Treating Hair Loss With Minoxidil and Finasteride: Are They Effective?

Did you know that hair loss can begin as early as 20 for some and progresses with time? Androgenic alopecia, or patterned hair loss, affects about 80% of the population by the time they are 60 years old. It can be devastating for some and can cause significant psychological distress. The earlier you treat it, the better the results. Let's learn more about minoxidil and finasteride, both FDA-approved treatments for this type of hair loss. Knowing the benefits and risks can help you make an informed choice about the best treatment for you.

How does hair grow?

Hair growth is an intricate process that varies depending on the hair type, such as scalp or eyelash. The entire process is influenced by your genetics, your current state of health, and your medications. Hair growth occurs in 3 stages.

  1. Anagen. The anagen phase is the growth phase of hair. It can last up to 5 years and varies depending on the hair type. Scalp hair has a longer anagen phase than eyebrow hair. About 90% of your scalp hairs are in the phase at any time;
  2. Catagen. The catagen phase is a transition phase. It lasts approximately 10 days. During this phase, the hair follicles shrink, and the hairs separate from them;
  3. Telogen. The telogen phase is sometimes divided into 2 phases: resting and shedding. The resting phase lasts about 3 months, and the shedding phase can last up to 5 months. It is normal to lose about 100 hairs per day. The loss of hair is necessary to make way for new ones to grow.

What is patterned hair loss?

There are many types of hair loss, but the most common form is male and female-patterned baldness, also known as androgenic alopecia. This type of hair loss usually runs in families. Male patients present with hair loss on the top of their heads, affecting the frontal hairline. Female patients experience hair loss on the top of their heads and sides of their temples, with the preservation of the frontal hairline.

What causes male and female patterned baldness?

Patterned baldness or hair loss is a multifactorial process. It involves the interplay of genetics, hormones, stress, free radicals, external factors, and inflammation. The best results come from combination treatments that treat the different aspects of hair loss.

How minoxidil works for hair loss

Topical minoxidil, also known as Rogaine in the US and Regaine in the UK, is FDA-approved to treat patterned hair loss in men and women. Now available over the counter, it is a vasodilator thought to increase blood flow to the scalp and prolong the anagen phase. This increased blood flow will help bring more nutrients to the scalp and increase hair growth. It comes in solution and foam that is applied twice a day. It can take several months to see the full effects, and it must be used forever to keep the hair from falling out. One bottle of topical minoxidil costs approximately $60 and can last up to 2-3 months.

Oral minoxidil for hair loss

Oral minoxidil is a prescription-only tablet. It is FDA approved for the treatment of high blood pressure and it's use orally for the treatment of hair loss is an off label indication. The dose of oral minoxidil ranges from 0.5mg to 5mg per day. This dose is less than that used to treat high blood pressure. Oral minoxidil should always be consumed with a meal and a month's supply of oral minoxidil costs approximately $5-$10.

What are the side effects of minoxidil?

There are a number of side effects of minoxidil.

  • Redness. May also present with itching, swelling and burning.
  • Dermatitis. Either irritation dermatitis or allergic contact dermatitis.
  • Unwanted facial hair growth. The topical solution may drip over the face if care is not taken and lead to unwanted hair growth over the face, which is not desirable, especially for women.
  • Changes in hair texture. Hair may feel slightly dry and of a different texture when used for a long time.

Many times this rash is caused by other ingredients in the product that irritate the scalp, not the minoxidil. Some people have found that the solution can irritate, while the foam does not. More severe side effects include weight gain, dizziness, swollen hands and feet, chest pain, and rapid heart rate.

Who should not take minoxidil?

Always discuss starting any new medications with your doctor first. Patients with a known allergy to minoxidil, should not use it. Also, patients that are pregnant or nursing, on certain medications, or have a disease of the liver and kidneys should avoid minoxidil.

How finasteride works for hair loss

Finasteride, also known as Propecia, is an FDA-approved medication to treat patterned hair loss in men, and it is only available with a prescription. It prevents the conversion of the hormone testosterone into DHT (Dihydrotestosterone), which is responsible for destroying hair follicles. Originally, finasteride was approved for the treatment of an enlarged prostate, but it was later discovered that it helps hair grow. It can take several months to see the full effects and must be taken forever to keep the hair from falling out.

Finasteride is available in the topical form, usually in combination with minoxidil as a solution. You will not find topical finasteride available in isolation.

Oral finasteride for hair loss

Oral finasteride is the recommended form of using finasteride for treating hair loss. It is usually taken in a dose of 1mg daily. It should be consumed with a meal and requires a prescription from your doctor. A months supply of oral finasteride costs approximately $20-$50.

What are the side effects of finasteride?

Finasteride can cause several unpleasant side effects.

  • Sex. It has been associated with lower sex drive, difficulty getting an erection, and ejaculation problems.
  • Swelling. Swelling of the tongue and lips.
  • Depression. Feelings of sadness, anger, and sleep issues.
  • Breasts. Lumps in the breast, as well as a rash and nipple discharge.

Who should not take finasteride?

As with any drug, you need to discuss taking finasteride with your doctor. Finasteride is not for everyone. Patients with liver disease, prostate cancer, pregnant, breastfeeding, or premenopausal women should not take it.

What other treatments can regrow hair?

While minoxidil and finasteride can help with hair loss, they do have some serious side effects. It also takes several months to see the full effects of hair growth, and they do not work for everyone. Also, the treatments must be continued indefinitely to keep the hair from falling out again. Other treatment options for patterned hair loss may have fewer side effects. These include:

  • Low-level laser therapy
  • PRP/PRF
  • Micro-needling
  • Neutraceuticals
  • Hair transplantation
  • Exosomes

Patterned hair loss is a chronic, progressive disease that will affect most men and women as they age. It is a multifactorial process that can be difficult to treat. Minoxidil and finasteride are both FDA-approved to treat patterned hair loss, but may have serious side effects. They may also not be appropriate for all patients. It is best to discuss your options with your doctor first before starting any treatments. If you are suffering from hair loss, see your doctor right away.

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