Male-pattern hair loss

4 min read

Male-pattern hair loss (androgenetic alopecia) is a genetic condition with no known cure. In the past there have been no legitimate treatment options, but now, with the introduction of Rogaine (minoxidil) and Propecia, there's some hope.

Rogaine, an over-the-counter lotion that is rubbed on the scalp twice daily, is available in 2-percent and 5-percent strengths. Originally developed to treat high blood pressure, the drug has been studied for more than two decades and is considered safe, although how it works remains a mystery. While the 5-percent solution works faster, and most say better, some find the consistency too greasy and favor the lower dosage.

In general, the younger the candidate and the smaller the amount of hair loss, the more likely Rogaine will work. Those between the ages of 25 and 35 who have experienced hair loss for less than five years and have only a small area of baldness see the best results, says Arthur Jacknowitz, Pharm. D., chairman of the department of clinical pharmacy at West Virginia University. Learn about the potential risk factors for male pattern baldness.

The most common side effect (experienced in less than 2 percent of users) is an allergic rash. In some cases the drug can cause additional hair loss, which however can be reversed. According to Jacknowitz, those with a pre-existing cardiovascular problem should use the drug with extreme caution, as the possibility exists that increased heart rate, dizziness and other heart-related problems could occur.

Propecia is a prescription pill originally marketed at a higher dosage to treat enlarged prostates; it has been available for the treatment of hair loss since 1998. The drug lowers the production of dihydrotestosterone, a male hormone blamed for hair loss. (It is not prescribed for women, as it can cause birth defects in their offspring and has not been shown to be effective in studies of women beyond their childbearing years.)

As with Rogaine, Propecia works best in younger people with limited hair loss. Results can be seen anywhere from a couple of months to a year after beginning treatment.

While the drug appears safe -- and may even have some health benefits related to keeping the prostate small -- impotence has been associated with use of the drug in a very small percentage of men.

"Every man is afraid of that," says Wilma Bergfeld, M.D., head of clinical research for the department of dermatology at the Cleveland Clinic in Ohio, who was involved in studies of both drugs, "but in truth it hasn't been a problem."

One important note is that if a man is taking Propecia and going for a prostate screening, he needs to alert his doctor, as the drug can interfere with the test results.

Though some questions remain about the drug, most believe it is fairly safe.

"I think it would be surprising if (other side effects) were unveiled in the next several years," Jacknowitz says.

There are a number of issues to keep in mind when deciding whether or not to take one of these drugs:

  • Hair loss is a cosmetic, not health concern (although there can be psychological implications).
  • Drug therapy can be expensive, costing from $20 to $50 a month (although generic versions of Rogaine may be cheaper).
  • Treatment must be continued indefinitely, as stopping will result in loss of all hair that has been saved or restored.
  • Although unlikely, the potential does exist for long-term side effects.

If the decision is made that the benefits outweigh the drawbacks, a complete medical history should be taken by the person's doctor before beginning treatment.

Much work is being done on future treatments. Researchers are looking into everything from more highly concentrated Rogaine, to drugs that block the enzyme associated with hair loss, to trying to identify the responsible genes and finding the cells that promote hair growth.

"Up until (minoxidil) the feeling was once you lost your hair, it was gone and that was it.. but minoxidil does work in some people and that means it's possible to make hair grow," says Jean-Claude Bystryn, M.D., professor of dermatology at New York University School of Medicine. "Now the challenge is to make it happen more often."

Expect to see more treatment options in the next two-to-10 years.