A receding forehead. A bald spot extending over the top of the head. Very fine hair that is particularly visible where the hair parting. Around 90% of men will suffer from some form of hair loss in their lifetime, often leading to symptoms of low self-esteem, anxiety and depression.
Studies on the most effective non-surgical treatments for male pattern baldness have been limited, leaving men confused as to which solution is the most effective.
Now, a new meta-analysis of 23 studies sheds light on this question. The study, published Wednesday in the journal JAMA Dermatology, analyzed research on the impact on male hair thinning of using various doses of the three oral and topical medications – minoxidil, dutasteride and finasteride – for two to four months.
“This meta-analysis is important. We don’t have randomized clinical trials that compare these drugs for male pattern baldness to each other, which would be ideal,” said dermatologist Dr. Anthony Rossi of Memorial Sloan Kettering Cancer Center in New York, who has no not participated in the study. .
Most successful player: The analysis found that taking 0.5 milligrams daily of dutasteride by mouth had the highest likelihood of reducing hair loss in men.
Dutasteride is a prescription drug approved by the United States Food and Drug Administration for the treatment of enlarged prostate glands at men’s. It is also used to treat male pattern baldness, but this use is considered “off label” because dutasteride does not have FDA approval as a treatment for hair loss.
Off-label use is quite common in medicine, Rossi said. “Many drugs are used off-label, but there is usually enough evidence to explain why we think these drugs will work,” he added.
However, dutasteride has more serious side effects than many of the treatments, including loss of libido and the ability to get and keep an erection.
Second place: Taking 5 milligrams a day of finasteride by mouth was second in effectiveness, according to the study. Finasteride, another prescription drug from the same chemical family as dutasteride, is also used to treat an enlarged prostate. He received FDA approval as a treatment for hair loss.
Finasteride also produced the greatest increase in total hair count at 48 weeks. A total hair count is exactly what it sounds like – a tally of all the different types of hair on a head, including the finest baby hairs or “peach fuzz”.
Third place: The third most effective treatment for male pattern baldness was a pill containing 5 milligrams of minoxidil taken by mouth. This pill produced the greatest increase in terminal hair count after two months, much greater than the lowest dose.
“Terminal” hair is the most mature hair on the head (compared to new, fine baby hair) and is more likely to create that “full hair” effect that many seek, Rossi said.
Fourth place: Taking a reduced dose of finasteride, just one 1-milligram pill a day, came in fourth in the ability to reduce hair loss in men, according to the study. However, he showed the greatest increase in mature hair count at 48 weeks.
Fifth place and below: Using topical 5% minoxidil solution on the scalp was fifth in effectiveness, followed by topical 2% minoxidil solution. According to the study, last in terms of effectiveness was a much lower dose of oral minoxidil – just 0.25 milligrams per day.
Caution : Although the study ultimately ranked the treatments in descending order, each had different benefits at different points in the 24- and 48-week cycle, and each came with its own unique set of problematic side effects.
“In general, topical medications will have fewer systemic side effects than oral medications, but topical treatments may be more laborious to use,” said Dr. Amy McMichael, professor of dermatology at Atrium Health Wake Forest Baptist Medical Center at Winston-Salem, North Carolina, who did not participate in the study.
“The best medicine is the one the patient will comply with, because we’re always much better at keeping the hair they have than at turning back time,” she said over email.
Stopping male pattern hair loss in its tracks — rather than replacing hair with expensive hair plugs and other invasive surgical techniques — is the holy grail of treatment goals. Unfortunately, there is no better option, experts say.
Over-the-counter (and therefore without a prescription) minoxidil is the best-known treatment for both men and women, and is available in liquid, foam and shampoo form. Minoxidil requires application to the scalp morning and night, and some complain that it can leave hair sticky and unmanageable.
Side effects may include itching or a burning sensation on the scalp, as well as dryness, flaking, and flaking. It takes several months for positive effects to appear, and hair loss returns quickly once use is stopped.
Dutasteride can have severe side effects in some men, Rossi said, including loss of libido, erectile dysfunction and a form of low blood pressure called orthostatic hypotension.
On rare occasions, there may be more serious reactions to dutasteride. Call the doctor or go to the emergency room if you have peeling skin, swelling of the face, tongue, or throat, difficulty breathing or swallowing, or any breast changes such as enlargement. nipple size, lumps, pain or discharge, experts say.
Older men should talk to their doctor about their risk for prostate cancer before starting dutasteride, experts say, because taking the drug may increase the risk of high-grade prostate cancer, which spreads and spreads. grows faster than other forms of prostate cancer.
Finasteride may also impact male sexual abilities, but it’s less potent than its cousin dutasteride, so it might be a better choice for some men.
Consider seeing a dermatologist who specializes in treating hair loss who can help you navigate the confusing thicket of hair loss options, Rossi said. Often, he says, your doctor will suggest you start small.
“A lot of people take a step-by-step approach,” he said. “They can start on finasteride and if they don’t get better on finasteride then they switch to dutasteride. Or they can start with topical minoxidil and if they are not well, switch to oral minoxidil.
Finally, a caveat: None of the study results should be applied to women with hair loss, McMichael stressed. About 50% of women experience hair loss at some point in their lives.
“Studies of all of these drugs in women have been much less thorough, and there is no evidence that the effectiveness would be the same,” she said. “In clinical practice, many of these drugs are used off-label in women, but there are real concerns.”
None of the oral medications are acceptable for women of childbearing age, for example, because of the risk of pregnancy, McMichael said.
“The only drugs evaluated here that have been approved for use in women are 2% and 5% minoxidil, and of the two, we know that 5% works better than 2%,” she said. “I would not extrapolate the results discussed in this article to women.”