Treatment Options for Androgenetic Alopecia: Efficacy, Side Effects, Compliance, Financial Considerations, and Ethics

November 2021 in “ Journal of Cosmetic Dermatology ”

Mark S Nestor, Glynis Ablon, Anita Gade, Haowei Han, Daniel A. Fischer

androgenetic alopecia topical minoxidil oral finasteride low-level light therapy platelet-rich plasma exosomes microneedling scalp irritation erectile dysfunction combination therapies AGA Rogaine Propecia LLLT PRP

TLDR Combination therapies for androgenetic alopecia work best but can have significant side effects and costs.

The document reviews various treatment options for androgenetic alopecia (AGA), focusing on their efficacy, side effects, compliance, financial considerations, and ethical issues. Treatments discussed include FDA-approved options like topical minoxidil and oral finasteride, as well as newer therapies like low-level light therapy, PRP, exosomes, and microneedling. Efficacy varies, with combination therapies often showing superior results. Side effects range from mild (e.g., scalp irritation) to severe (e.g., erectile dysfunction with finasteride). Compliance is crucial due to the chronic nature of AGA, and financial costs can be significant. Ethical considerations emphasize patient education and unbiased treatment recommendations. The document calls for more high-quality clinical trials to better compare treatment outcomes.

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research Depressive Symptoms and Suicidal Thoughts Among Former Users of Finasteride With Persistent Sexual Side Effects

134 citations , August 2012 in “The Journal of Clinical Psychiatry”

Former finasteride users with persistent sexual side effects have higher rates of depression and suicidal thoughts.

research Persistent Sexual Side Effects of Finasteride: Could They Be Permanent?

112 citations , July 2012 in “The Journal of Sexual Medicine”

Finasteride may cause long-lasting sexual side effects.

Mesotherapy Using Dutasteride-Containing Preparation in Treatment of Female Pattern Hair Loss: Photographic, Morphometric and Ultrastructural Evaluation

research Mesotherapy Using Dutasteride-Containing Preparation in Treatment of Female Pattern Hair Loss: Photographic, Morphometric and Ultrastructural Evaluation

41 citations , April 2012 in “Journal of The European Academy of Dermatology and Venereology”

Dutasteride-containing mesotherapy effectively treats female hair loss, improving density and thickness with minimal side effects.

research Minoxidil Use in Dermatology, Side Effects, and Recent Patents

152 citations , April 2012 in “Recent Patents on Inflammation & Allergy Drug Discovery”

Minoxidil treats hair loss, promotes growth, has side effects, and has recent patents.

research The Nuts and Bolts of Low-Level Laser Therapy

1057 citations , November 2011 in “Annals of Biomedical Engineering”

Low-level Laser Therapy may help reduce inflammation, pain, and aid healing, but more research is needed to confirm its effectiveness and establish standard treatment guidelines.

research Evaluation of Efficacy and Safety of Finasteride 1 mg in 3177 Japanese Men with Androgenetic Alopecia

41 citations , October 2011 in “Journal of Dermatology”

Finasteride 1 mg effectively and safely increases hair growth in Japanese men with hair loss.

A Randomized Double-Blind Placebo-Controlled Pilot Study to Assess the Efficacy of a 24-Week Topical Treatment by Latanoprost 0.1% on Hair Growth and Pigmentation in Healthy Volunteers with Androgenetic Alopecia

research A Randomized Double-Blind Placebo-Controlled Pilot Study to Assess the Efficacy of a 24-Week Topical Treatment by Latanoprost 0.1% on Hair Growth and Pigmentation in Healthy Volunteers with Androgenetic Alopecia

81 citations , August 2011 in “Journal of The American Academy of Dermatology”

Latanoprost 0.1% may effectively treat hair loss.

research Young Men's Coping with Androgenetic Alopecia: Acceptance Counts When Hair Gets Thinner

21 citations , August 2011 in “Body Image”

Acceptance reduces hair loss distress and medical consultations; coping mechanisms increase them.

research Finasteride, 1 Mg Daily Administration on Male Androgenetic Alopecia in Different Age Groups: 10-Year Follow-Up

44 citations , July 2011 in “Dermatologic Therapy”

Finasteride effectively increases hair growth in men with AGA, works better for those over 30, and may cause some side effects.

A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

research A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

100 citations , June 2011 in “Journal of The American Academy of Dermatology”

5% minoxidil foam once daily works as well as 2% minoxidil solution twice daily for female hair growth and is more convenient.

research Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA

10 citations , May 2011

The new treatment regimen was effective in promoting significant hair growth in all 15 male patients with androgenic alopecia.

research Prospective Cohort Study on the Effects and Tolerability of Flutamide in Patients with Female Pattern Hair Loss

42 citations , April 2011 in “Annals of Pharmacotherapy”

Flutamide effectively treats female pattern hair loss with low doses showing good liver tolerance.

research Persistent Sexual Side Effects of Finasteride for Male Pattern Hair Loss

185 citations , March 2011 in “The Journal of Sexual Medicine”

Finasteride for hair loss can cause long-lasting sexual side effects like low libido and erectile dysfunction.

research Treatment of Female Pattern Hair Loss with the Androgen Receptor Antagonist Flutamide

30 citations , March 2011 in “Australasian Journal of Dermatology”

Flutamide improves female hair loss when other treatments fail, but may cause liver toxicity.

research Male Androgenetic Alopecia

100 citations , April 2010 in “Expert Opinion on Pharmacotherapy”

Hair loss in men treated best with early medication or transplant, new treatments researched.

research Follicular Unit Extraction Hair Transplant

29 citations , January 2010 in “PubMed”

FUE hair transplants offer minimal scarring and are good for short hairstyles but are time-consuming and can be costly.

research Successful Treatment of Female-Pattern Hair Loss with Spironolactone in a 9-Year-Old Girl

26 citations , April 2009 in “Australasian Journal of Dermatology”

Spironolactone successfully treated hair loss in a 9-year-old girl.

research The Effects of Autologous Platelet-Rich Plasma and Various Growth Factors on Non-Transplanted Miniaturized Hair

37 citations , March 2009 in “Hair transplant forum international”

PRP treatment helped reverse hair thinning and promoted new hair growth.

research Serenoa Repens: Does It Have Any Role in the Management of Androgenetic Alopecia?

28 citations , January 2009 in “Journal of Cutaneous and Aesthetic Surgery”

Serenoa repens is not proven effective for hair loss and may delay prostate cancer detection.

research Comparing the Therapeutic Effects of Finasteride Gel and Tablet in Treatment of Androgenetic Alopecia

57 citations , January 2009 in “Indian Journal of Dermatology, Venereology and Leprology”

Finasteride gel is slightly more effective than the tablet for treating hair loss.

Long-Term Treatment with Finasteride 1 mg Decreases the Likelihood of Developing Further Visible Hair Loss in Men with Androgenetic Alopecia

research Long-Term Treatment with Finasteride 1 mg Decreases the Likelihood of Developing Further Visible Hair Loss in Men with Androgenetic Alopecia

20 citations , December 2008 in “PubMed”

Finasteride 1 mg helps prevent more hair loss in men with male pattern baldness.

A Multicenter, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of a Novel Formulation of 5% Minoxidil Topical Foam Versus Placebo in the Treatment of Androgenetic Alopecia in Men

research A Multicenter, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of a Novel Formulation of 5% Minoxidil Topical Foam Versus Placebo in the Treatment of Androgenetic Alopecia in Men

142 citations , August 2007 in “Journal of The American Academy of Dermatology”

New 5% minoxidil foam effectively promotes hair growth and is safe for use.

research Finasteride 5mg and Sexual Side Effects: How Many Are Related to a Nocebo Phenomenon?

225 citations , July 2007 in “The Journal of Sexual Medicine”

Knowing about finasteride's sexual side effects increases reported dysfunction.

research Treatment of Female Pattern Hair Loss with a Combination of Spironolactone and Minoxidil

21 citations , January 2007 in “Australasian Journal of Dermatology”

Spironolactone and minoxidil together effectively treat female pattern hair loss.

research Female Pattern Hair Loss: Current Treatment Concepts

50 citations , January 2007 in “PubMed”

Minoxidil 2% and 5% are common treatments for female pattern hair loss, with other options including anti-androgens, oral contraceptives, and hair transplantation.

The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

research The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

215 citations , November 2006 in “Journal of The American Academy of Dermatology”

Dutasteride more effective for hair growth, but has more side effects than finasteride.

research Effects of Finasteride (1 mg) on Hair Transplant

30 citations , March 2006 in “Dermatologic Surgery”

Finasteride improves surrounding scalp hair and increases hair density after hair transplant.

research Effective Treatment of Female Androgenic Alopecia with Dutasteride

33 citations , October 2005 in “PubMed”

Dutasteride successfully treated a woman's hair loss when other treatments failed.

research Treatment of Female Pattern Hair Loss With Oral Antiandrogens

179 citations , March 2005 in “British Journal of Dermatology”

Oral antiandrogens effectively treat female hair loss, with better results in higher hair loss grades.

research Marked Suppression of Dihydrotestosterone in Men with Benign Prostatic Hyperplasia by Dutasteride, a Dual 5α-Reductase Inhibitor

408 citations , May 2004 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

Dutasteride more effectively lowers DHT levels in men with enlarged prostates than finasteride.

Melatonin Increases Anagen Hair Rate in Women With Androgenetic Alopecia or Diffuse Alopecia: Results of a Pilot Randomized Controlled Trial

research Melatonin Increases Anagen Hair Rate in Women With Androgenetic Alopecia or Diffuse Alopecia: Results of a Pilot Randomized Controlled Trial

78 citations , February 2004 in “British Journal of Dermatology”

Melatonin helps hair growth in women with hair loss.

research Finasteride-Associated Male Infertility

34 citations , January 2004 in “Revista do Hospital das Clínicas”

Finasteride may worsen infertility in men with existing issues, but stopping it can improve sperm health.

research Minoxidil vs Finasteride in the Treatment of Men With Androgenetic Alopecia

40 citations , September 2003 in “Archives of Dermatology”

Finasteride slightly better long-term, minoxidil faster initial results, but stopping minoxidil may cause hair loss.

research The Effects of Minoxidil, 1% Pyrithione Zinc, and a Combination of Both on Hair Density: A Randomized Controlled Trial

57 citations , August 2003 in “British Journal of Dermatology”

Minoxidil and pyrithione zinc combo most effectively increases hair density.

research Treatment of Hyperandrogenic Alopecia in Women

108 citations , January 2003 in “Fertility and Sterility”

Flutamide may slightly improve hair loss in women, but finasteride does not work.

A Randomized Clinical Trial of 5% Topical Minoxidil Versus 2% Topical Minoxidil and Placebo in the Treatment of Androgenetic Alopecia in Men

research A Randomized Clinical Trial of 5% Topical Minoxidil Versus 2% Topical Minoxidil and Placebo in the Treatment of Androgenetic Alopecia in Men

269 citations , August 2002 in “Journal of The American Academy of Dermatology”

5% minoxidil works better for hair growth and density, with minor irritation.

research Prostaglandin-Induced Hair Growth

162 citations , August 2002 in “Survey of Ophthalmology”

Latanoprost can make eyelashes longer, thicker, and darker.

research Comparative Efficacy of Various Treatment Regimens for Androgenetic Alopecia in Men

80 citations , August 2002 in “Journal of Dermatology”

Best hair growth results from combining finasteride and minoxidil.

research Effects of Minoxidil 2% vs. Cyproterone Acetate Treatment on Female Androgenetic Alopecia: A Controlled, 12-Month Randomized Trial

149 citations , June 2002 in “British Journal of Dermatology”

Minoxidil works better for female hair loss, but cyproterone reduces scalp oiliness and causes menstrual issues.

A Randomized, Double-Blind, Placebo-Controlled Trial to Determine the Effectiveness of Botanically Derived Inhibitors of 5-Alpha-Reductase in the Treatment of Androgenetic Alopecia

research A Randomized, Double-Blind, Placebo-Controlled Trial to Determine the Effectiveness of Botanically Derived Inhibitors of 5-Alpha-Reductase in the Treatment of Androgenetic Alopecia

68 citations , April 2002 in “Journal of Alternative and Complementary Medicine”

Natural 5AR inhibitors effectively improve mild to moderate hair loss in men.

research A Randomized, Double-Blind, Placebo-Controlled Trial to Determine the Effectiveness of Botanically Derived Inhibitors of 5-Alpha-Reductase in the Treatment of Androgenetic Alopecia

65 citations , April 2002 in “Journal of Alternative and Complementary Medicine”

Plant extracts effectively reduce hair loss and increase growth, offering a safe alternative treatment.

Minoxidil-Induced Hair Growth Is Mediated by Adenosine in Cultured Dermal Papilla Cells: Possible Involvement of Sulfonylurea Receptor 2B as a Target of Minoxidil

research Minoxidil-Induced Hair Growth Is Mediated by Adenosine in Cultured Dermal Papilla Cells: Possible Involvement of Sulfonylurea Receptor 2B as a Target of Minoxidil

83 citations , December 2001 in “Journal of Investigative Dermatology”

Minoxidil boosts hair growth by targeting adenosine and possibly sulfonylurea receptor 2B.

research Finasteride Increases Anagen Hair in Men with Androgenetic Alopecia

129 citations , October 2000 in “British Journal of Dermatology”

Finasteride helps increase hair growth in men with hair loss.

Changes in Hair Weight and Hair Count in Men with Androgenetic Alopecia After Application of 5% and 2% Topical Minoxidil, Placebo, or No Treatment

research Changes in Hair Weight and Hair Count in Men with Androgenetic Alopecia After Application of 5% and 2% Topical Minoxidil, Placebo, or No Treatment

115 citations , November 1999 in “Journal of The American Academy of Dermatology”

Minoxidil increases hair weight and count temporarily in men with hair loss.

research Chronic Treatment with Finasteride Daily Does Not Affect Spermatogenesis or Semen Production in Young Men

104 citations , October 1999 in “The Journal of Urology”

Finasteride doesn't harm male fertility or sperm quality, but may slightly reduce ejaculate volume.

Hypertrichosis and Increased Pigmentation of Eyelashes and Adjacent Hair in the Region of the Ipsilateral Eyelids of Patients Treated with Unilateral Topical Latanoprost

research Hypertrichosis and Increased Pigmentation of Eyelashes and Adjacent Hair in the Region of the Ipsilateral Eyelids of Patients Treated with Unilateral Topical Latanoprost

216 citations , October 1997 in “American Journal of Ophthalmology”

Using the eye pressure medication latanoprost can cause excessive hair growth and darker eyelashes on the treated eye.

research Topical Finasteride in the Treatment of Androgenic Alopecia: Preliminary Evaluations After a 16-Month Therapy Course

30 citations , January 1997 in “Journal of Dermatological Treatment”

Topical finasteride helps regrow hair and reduce balding without side effects.

research Improvement in Androgenetic Alopecia (Stage V) Using Topical Minoxidil in a Retinoid Vehicle and Oral Finasteride

23 citations , December 1995 in “Archives of Dermatology”

Combination therapy improves hair growth in advanced hair loss.

research Allergic Contact Dermatitis from Minoxidil

32 citations , May 1995 in “Contact Dermatitis”

Minoxidil can cause allergic reactions, but testing helps identify the cause.

A Comparative Study of a New Food Supplement, Viviscal, with Fish Extract for the Treatment of Hereditary Androgenic Alopecia in Young Males

research A Comparative Study of a New Food Supplement, Viviscal, with Fish Extract for the Treatment of Hereditary Androgenic Alopecia in Young Males

16 citations , November 1992 in “Journal of International Medical Research”

ViviScal®, a food supplement, was found to be highly effective in treating hereditary hair loss in young males, while fish extract showed no impact.

The Psychological Effects of Androgenetic Alopecia in Men

research Minoxidil Stimulates Cutaneous Blood Flow in Human Balding Scalps: Pharmacodynamics Measured by Laser Doppler Velocimetry and Photopulse Plethysmography

137 citations , May 1984 in “Journal of Investigative Dermatology”

Minoxidil increases blood flow in balding scalps, possibly reversing hair loss.