What treatment is there for hair loss in men?

There are few scientifically proven and FDA-approved treatments for hair loss. There are thousands of unproven claims and products to help with hair regrowth. Many conditioners, shampoos, vitamins, and other products claim to help hair grow in some unspecified way. Nioxin has been a popular brand of shampoo for hair loss, but there is no compelling evidence showing it is any more effective than regular shampoos. These products are usually harmless but generally not scientifically proven and therefore potentially useless. To slow down hair loss, there are at least four potentially effective, basic options. These include medications like Minoxidil, and Propecia, which are for long-term use. Stopping these drugs does not seem to worsen or exacerbate the prior hair loss. The patient will simply revert to the state he would have been in had he never started treatment.

• Minoxidil (Rogaine): This topical medication is available over the counter, and no prescription is required. Men and women can use it. It works best on the crown, less on the frontal region. Minoxidil is available as a 2% solution, 4% solution, an extra-strength 5% solution, and a new foam or mousse preparation. Rogaine may grow a little hair, but it’s better at holding onto what’s still there. There are few side effects with Rogaine. The main problem with this treatment is the need to keep applying it once or twice daily, and most men get tired of it after a while. In addition, minoxidil tends to work less well on the front of the head, which is where baldness bothers most men. Inadvertent application to the face or neck skin can cause unwanted hair growth in those areas.
• Finasteride (Propecia): This medication is FDA approved for use in only men with androgenic hair loss. Finasteride is in a class of medications called 5-alpha reductase inhibitors. It helps reduce hair loss by blocking the action of natural hormones in scalp hair follicles. Propecia is a lower-dose version of a commercially available drug called Proscar that helps shrink enlarged prostates in middle-aged and older men. Women of child-bearing potential should avoid finasteride. Propecia 1 mg tablets are available by prescription and taken once daily. Propecia may grow and thicken hair to some extent for some people, but its main use is to keep (maintain) hair that’s still there. Studies have shown that this medication works well in some types of hair loss, and patients should use it for about six to 12 months before full effects are determined. This medication does not “work” in days to weeks, and its onset of visible improvement tends to be gradual. It may be best for men who still have enough hair to retain but also can help some regrow hair. Possible but very unlikely side effects include impotence or a decreased sex drive (libido). Studies show that these side effects were possibly slightly more common than seen in the general population and are reversible when patients stop taking the drug. The cost is about $70-$100/month, and most health insurers do not reimburse for the expense.
• A group of topical medications called prostaglandin analogs have recently began undergoing testing for potential hair regrowth. They may be used in men and women. These drugs are not currently FDA approved for scalp hair loss. Currently, these are primarily used for eyelash enhancement. One of the new medications is called bimatoprost (Latisse). Further testing and studies are required to assess the efficacy of these products in scalp hair loss. Bimatoprost solution is sometimes used off-label for help in selected cases of hair loss. It is currently FDA approved for cosmetic eyelash enhancement. Studies have shown it can treat hypotrichosis (short or sparse) of the eyelashes by increasing their growth, including length, thickness, and darkness. This medication is also commercially available as Lumigan, which is used to treat glaucoma. It is not known exactly how this medication works in hair regrowth, but it is thought to lengthen the anagen phase (active phase) of hair growth. Interestingly, during routine medical use of Lumigan eyedrops for glaucoma patients, it was serendipitously found that eyelashes got longer and thicker in many users. This led to clinical trials and the approval of cosmetic use of Latisse for eyelashes.