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Medical treatment

At present, minoxidil and finasteride are the only treatments approved by the FDA for MPHL.


How does Finasteride work?

Finasteride is a 5α-reductase type 2 inhibitor. It reduces the conversion of testosterone to DHT.

What is the benefit of taking Finasteride?

In 80% of those undergoing Finasteride treatment, significant increases in hair count and fiber size are observed along with prolonged hair growth periods.

How long will it be before improvements are noticed through the use of Finasteride?

Improvements are noticed 6-12 months from the commencement of treatment. Two years of use are required to achieve the maximum effect, and continuous use is recommended in order to maintain this benefit. The discontinuance of the treatment will cause undesirable results.

Where on the scalp is Finasteride more effective?

Finasteride is more effective over the vertex and superior-frontal regions of the scalp. However, it is potentially effective wherever miniaturized hair is present.

What is the recommended dosage?

The average dosage is 1 mg/day, but with a dosage of 0.2 mg/day significant improvement is observed.

Is there a potential for reaction with other drugs?

No known drug interaction exists.

Is there any disease or condition that contraindicates the use of Finasteride?

Finasteride use should not be used by women who are pregnant and by patients with liver disease.

What are the adverse effects?

Reported adverse effects of Finasteride use include: decreased libido (1.9%), erectile dysfunction (1.3%), and ejaculatory dysfunction (1%). In some patients, the adverse effects of the medication persisted for at least 3 months after discontinuing use. Although clear causation has not been determined, the FDA has warned about its potentially persistent adverse sexual effects, despite discontinuation. Finasteride works to reduce prostate-specific antigen (PSA) levels and gynecomastia has been reported in rare cases. A recent study investigated the association between 5-ARI’s and male breast cancer. The result revealed a lack of positive association.


How does Minoxidil work?

It is still unclear how Minoxidil works. It may prevent or delay follicular miniaturization.

What is the recommended dosage of Minoxidil?

With MPHL, a 5% solution is superior to a 2% solution. With FPHL, both 1% and 2% Minoxidil solutions increase hair count. The recommended dosage is 1 ml (25 drops) for both 2% and 5% formulation, or half a cap full of foam applied twice daily.

How long is the Minoxidil treatment?

Minoxidil treatment is long-term. The discontinuation of Minoxidil will cause the shedding of all Minoxidil-dependent hair within 4 to 6 months.

What are the adverse effects of Minoxidil?

The adverse effects of Minoxidil include skin irritation, hypertrichosis on the face and hands, and tachycardia. A propylene glycol–free foam preparation of 5% is potentially less irritating and less messy. Hypertrichosis is totally reversible.

The adverse effects of Minoxidil include skin irritation, hypertrichosis on the face and hands, and tachycardia. A propylene glycol–free foam preparation of 5% is potentially less irritating and less messy. Hypertrichosis is totally reversible.

Is there any disease or condition that contraindicates the use of Minoxidil?

Minoxidil should not be used in pregnant or nursing women. It should be used with caution in patients with cardiovascular disease as well.


How does Dutasteride work?

Dutasteride inhibits both type I and II 5α-reductase consequently increasing hair count and hair weight by improving the ratio of anagen to telogen hairs, and resulting in improvement in scalp coverage.

What is the recommended dosage?

The Dutasteride dosage of 0.5 mg/day is considered adequate to improve or prevent the progression of MPHL.

What are the adverse effects of Dutasteride?

The adverse effects of Dutasteride are impotence, decreased libido, breast tenderness, breast enlargement, and ejaculatory disorders.

Is there any disease or condition that contraindicates the use of Dutasteride?

Because of its long half-life, men who are being treated with Dutasteride should not donate blood. Dutasteride should not be used in women of a reproductive age without the use of effective contraception. Additionally, liver function should be monitored while taking this drug.

Prostaglandin (PG) Analogs

The PG pathway is intimately related to hair growth because PGE2 and PGF2α promote hair growth, whereas PGD2 inhibits hair growth. In men with mild cases of AGA, 0.1 % latanoprost, a PGF2 analog, has shown to significantly increase hair density and pigmentation.


Ketoconazole is an anti-fungal agent effective for the treatment of dermatitis and dandruff that may stimulate hair growth. It is typically utilized in conjunction with other AGA treatments.

Platelet-Rich Plasma

Platelet-rich plasma (PRP) is an autologous preparation of plasma with platelets. PRP is frequently used in cosmetic surgery and related aspects of wound healing. Some hair transplant surgeons use PRP, either by storing the grafts in PRP or by injecting PRP into the scalp prior to the placement of grafts. Data to support its direct effect on the stimulation of hair growth is limited.

Low Level Laser Therapy (LLLT)

Several types of products using LLLT are available for adjunctive treatment including the Hair Max Laser Comb approved by the FDA for the treatment of MPHL and FPHL. LLLT, particularly the 650–900 nm wavelength at 5mW, may be considered an effective alternative treatment for either condition as stand-alone or adjunctive therapy.

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