There are currently two FDA-approved medical treatments for hair loss, Minoxidil (Rogaine®) and Finasteride (Propecia®). A third, called Dutesteride (Avodart®), is similar to Finesteride but has not been officially approved by the FDA for hair loss.

In order to obtain maximum density now and in the future, it is important to use adjunctive medical therapy to preserve existing native hair. Medical therapy may bring back some lost hair, but just as important, it is slowing down or stopping future loss. The use of medical therapy can affect surgical planning in a number of ways. Sometimes the response is so good that patients decide they don’t need surgery. Sometimes it improves the situation so a smaller, less aggressive procedure is needed. Even if medical therapy is only minimally effective, a small amount of regrowth can significantly improve the appearance of density in transplanted areas.

Finasteride (Propecia®) is a 1 mg oral tablet taken daily that acts as a potent 5-alpaha-reducates type-2 inhibitor. It blocks the conversion of testosterone to Di-Hydro-Testosterone and decreases levels of DHT by about 65 percent. It has been shown to block further hair loss as well as produce re-growth. The effects are greatest on the crown, however, it has some beneficial effect in the frontal area as well. Five-year results show that by hair-count, 65% of men are stable or improve. There is concern that the efficacy of Finasteride may wear off with time, however, we have patients who have been on Finasteride for over 10 years with continued affects. In men, Finasteride has a very low side-effect profile. The most common concerns are sexual side effects, gynecomastia and decreased sperm count. Even though the incidence of sexual side effects is low (1.8 percent with Finasteride compared to 1.6 percent with a placebo) and reversible when stopped, it is still unsettling to some men. Recently, it has been suggested that Finesteride may be protective against prostate cancer. Finasteride is not officially approved for use in women, and a study by Merck on post-menopausal women over the age of 50 did not show any benefit. However, there are a few small, independent studies and anecdotal reports that suggest Finasteride may have some beneficial effects in women as well. The use of Finasteride is strictly contraindicated in women of child-bearing age because of potential birth abnormalities that could occur to the fetus of pregnant women taking Finasteride.

Dutesturide (Avodart®) works similarly to Finesteride by blocking the conversion of testosterone to Di-Hydro-Testosterone. It is, however, more powerful and decreases levels of DHT by 90 percent as opposed to 65 percent. Most physicians feel that it is more effective than Propecia, but there is concern that the side-effect profile may be greater. It has not been officially released for hair loss, and many physicians only use this medication as a second-line treatment if Finesteride is ineffective.

Minoxidil (Rogaine®) is a topical application approved for both men and women. It has been shown to either reduce hair loss or promote hair growth in about 80% of patients. Minoxidil acts as a direct anlagen-prolonging agent. The original product, however, was oily and messy, and the propylene glycol additive could cause irritation in some patients. Recently, a new 5% foam delivery system has been released without any propylene glycol. It is much easier to use and better accepted by patients. Although the 5% is labeled for men, it can be used by both men and women.