Hair Loss Medications
While some hair loss is inevitable, there are treatments that can stimulate regrowth and slow progression. Available therapies are reviewed below.
- Finasteride (Propecia®) - finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT), a potent androgen that suppresses hair growth. In studies, finasteride has been shown to increase average hair counts and slow balding for up to 5 years. An effect is seen in as early as 3 months, and it peaks between 1 and 2 years. Some men avoid finasteride over concerns that it may cause sexual side effects. In studies, the incidence of these events is very low (< 2%) and similar to placebo. See finasteride sexual side effects for more.
- Dutasteride (Avodart®) - like finasteride, dutasteride also blocks the conversion of testosterone to dihydrotestosterone (DHT), but its effects are more potent. In head-to-head hair loss studies, dutasteride has proven to be slightly superior to finasteride. In the U.S., dutasteride is only FDA-approved to treat benign prostatic hyperplasia, but it can be prescribed off-label for hair loss; in other countries, it is approved to treat male pattern baldness. Sexual side effects of dutasteride are detailed in the table below - dutasteride sexual side effects
- Low-dose oral minoxidil - minoxidil is an old blood pressure medication that is sometimes used to treat resistant hypertension. A notable side effect of minoxidil is hair growth, and this led to its development as a topical hair loss treatment; it is the active ingredient in Rogaine®. At doses used for hypertension (≥ 10 mg/day), oral minoxidil can have some significant side effects, but low-dose minoxidil (≤ 5 mg/day) has been shown to be well-tolerated while maintaining its hair-stimulating properties. Low-dose oral minoxidil can be used in men and women.
- Topical minoxidil (Rogaine®) - topical minoxidil has been used for years to treat hair loss in men and women. It is available over the counter as a solution and foam.
- Reference: Propecia prescribing information
| Finasteride sexual side effects during the first year of treatment |
| Side effect |
Finasteride 1 mg
(N=945) |
Placebo
(N=934) |
| Decreased Libido |
1.8% |
1.3% |
| Erectile Dysfunction |
1.3% |
0.7% |
| Ejaculation disorder |
1.2% |
0.7% |
| Decreased volume of ejaculate |
0.8% |
0.4% |
| Stopped drug due to sexual side effects |
1.2% |
0.9% |
- Overall, 3.8% of finasteride-treated men reported ≥ 1 sexual adverse event compared to 2.1% of placebo-treated patients (p=0.04)
- The incidence of sexual side effects did not increase with continued use up to 5 years
- In a study of finasteride 1 mg daily in healthy men, a median decrease in ejaculate volume of 0.3 mL (-11%) compared with 0.2 mL (-8%) for placebo was observed after 48 weeks of treatment
|
- Reference: Avodart prescribing information
| Dutateride sexual side effects during the first six months of BPH treatment |
| Side effect |
Dutasteride 0.5 mg
(N=2167) |
Placebo
(N=2158) |
| Impotence |
4.7% |
1.7% |
| Decreased libido |
3% |
1.4% |
| Ejaculation disorder |
1.4% |
0.5% |
- The incidence of sexual side effects did not increase with continued use up to 2 years
- In a 52-week study, dutasteride caused a mean reduction in total sperm count, semen volume, and sperm motility compared to placebo. Sperm concentration and sperm morphology were unaffected and mean values for all semen parameters remained within the normal range at all timepoints. The effects on total sperm count were not reversible after 24 weeks of follow-up.
|
