatments are used, patience is a virtue. It is not unusual for results to
take between 6 months and a year to become visible. Medication must be taken in perpetuity in
order to maintain the results. For this reason, long-term cost and side-effects are major
considerations.
Finasteride (Propecia)
 |
| Finasteride as treatment for hair loss in men. |
Finasteride-based treatments are best represented by the adage “an ounce of prevention is worth
a pound of cure.” While they can be quite effective in delaying the progression of male pattern
baldness, they do very little for people that already have extensive hair loss. Nevertheless, 5AR
inhibitors like Propecia and Proscar are currently the strongest weapons available in the war on
baldness.
History: In 1992, Finasteride was approved by the FDA for the treatment of Benign Prostatic
Pyperplasia (BPH). In 1997 Merck and Company marketed the product as a hair loss treatment
(although at a different dosage) after noticing its positive effects on hair growth. 13 years later,
Finasteride remains 1 of only 2 FDA approved medications for the treatment of androgenetic
alopecia.
Method of Action: The enzyme 5-alpha-reductase is involved in the conversion of testosterone
into its active form of dihydrotestosterone (DHT – the androgen primarily responsible for male
pattern baldness). Over time, DHT shrinks hair follicles until they no longer produce visible
hairs. Finasteride is a 5AR inhibitor. By reducing circulating levels of DHT, androgen receptors
in the hair follicle are protected from its adverse effects.
Usage: Finasteride is generally administered in the form of once daily pills. Results are not
typically visible for period of about 6 months (with optimal results occurring around 12 months).
After a period of 5-6 years, these results steadily diminish.
How Finasteride Works
Finasteride is primarily designed to halt the progression of hair loss. Finasteride is most
efficacious at the crown and vertex areas of the scalp, and generally does not affect (positively or
negatively) the frontal scalp.
Starting Finasteride early is the key to its success. At the first sign of hair loss, ask your doctor
about starting a regimen that includes Finasteride pills like Propecia or Proscar. Although new
hair growth will not be visible, it is important to remember that Propecia is working actively to
stop hair loss from becoming worse. Many patients quit Finasteride, thinking that it has not
provided any results, only to lose a great amount of hair shortly after discontinuing regular use.
Side-effects of Finasteride
As with other medications, there are several side-effects that can manifest while taking
Finasteride. Most of Finasteride-induced side-effects are temporary and will diminish quickly if
Finasteride use is discontinued. However, recent studies indicate that many side effects, such as
sexual dysfunction may in fact be permanent. This is still a subject of debate among industry
37
professionals. Although only a very small percentage of men experience side-effects while on
Finasteride, it is important to be aware of these possible complications:
- low sex drive
- temporary impotence
- decreased volume in the amount of semen
Some serious side-effects include:
- changes in breasts (lumps, pain, etc.)
- allergic reactions (itching, rash, hives)
- testicular pain
- permanent sexual dysfunction
Proper Dosing of Finasteride
1 mg of Finasteride is the recommended dose for the treatment of Androgenetic Alopecia.
Taking a higher dosage will not result in any additional benefits.
Finasteride is also available in a 5 mg dosage under the brand name Proscar. Some people
purchase Proscar (because it is less expensive) and cut the tablets into several pieces. Others
simply take the entire 5 mg. Once again, there is no scientific proof that this is as effective as the 1 mg dose of Finasteride.
***Pregnant women should not handle Finasteride. Broken or crushed tablets can be absorbed by the skin, leading to several serious complications.
Combining Finasteride and Minoxidil
The combination of minoxidil and finasteride is popular because both treatments can be used in
synergy. Minoxidil and finasteride work in different ways; minoxidil stimulates hair growth and
finasteride blocks the negative effects of DHT. Together, these effects can produce dramatic and
noticeable results.
Both medications must be used regularly, however, and the discontinued use of either product
will adversely affect results.
Minoxidil (Rogaine)
Minoxidil (distributed under brand names Rogaine™ and Regaine™) is perhaps the best-known
treatment for male pattern baldness. Minoxidil is unique because of its topical formulation and
availability to both men and women.
History: Minoxidil was initially used as a treatment for high blood pressure, marketed under the
brand name Loniten. After hair growth was discovered as a common side-effect, Minoxidil was
reformulated by Upjohn Corporation into a 2% topical solution. In 1988, after clinical trials had
concluded, Rogaine became the first treatment approved by the FDA with the indication of
treating androgenetic alopecia.
Method of Action: Although Minoxidil is the oldest existing medication for AGA, its precise
method of action remains unknown. Minoxidil is a potassium channel agonist; meaning that it
facilitates in the movement of ions between cells within the body. How this function relates to
male-pattern baldness is still being investigated.
Usage: Minoxidil is applied twice daily to the scalp, either in foam or liquid form. Patients often
report excessive shedding when they start regimens that include Minoxidil. This shedding period
is mostly temporary, however, and generally ceases once the body becomes accustomed to the
treatment.
Unlike Finasteride, Minoxidil has the ability to regrow new hair, albeit in very small quantities.
It is most effective rejuvenating hairs in the vertex and crown areas of the scalp. Minoxidil has
also been found to be quite effective in patients with diffuse thinning.
It should be noted that results will only be seen after 4 months of continuous application. Hairs
rejuvenated with Minoxidil are generally sparse, weak and often colorless. Once Minoxidil
treatment is stopped, these minimal gains are lost within a period of 6 months.
Cost: Rogaine can be purchased over-the-counter at most local pharmacies. A month’s supply of
treatment costs approximately 30 dollars, but bulk rates and discounts are available.
How Minoxidil Works
 | |
| A diagram showing how minoxidil works on the skin. |
notice hair growth as a popular side-effect.
Researchers developed a topical formulation of Minoxidil that is directly applied to the scalp.
Studies conducted since have supported the notion that Minoxidil can cause moderate hair
growth.
The exact mechanism that makes Minoxidil so effective remains unknown.
Side-effects of Minoxidil
Since Minoxidil (Rogaine) is a topical treatment, it is only used externally. Avoid getting
Minoxidil into your eyes, nose or mouth. Minoxidil should also be used singularily, as other
topical solutions might increase its absorption rate and exacerbate side-effects. Side-effects are
only minor, but be observant and consult your physician if you experience:
- skin irritation
- itching
- contact dermatitis
- dryness or flaking of the scalp (dandruff)
- nausea or lightheadedness
- swelling of the face, ankles, hands or stomach
- difficulty breathing
- rapid heartbeat
- chest pain
Applying Minoxidil Onto the Scalp
Doctors recommend that Minoxidil is applied directly to the scalp twice a day, once in the
morning and once in the evening. The solution should be applied to all the thinning areas to
regain lost hair.
 |
provide acute and chronic pain relief. The two primary devices that employ this technology in
relation to hair growth are the HairMax Laser Comb and the X5 Laser.
How Laser Therapy Works
Low level laser therapy is a non-invasive, painless treatment option for hair loss. The laser light
decreases inflammation and cellular metabolism. Cells of LLLT, according to further European
studies, increases the blood and lymph to the root of the hair and scalp, stimulating hair growth.
Whether or not laser therapy is truly effective is a common point of debate among industry
professionals.
Low-level Laser Therapy for Hair Loss
History: In 2007, the HairMax Laser Comb received a 501(k) clearance from the U.S. Food and
Drug Administration. It is currently the only medical device approved by the FDA to be
marketed to individuals suffering from certain classes of male pattern baldness (NW1-NW2V).
Method of Action: The HairMax Laser Comb claims to reverse miniaturization and stimulate
dormant hair follicles with laser photo therapy. This approach has been hypothesized to increase
blood circulation, promote cellular activity and reverse apoptosis (natural degradation of cells) in
various tissues throughout the body. Within the follicle this increased circulation fosters a
nutrient-rich environment and eliminates waste, promoting healthier hair overall.
It is also theorized that the concentrated light energy emitted by the HairMax Laser Comb
increases the production of adenosine triphosphate (ATP). This molecule provides cells with
usable energy, increasing their propensity to grow and repair.
Cost: The most popular LLLT device, the HairMax Laser Comb, costs roughly 500 dollars. It
can be purchased via the HairMax website and comes with a two-year warranty. Various
payment options are available.
Handheld Laser for Home Use
 |
| Handheld home use laser. |
hairline and slowly moved backward towards the crown at four-second intervals. This
progression is then repeated in the opposite direction. For best results it is recommended that this
process is performed for 15 minutes, 3 times per week.
Results experienced by the HairMax Laser Comb are minimal at best. There is insufficient data
to suggest definitively that this process works, but a recent clinical study performed by the
company confirmed limited efficacy with no major safety concerns.
Advantages of handheld device:
• Less expensive and more convenient than doctor visits
• may permit the laser better access to the scalp
Disadvantages of handheld device:
• can be easy to forget and tedious to use on a regular basis
• it may be difficult to determine whether or not the treatment is working and when use
should be discontinued.
Potential risks of LLLT
Handheld lasers are considerably safe devices for hair/scalp use. Although there are no scientific
studies that specifically promote their efficacy, handheld lasers can provide results for some
people. No safety issues have ever been reported.
