Medical treatment for hair loss

Medication Options for Treating Hair Loss and Baldness

Treatment of male pattern hair loss, hair thinning, and baldness with finasteride, dutasteride, minoxidil, Propecia, Rogaine, and Regaine products

Medication can be recommended for weakening or falling hair, and against hair loss. There are many different hair growth products on the market, but the reason for this is that none of them are truly effective against male pattern hair loss. With our current knowledge, inherited hair thinning cannot be stopped. However, hair loss can be slowed down, and the existing hair strands and still-functioning hair follicles can be preserved for a longer period with a few approved treatments, products, and medications that have been proven to be effective to some extent.

After a hair transplant, however, there is no need to take medication. In this case, fully viable hair is transplanted to the bald area, where there are few or no functioning hair follicles left, and where medication would no longer have a significant effect.

The use of hair loss medications after a hair transplant remains possible to help preserve the existing hair. However, these medications have no effect on the growth of the transplanted, fully viable hair strands.

To achieve the effects of a hair transplant, it is not necessary (and unnecessary) to take medication. However, medications may be recommended to slow down the loss of any remaining hair.

Androgenic alopecia (AA – male pattern baldness, hair loss) is caused by dihydrotestosterone (DHT), which is produced from testosterone by the enzyme 5-alpha-reductase. DHT exerts its effect on the lower part of the hair follicle, specifically through the dermal papilla (“hair bulb”). Here, by binding to androgen receptors, DHT inhibits the growth of matrix cells, leading to clinically observable hair loss. This process, known as miniaturization, occurs over several growth cycles, resulting in the progressive thinning and depigmentation of hair strands. The affected hair loses its thickness, with the diameter gradually decreasing, and miniaturization ultimately ends with the complete cessation of hair bulb function and its eventual death.

DHT is produced from testosterone by the action of the 5-alpha-reductase enzyme. Finasteride is a synthetic steroid medication that specifically blocks the 5-alpha-reductase enzyme, which converts testosterone into its active form, dihydrotestosterone (DHT). This effect primarily targets the type II 5-alpha-reductase enzyme. In the absence of this enzyme, male pattern hair loss and prostate enlargement do not develop.

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propecia (MERCK)

Finasteride is the only oral medication approved by the FDA (U.S. Food and Drug Administration) for the treatment of hair loss since 1997. Finasteride significantly reduces DHT levels in both the blood and the scalp. A daily dose of 1 mg of finasteride decreases DHT levels in the blood by almost 70%. Due to this effect, finasteride is also suitable for treating benign prostatic hyperplasia. It is not available in Hungary but can be ordered from abroad. Its effects may manifest in slowing down hair loss on the crown and potentially promoting slight hair growth and thickening. However, it is not a miracle cure, and its use unfortunately does not fundamentally prevent baldness. In certain cases, it can halt hair loss and induce a modest amount of regrowth. If the medication is discontinued, the original condition, or the state corresponding to that point in time, will return.

How to Use Propecia Medication?

Propecia should be taken once daily in the form of a 1 mg tablet. It may take at least a year or longer before its hair loss prevention and hair growth-promoting effects become noticeable. It works well in young men where hair transplantation is not yet recommended.

During the first 6 months, hair thinning may occur, which can be attributed to the normal process before the medication has fully taken effect, or to the shedding of miniaturized hairs to make way for new hair growth.

It's important to remain patient and wait for a full year. Only then can you assess whether the treatment is having an effect and if it is significant.

The medication must be taken continuously, as its effects cease once the treatment is stopped. It is recommended that men discontinue the use of Finasteride at least three months before attempting to conceive, as it can cause harm to the embryo. This timeframe allows the drug to be completely eliminated from the body.

Common Misconceptions About Propecia with Finasteride

Myth: Women should not touch the medication.
Reality: Pregnant women should not handle damaged or crushed tablets.

Myth: It is only effective on the crown area.
Reality: It can actually work anywhere on the scalp where there is still some hair.

Myth: Once you start taking it, you have to take it forever.
Reality: You can stop taking it at any time, but its effects will cease.

Myth: Finasteride reduces testosterone.
Reality: The medication causes a slight increase in serum testosterone levels by about 9%.

Myth: Sexual side effects are common and irreversible.
Reality: Sexual side effects occur in less than 2% of cases and are reversible once the medication is discontinued.

Myth: Finasteride causes birth defects if taken by a man whose wife is pregnant.
Reality: The sperm of men taking the medication poses no risk to the embryo in pregnant women.

What are the side effects?

They are rare but reversible. A very low percentage of users have reported decreased libido, erectile dysfunction, and reduced ejaculate volume. Some have also experienced breast tenderness or slight enlargement. These issues resolved within a few weeks after discontinuing the medication. Women should not take it, as it can have harmful effects on a male embryo.

Avodart (DUTASTERIDE)

It is a synthetic hormone medication, registered and approved in our country for the treatment of benign prostatic hyperplasia (BPH). It is not yet officially approved for the treatment of hair loss, although its effects in this area have been observed, as it is a so-called “dual DHT inhibitor” (it inhibits both forms of the enzyme: type 1 and type 2 5-alpha-reductase). As a result, its function is more specific than that of finasteride. The role of the type 1 enzyme in male pattern baldness is not yet fully proven. For hair loss, a daily dose of 2.5 mg is recommended. Only the original (genuine) Glaxo product should be taken, and even then, only under medical supervision. The active ingredient dutasteride is not (and has not been for a long time) approved for the treatment of hair loss; it is only known to be used “off-label,” meaning outside of FDA approval.

Effect of Finasteride and Dutasteride on PSA Levels

Regular use of both finasteride and dutasteride reduces serum PSA (Prostate-Specific Antigen, an increase of which may indicate prostate cancer) levels by 30-50%. Therefore, it is important to inform your urologist or general practitioner if you are taking these medications. The actual PSA level can be estimated by approximately doubling the reported value.

Rogaine (MINOXIDIL)

Rogaine is a topical solution containing the active ingredient “minoxidil,” which was the first FDA-approved treatment for hair loss and baldness. Rogaine is a rub-on product applied directly to the scalp and is available as a 5% solution (for men), a 2% solution (for women), and Rogaine Foam, which also contains 5% minoxidil. In Hungary, only the 2% solution is available as Regain in pharmacies, although some places also sell the foam. The exact mechanism of its effect is unknown, but it appears to increase the length of the anagen phase. This improves hair quality, thickening, and lengthening it. When used in combination with Propecia, it may have a slight synergistic effect, but Propecia is a much more effective medication. It can be primarily effective between 5 months and 2 years; over the long term, hair loss continues, but at a slower rate.

APPLICATION OF ROGAINE

It should be rubbed into the scalp twice a day, and it works where it is applied. The 5% solution is twice as effective as the 2% solution, but it contains propylene glycol, which may cause scalp irritation in some users. Therefore, the foam is a better option, as this problem does not occur, and it does not leave a sticky residue. Its effect is only maintained with continuous use. After stopping the application, the hair growth effect diminishes, and the original condition returns. For women, the 2% solution is recommended. As a side effect, facial hair may appear, so it should be used with caution.

Other Products

Spectral DNC is a combined hair loss treatment that contains 5% Minoxidil, Adenosine, Procyanidin, and Aminexil.

MINOXIDIL 5%

A strong DHT blocker prevents the DHT hormone from exerting its effects on hair follicles, thereby preventing baldness.

AMINEXIL SP49

It prevents the collagen surrounding the hair root from hardening, allowing the root to anchor more firmly into the scalp.

The SP94 molecule integrates into the hair follicle, participates in the synthesis of ceramides*, and provides the necessary nutrients for building strong, thick hair strands.

Adenozin

A potent hair growth-inducing nucleic acid with effects similar to Minoxidil. (One of the most important ingredients, as DHT inhibits the production of adenosine, and without it, the hair growth phase slows down, and the lifespan of hair follicles is significantly shortened.)

Procyanidin B-2 and C-1

A natural DHT blocker derived from apples, when combined with minoxidil, has an exceptional hair growth-promoting effect and is a highly potent antioxidant. (It has an antioxidant effect that is 20 times stronger than vitamin C and 50 times stronger than vitamin E.)

Covering balding areas with microfibers (camouflage) using Toppik powder. However, the effects of the medications discussed can vary significantly, both generally and individually, and unfortunately, they cannot fundamentally prevent male pattern baldness or hair loss, though they may slow it down. It is advisable to use only original, genuine products from the original developers and manufacturers, as they offer a much higher guarantee of potential results, even if they may be available elsewhere at a slightly lower cost. According to our current knowledge, the best and permanent solution for hair restoration is hair transplantation, which can be supplemented with medication.

New discoveries in hair loss treatments, future possibilities

PROSZTAGLANDIN

https://hajszalhijan.blog.hu/2012/04/08/a_kopaszodas_kezelheto_lesz_prosztaglandin_ellenes_kezelessel

SVF Treatment

Application of Stromal Vascular Fraction (SVF), a stem cell-based hair restoration therapy derived from adipose tissue.

Exosome Therapy

Exosomes from adipose-derived mesenchymal stem cells (ADMSCs) have become a potential treatment option for hair loss due to their regenerative and immunomodulatory properties. Numerous studies suggest that ADMSC exosomes may promote hair growth by influencing various cellular and molecular processes involved in hair follicle biology.

Do I need to take medication after a hair transplant?

The short answer: NO

In more detail:
Hair transplantation replaces hair that is already missing. It has no effect on hair that has already fallen out or on hair that has not yet fallen out. (However, there may be a temporary effect on the latter—see the “shock loss” phenomenon. Occasionally, a temporary thinning of existing hair may occur in the transplant area, and in some cases, in the donor area as well, known as “shock loss” or “telogen effluvium,” but these hairs will regrow at the same time as the transplanted hair. This phenomenon is caused by surgical stress, and the situation spontaneously resolves as the scalp’s blood circulation regenerates.)

Where hair no longer grows, there are no functioning hair follicles. These are replaced during a hair transplant with fully viable hairs transplanted from the so-called safe donor area, located at the back and sides of the head. These hairs will not fall out later—they are not sensitive to hormonal effects.

There are certain medications (finasteride, dutasteride, minoxidil) known to have hair-retaining effects, which can be used for thinning or shedding hair, with certain limitations (see “Medical Treatment for Hair Loss”). The use of these medications after a hair transplant remains possible to preserve existing hair, but they have no effect on the growth of the transplanted, fully viable hair strands.

Therefore, taking medication is not necessary (and unnecessary) to achieve the effects of a hair transplant, but products may be recommended to slow the loss of any remaining hair.

For further information, visit the ISHRS website:
https://ishrs.org/patients/treatments-for-hair-loss/