Treatment and Prevention of Male Pattern Baldness
... Recent progress in the understanding of the biology and pathology of hair follicles will produce more effective therapies for disorders of hair growth such as androgenic alopecia, or male pattern baldness. ... The inheritance pattern is polygenic. ... In men, androgenic alopecia ranges from the bitemporal recession of the hairline to complete baldness. ... The pattern of hair loss, combined with early onset and the presence of miniaturized hairs, supports the diagnosis. ... A good candidate for drug treatment has definite thinning and many miniaturized hairs. ... Continued treatment is necessary to maintain benefit. If treatment is stopped, any benefits will be lost in 6-12 months and hair density will be the same as it would have been without treatment6. ... In three randomized, double-blind, placebo-controlled studies, a total of 1879 men who were between the ages of 18 and 41 with mild to moderately severe baldness received oral finasteride at a dose of 1 mg per day or placebo for one year3-4. ... The results indicated that the number of responding hairs is established after about one year and that continued treatment increases length, diameter, and even pigmentation of these hairs so that coverage of the scalp increases. After two years of treatment with finasteride, about two thirds of men have improved scalp coverage, and about one third have the same amount of hair as they did at the beginning of therapy. ... With treatment for more than two years, it seems that scalp coverage continues to increase. ... It is unknown to what extent hair follicles will enlarge, and there is no way to identify who will have the best response to treatment. In December of 1997, 1-mg tablets of finasteride were approved by the FDA for treatment of androgenic alopecia in men. ... Treatment may not be as effective in men over 60 years of age, because type 2 5-alpha-reductase activity in the scalp may not be as high as in younger men. This may explain why there have been few reports of reversal of male-pattern baldness in men who are predominantly in their 60’s and 70’s and who are treated with 5 mg of finasteride for benign prostatic hyperplasia (BPH). ... These adverse effects, which included decreased libido in about 2 percent of men, gradually disappeared in days or weeks after treatment was discontinued4.