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       Medical Hair Loss Treatment



Medical Therapy:

  • Prevent further hair loss & if possible stimulate hair growth

  • General: pts should avoid hair care products likely to damage scalp/hair.

  • Pts should maintain an adequate diet (especially protein)

  • Topical medications work only where the medication is applied

  • If possible, any drugs that could negatively affect hair growth should be stopped.

  • Treat any underlying scalp disorder (seborrhea, pso,..)


Cyclic Treatment Orally following food supplyments are given
2.Essential fatty acids
4.Iron preparation
6.Finesteriod or Dutestriods


For Men

  • Finasteride 1mg/d & minoxidil 2-5% =FDA approved for men > 18 years old. 5% is a more rapid onset of action.

  • Treatment should be used for 12 mo before making a decision about efficacy although benefit may be seen sooner.

  • Finasteride : 2/3 decreased DHT in serum & scalp

  • Efficacy: target area hair counts (TAHC): are circular target areas 1cm to 1 inch in diameter typically at the anterior leading edge of the vertex balding area where the terminal, non-vellus, or visible hairs are counted pre & post treatment. TAHC increase over the first year and peak by 12 mo. : in men age 18-41, hair counts increase 17/cm2 for those on 1 mg finasteride vs-4/cm2 for placebo.

  • Hair growth continue to improve for at least the first 24 mo of treatment .in 18-41 yr, 50% of men showed an increase in hair growth by 1 yr, and 66% by 2 yr, compared  to 7% & 7% by placebo (1 yr=10% increase)

  • In 41-60 yr, 39% on finasteride versus 3% on placebo in 2 yr.

  • (90% stop hair loss in men for at least 5 yrs, hair regrowth in 65%)

  • Discontinue: any positive effect will be lost in 12 mo.

  • Safety: no known drug interaction, no effect on liver, BM, kidney,…, no effect on spermatogenesis

  • Reversible sexually related side effects (decreased libido , erectile dysfunction, decreased ejaculate volume): in 2% versus 1% with placebo. In 41-60 yr : increased side effect in 8% vs 5% on placebo.

  • Painful gynaecomastia (0.001%)

  • This side effects often resolve during continued treatment or within days to wks after discontinued.

  • The level of drug in semen is very low, and semen no risk to a pregnant women or her fetus.

  • F. is teratogen. In male fetus : hypospadias with cleft prepuce, decreased anogenital distance, reduced prostate weight, altered nipple formation.

  • F. has not effect on spermatogenesis or semen production

  • No effect on bone density

  • Reduction in PSA is based on the effect decreased DHT on the prostate. Recommendation is that any PSA test value should be doubled for any man taking finasteride to compensate for the effect of the drug.

  • (40% reduced PSA in 40-49 yrs & 50% in 50-59 yrs.)

  • Finasteride may selectively inhibit low grade prostate tumors (Gleason stage 2-6) ,25% reduce among men aged 55 and over.
    – low DHT may induce histologic changes that mimic high grade disease
    -low DHT may induce higher grade prostate cancers (Gleason stage 7-10)
    (5mg/d: high grade prostatic carcinoma in elderly men (or reduced?)



  • is a combined type 1 & 2 5aR inhibitor. 0.5 mg/d a 53% reduction is scalp DHT and at 2.5 mg/d the reduction is 83%.

  • Sexual side effects are more common but reversible.



  • FDA approved for upper 18 yrs old (in adolescents)

  • Mode of action: increases duration of anagen & enlarges miniaturized follicles(enlargement of shaft diameter)

  • – K channel opener & vasodilator

  • 1 ml twice daily, require 1h for absorption

  • Best result in early case (<10 yrs), limited extend(<10 cm, on the vertex), hair density above 20 hairs/cm2)

  • Efficacy: TAHC & photographs confirm a significant increase in hair density, hair growth appears to peak at 16 wk, 5% is superior to 2%, TAHC increases are 19/cm2 for 5% & 13/cm2 for 2% & 4/cm2 for placebo at 6 mo.

  • photography: 58% increased hair growth on 5% & 41% for 2% & 23% on placebo at 1 yrs.

  • Conversion of vellus to terminal hair (30%), complete remission (10%)

  • Discontinue: any positive effect will be lost in 4-6 mo.

  • Initial telogen effluvium, begin 2-8 wk after treatment initiation ( result from release of telogen hair as anagen promotion begins), self limiting with continued treat.

  • Safety: side effects are mainly dermatologic: scalp irritation, dryness, scaling, itching, redness (more common with 5%) -Allergic C.D: is uncommon (with minoxidil or PG)


Combination therapy

  • Additive effect

  • For switch from treatment with one of these agents to other should continue for at least 3 mo together.


Treatment for women

  • Women with or without hyperandrogenism: – no androgen therapy -FDA : only 2% minoxidil approved for women (60% arrested hair loss or mild to moderate hair growth) – treatment should be used for 12 mo before making a decision about efficacy although benefit may be seen sooner. – minoxidil in those women with FPHL both with or without hyperandrogenism, in young & old, in pre & postmenopausal women alike.

  • Safety: either 2 or 5% appears safe to use in women with FPHL, with the only additional risk of the 5% for face hypertrichosis (3-5%). The hypertrichosis tends to occur over the cheeks & forehead as vellus, not terminal, hair and disappears within 4 mo. of stopping the drug.- hypertrichosis due to spreading to the face or may also be a result of hypersensitivity to low levels of systemic absorption.


Women with hyperandrogenism

  • <40% of women with FPHL have hyperandrogenism (androgen hypersensitivity or overproduction)

  • Efficacy of this drugs in women with FPHL who do not have overt H.A have not specifically shown proven efficacy.

  • Since all antiandrogens or 5aR inhibitors may cause feminization of the mal fetus, all women of childbearing = OCP.



  • Act by blocking cytoplasmic receptors for DHT. Also weakly inhibits androgen biosynthesis.

  • Spironolactone 100-300mg /d.(usually 200mg), check K at baseline & 1 mo after beginning treatment (hyperkalemia). Pts should keep well hydrated.

  • Spironolactone 200mg/d or cyproterone acetate 100mg (days 5-15), will prevent further hair loss in up to 90% of women. Regrowth may be seen in up to 40% after 1-2 yr of treatment.

  • Contraindication: in pregnancy: risk of feminization in male fetus & hypospadias.

  • (In childbearing: OCP is choice)

  • Side eff.: are dose related, mense irregularity, postmenopausal bleeding, breast tenderness or enlargement, fatigue

  • Concomitant use of OCP: reduced side eff.

  • Rare cases of hepatocellular carcinoma & hepatitis(with higher dose) Contraindication: in pregnancy: risk of feminization in male fetus & hypospadias.



  • 1-1.25 mg/d. not useful in post-menopausal with FPHL.

  • Some positive reports in women with HA treated with 1.25 mg /d have emerged.

  • There are no anticipated side effects and no blood tests are necessary.


Cyproterone acetate

  • Androgen receptor blocker, potent progestin, antigonadotrophic effect.

  • May use for over 40 yr. For postmenopause, androcor with or without estrogens may be used continuously.

  • 100 mg days 5-15 with Diane 5-26, appears most useful.

  • Diane only , less effective in hair loss.

  • Side eff.: wieght gain, breast tenderness, loss of libido, lassitude, depression, nausea, feminization of male fetus

  • No specific blood tests are necessary.



  • A non-steroidal antiandrogen: inhibiting androgen uptake, inhibiting nuclear binding of andogen within the target tissue.

  • In one study: F. is superior to androcor & finasteride

  • Side eff.: rare but potentially fatal hepatotoxicity

Low-level light therapy
  • Most are packaged like a hairbrush or comb which shines red light directly on the scalp while it is used to comb through the hair.

  • Only on such device, called the HairMax LaserComb, has obtained 510k FDA  approval for use as a medical device Should be explain to patients: this device has safety rather than actual efficacy.Cosmetic aids & …. Not all treatment work for all people

  • Tinted powders, lotions, hair sprays

  • Shampoo ketoconazol,Sawpalmetto, palminex

  •  Vitamins, supplements?

  • Wigs, hair pieces, Camouflages,…

  • Hair transplantation