"Minoxidil definitely has an effect in most men," Cotsarelis agrees. "It is not something a bald person would use, but someone starting to go bald would use it. The goal is to maintain the hair you have."
The other currently approved drug for hair loss is Propecia (generic name, finasteride). It works only for men. Why? It keeps the male sex hormone testosterone from forming its DHT by-product. DHT signals shorten the growth phase -- and lengthen the rest stage -- of hormone-sensitive follicles.
One side effect of Propecia can be loss of libido. But it usually goes away over time, Cotsarelis says.
Testosterone replacement is becoming popular for men. Cotsarelis warns that this may accelerate hair loss. Propecia might help -- but because it prevents testosterone breakdown, it might affect the dose of male hormone replacement therapy. Cotsarelis warns men taking both Propecia and testosterone replacement to make sure their doctor carefully monitors their testosterone levels.
Many men use both minoxidil and Propecia for maximum effect. The drugs can also be combined with hair replacement surgery.
"It's possible to take one or the other or both," Kaufman says. "But if a person isn't going to use Rogaine twice every day, or take the Propecia pill once every day, he shouldn't use them."
Why? Once treatment with either minoxidil or Propecia stops, hair loss resumes -- and any gains soon are lost.
What About Surgery?
One way to combat hair loss is to transplant hair follicles from the sides and back of the head to the top of the head. This surgery has evolved over the years, Kaufman says.
"In the late 1980s, the standard of care was to take large grafts, plugs of 12 to 20 hairs, and implant them," he says. "It would give either a very good or acceptable result. But some men, as they got older and lost some more hair, they got that doll's-hair or corn-row phenomenon: Little poles of hair jutting out."
Today's hair grafts are called follicular unit hair transplants of one to four hairs, transplanted very close together for a more natural look.