THURSDAY, Feb. 10, 2022 (HealthDay News) — Almost all men experience receding hairline or baldness at some point in their lives. For those looking to slow down the march of time, a new study helps determine which hair loss medications work best.
The analysis, of 23 previous studies, ranks available hair loss medications from most effective to least effective.
Experts said the list was useful. The drugs – dutasteride, finasteride and minoxidil – have been used for a long time, but there is little information about their effectiveness.
“We don’t have any trials comparing these drugs head-to-head,” said Dr. Anthony Rossi, a dermatologist who was not involved in the research.
This has left doctors without a solid answer to the inevitable question, which option works best?
The new research will help fill that gap, according to Rossi, of Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, both in New York.
The first-line treatment was dutasteride capsules (Avodart), at a dose of 0.5 milligrams per day. On average, it produced the greatest increase in total hair count after six months of use. This means that men who use it can expect more hair to pop up where there was none, although this includes smaller, “peach fuzz” hairs.
This is followed by finasteride (Propecia) pills, taken at a dose of 5 mg each day, followed by the same dose of oral minoxidil (Rogaine).
Not surprisingly, dose and administration mattered, according to the analysis. A lower dose of finasteride (1mg per day) ranked fourth, followed by two topical formulations of minoxidil, with the higher dose (5%) giving better results than the lower (2%).
At the bottom was low-dose oral minoxidil, taken at 0.25 mg per day.
Efficiency, however, is only part of the story, Rossi pointed out.
“Dutasteride may outperform others, but it may also have more side effects,” he said. “And we have to counsel patients about that.”
Dutasteride can cause loss of sex drive, erectile dysfunction, and breast tenderness, as well as a form of low blood pressure called orthostatic hypotension. In rare cases, men may have serious reactions to the drug that require medical attention, including peeling skin, facial swelling, and difficulty breathing.
Finasteride can also dampen libido or cause breast tenderness, but only in a minority of patients, said Dr. Amy McMichael, professor of dermatology at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.
Whenever a healthy person has hair loss, the goal is to increase hair density while maintaining that good health, said McMichael, who was not involved in the study.
“In general, topical minoxidil, oral finasteride, and oral minoxidil are well tolerated by most patients and cause no side effects,” she said.
But any oral medication can cause issues like diarrhea or a rash, McMichael noted, and even topical minoxidil has downsides: It can be cumbersome to apply daily and sometimes irritates the scalp, causing it to peel or peel.
Ultimately, both doctors said, men should discuss the pros and cons of each option with their dermatologist.
The results were published online February 2 in JAMA Dermatology. They are based on 23 clinical trials, most of which compared a drug to a placebo (an inactive substance).
All three drugs were originally developed for purposes other than hair loss. Oral minoxidil was first used as a blood pressure medication; the topical formulation was created after doctors realized that men taking the drug showed increased hair growth, according to Dr. Kathie Huang, who wrote a editorial published with the study.
During this time, dutasteride and finasteride were first used to treat urinary symptoms caused by an enlarged prostate. The drugs block an enzyme that converts testosterone to dihydrotestosterone – the main hormonal contributor to male pattern baldness, according to Huang, a dermatologist at Brigham and Women’s Hospital in Boston.
Finasteride is approved by the United States Food and Drug Administration to treat hair loss in men. dutasteride is not, but doctors are allowed to prescribe it”without label” For this reason.
In the real world, most hair loss patients end up needing a combination of treatments.
“Most often the backbone of treatment is the combination of finasteride and topical 5% minoxidil,” McMichael said. “But patients often get the best results with even more added to that spine.”
This may include low-intensity laser light or platelet-rich plasma injected into the scalp. This plasma (the liquid part of blood) is taken from the patient’s own blood sample.
Rossi agreed that finding the best treatment can be a process.
“It’s important to be realistic,” he said. “A lot of times you won’t hit a home run with just one option.”
He also recommended that men seeking help with hair loss see a dermatologist for a “comprehensive checkup.” This is, in part, to find out if there is an underlying condition causing the hair loss, such as a thyroid disorder or a nutritional problem.
The American Academy of Dermatology has more on hair loss in men.
SOURCES: Anthony Rossi, MD, attending assistant, Memorial Sloan Kettering Cancer Center, and assistant professor, Weill Cornell Medical College, New York; Amy McMichael, MD, professor and chair, dermatology, Wake Forest Baptist Medical Center, Winston-Salem, NC; JAMA Dermatology, February 2, 2022, online