Experts say that Men's Rogaine Extra Strength Hair Regrowth Treatment (*Est. $25 per one-month supply) , a topical treatment, is a good starting place for men, and some women, in the early stages of pattern baldness. Studies show that everyone experiences re-growth of hair with it, but that approximately 90 percent of the time it at least slows the progression of hair loss and, for many, hair loss stops completely. It contains five percent minoxidil, which studies have shown to be more effective than the original strength of two percent (*est. $22 for a one-month supply). Both forms have been approved by the FDA for topical treatment of pattern baldness, but only the two percent strength has been approved for women, though studies suggest that both forms are more effective on women than they are on men. Minoxidil is also available in several generic store brand products.
Some physicians make their own treatments for pattern baldness by mixing tretinoin (Retin-A or Renova) with minoxidil. Tretinoin is often prescribed as an acne treatment, but studies suggest it increases the effect of minoxidil by 10% over minoxidil alone. This type of hair loss therapy is only available with a prescription.
One common side effect of minoxidil usage is a red, itchy scalp, but users claim that merely switching brands can sometimes alleviate that symptom. Another possible side effect is excess hair growth in unwanted places, including the face. Paula Begoun cites a 2003 study in which four percent of 1,333 women using either two-percent or five-percent minoxidil experienced unwanted hair growth. She says, "The study also pointed out, however, that a large percentage of the women in a part of this study (27%) reported that they experienced facial hair growth before they began using minoxidil, so it's possible that the women who reported the unwanted hair growth before applying minoxidil were more prone to the potential for that growth when using minoxidil." It is important to point out that unwanted hair growth, as well as other side effects, completely reverses itself once treatment is discontinued.
Experts say that the biggest drawbacks with minoxidil/Rogaine are that it has to be applied twice daily and that treatment must be continued for the rest of the patient's life in order to maintain the results. All growth resulting from minoxidil use will fall out approximately three months after treatment is stopped.
Many physicians recommend that patients engage in a combination therapy that includes minoxidil and Propecia (*Est. $70 per 30-day supply) with prescription. Propecia is an oral medication with an active ingredient of finasteride, which was originally developed by Merck to treat enlarged prostate glands. Excess hair growth was a surprise side effect of the drug and led to the development of Propecia, which was approved by the FDA for treatment of male-pattern baldness in 1997. It has not been approved for women.
Propecia works by inhibiting the five-alpha reductase enzyme, which is responsible for converting testosterone into DHT. The American Hair Loss Association says, "Propecia is the first drug in history to effectively treat male-pattern baldness in the vast majority of men who use it." They recommend it as "the first line of defense" for men with AGA.
Studies show that Propecia is effective for 86 percent of the men who use it, but doctors interviewed by USA Today say that, "anyone who expects miracles will be disappointed." They explain that only about 1/3 of men in the early stages of hair loss will regrow some with Propecia. These doctors say that it "primarily slow(s) down hair loss and improve(s) hair quality." As reported at HairLossHelp.com, a five-year study published in 2001 shows that Propecia continued to prevent hair loss but there was a "progressive decrease in the amount of hair grown over the five-year period." Experts say that it is effective at growing back more hair than minoxidil (Rogaine), but that it can take up to a year to see results.
Men taking Propecia have a risk of sexual side effects, but most experts say that it only affects a small minority of men. The risks are greater for women, especially those who are pregnant or may become pregnant. Better Nutrition magazine explains that for these women "handling the tablets can cause serious birth defects." Like minoxidil, Propecia use must be continued for as long as results are desired.
Some doctors prescribe Avodart off-label (meaning to treat something other than illnesses or conditions listed on the drug's label), to patients suffering from male-pattern baldness. Dutasteride, the active ingredient in Avodart, is another drug used to treat enlarged prostate glands, but unlike finasteride (Propecia), it blocks both types of the enzyme that create DHT, instead of just one. Studies show that dutasteride is superior to finasteride in treating AGA, but it has yet to be approved by the FDA for that purpose.
Another off-label treatment for hair loss is ketoconazole. Ketoconazole is the active ingredient in Nizoral shampoo and two-percent strength is often prescribed to treat dandruff - a one-percent formula is sold over-the-counter, but reviewers say that it isn't as effective. Many men choose to triple-treat their hair loss with minoxidil, Propecia, and Nizoral shampoo. Studies show promising results with ketoconazole, though not any better than minoxidil or Propecia, but experts insist that further study is needed.
Other off-label products that show possibilities are Tagamet (an antacid treatment), azelaic acid (a rosacea and acne treatment) and some birth control pills. Experts say that these products require further study into their effectiveness, as well as any possible side effects.
Copper peptides have received a lot of hype in recent years, but some experts are not convinced of their effectiveness in treating hair loss. Tricomin and Folligen both produce products that contain copper peptides and claim that they inhibit five-alpha reductase enzyme, much like finasteride. Paula Begoun points out, however, that the only study with promising results was performed by ProCyte Corporation, the company that owns Tricomin. She says, "While this research is interesting, it has not convinced the FDA to approve copper peptides for hair regrowth, and no other research supports these results." Users at HairLossHelp.com recommend using it in conjunction with other treatments.
There has been very little research, unfortunately, into female-pattern baldness. The American Hair Loss Association says, "While many drugs may work to some degree for women, doctors are reluctant to prescribe them, and drug companies aren't exactly falling over themselves to test existing or new drugs specifically for their ability to prevent and treat female-pattern baldness." The only FDA-approved treatment for hair loss in women is two-percent minoxidil, although some doctors will prescribe other drugs off-label.
A commonly prescribed treatment for women is hormone replacement therapy (HRT). HRT is only prescribed to women with AGA during menopause or who have low estrogen and/or progesterone for other reasons. These female hormones suppress male hormone production and seem to keep hair loss at bay. Physicians, however, do not recommend long periods of HRT treatment because of the increased risk of breast cancer, heart disease and stroke.