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You notice that you are beginning to lose hair and you want to halt or reverse hair loss if you can. One of your options is a medical approach to hair restoration—using one of the medications that are offered with a claim to stop loss of hair and stimulate hair regrowth. But which one?

Choosing a hair restoration medication can appear to be a forbidding task. Dozens are advertised on the World Wide Web and in magazines or other print media. Some are “herbal”, some are “all natural”, some are pharmaceutical agents, and most are “proven effective” (Click on Hair Loss & Miracle Cures).  What criteria should you use to choose among all of the products offered?

The gold standard for making a choice is approval of a product by the U.S. Food and Drug Administration (FDA), for use in treating hair loss. Approval of a product by the FDA for treatment of hair loss means that the product has been rigorously tested for safety and efficacy in clinical trials that meet FDA standards for study design, number of persons enrolled in the trials, and statistical analysis of study data.

When your criterion for product choice is FDA approval, your choice is made clear. Just two products have been approved for halting hair loss and stimulating hair regrowth:

  • Minoxidil, a topical agent available over-the-counter, and
  • Finasteride, a drug taken by mouth, available only by prescription in the United States.

A third drug, dutasteride, is in clinical trials. Similar to finasteride in action, it has been approved in Europe for use in hair restoration and is sometimes prescribed “off-label” for that purpose in the U.S. Under the brand name Avodart, dutasteride is approved in the U.S. for treatment of benign prostatic hypertrophy (prostate enlargement) in men.

The most effective use of hair restoration medication is under the supervision of a physician hair restoration specialist. Treatment of hair loss by medical or surgical means is best carried out after the reason for hair loss is correctly diagnosed (Click on About Your Hair Loss). For some persons, medical hair restoration is most effective when carried out in conjunction with hair transplantation or other surgical means of hair restoration (Click on Combined Surgical and Medical Therapy).

What are the important things to know about FDA-approved hair restoration medications? Here is a summary at a glance:

Minoxidil (Brand Name Rogaine)(1)

Topical: applied to the scalp as a liquid or foam.Minoxidil is offered in 2% and 5% concentrations. The 5% concentration was developed for treatment of male-pattern hair loss, but studies have shown that women also can benefit from the 5% formula.(2)
Over-the-counter. Generic minoxidil is also offered under a variety of trade names; it may also be an ingredient in an over-the-counter product.

Rogaine is the brand name for minoxidil before its patent expired and generic versions could be developed.

Mode of Action
How minoxidil acts to slow hair loss and stimulate hair regrowth is not well understood. Minoxidil was first developed as an oral medication to lower blood pressure by dilating blood vessels. Its activity in stimulating hair growth was noted as a side effect. The side effect on hair growth became the basis for development of the hair restoration product Rogaine. Whether minoxidil’s effect in dilating blood vessels contributes to its effect on hair growth is not known.
Studies have shown that minoxidil slows or halts hair loss and promotes hair regrowth in both men and women, at both 2% and 5% formulations. The 5% formulation is generally more effective. (3)Positive response to minoxidil therapy (reduced hair loss and/or hair regrowth) has been noted in from less to 50% to more than 80% of persons treated in various studies. Positive response is lost if minoxidil therapy is discontinued. Minoxidil is more effective when applied to defined areas of hair loss, less effective when applied to large areas of hair loss.
Side Effects
Itchy scalp is the most common side effect of minoxidil therapy. Accidental application of minoxidil to the face can result in growth of unwanted facial hair. Repeated, large applications of minoxidil have been associated with a drop in blood pressure in a few reported cases.

1. For more information on minoxidil, finasteride and dutasteride, click on Medical Hair Restoration: Minoxidil (Rogaine) & Finasteride. For more information on minoxidil clinical trials, click on Two New Studies Confirm Effectiveness of 5% Minoxidil in Treating Male-Pattern Hair Loss.

2. Click on Using Rogaine for Women.

3. Click on Using Rogaine for Hair Restoration.

Finasteride (Brand Name Propecia)(1)

Oral: 1 milligram tablet.The 1 milligram dose is for treatment of male-pattern hair loss. Under the brand name Proscar, a 5 milligram dose is given to treat benign prostatic hypertrophy (prostate enlargement) in men.
By prescription. Finasteride for hair restoration is available under its brand name Propecia.
Mode of Action
Finasteride inhibits the activity of Type II 5-alpha reductase, an enzyme that converts the male hormone testosterone into a more potent form called dihydrotestosterone (DHT). DHT is believed to act on scalp hair follicles to render them inactive and incapable of producing full-grown hair.(2)
Large, multi-year studies have shown finasteride to reduce hair loss and/or stimulate hair regrowth in a majority of men treated.(3) In a 5-year study, 65% of men with mild to moderate male-pattern hair loss were found to have a positive result (hair loss reduced and/or hair regrowth stimulated). Finasteride therapy must be continued to maintain a positive result. Physician hair restoration specialists may combine minoxidil and finasteride therapy to achieve an optimal result in selected patients. Medical therapy may be combined with surgical hair restoration to achieve and maintain an optimal result.
Side Effects
Finasteride should not be used or handled by a woman who is pregnant or who may become pregnant. The drug can cause abnormal development in a fetus. Reported side effects include decreased libido (sex drive), erectile dysfunction, male breast enlargement and psychological depression.

1. For more information on finasteride, click on Medical Hair Restoration: Minoxidil (Rogaine) & Finasteride.

2. Click on About Your Hair Loss.

3. Click on Using Finasteride for Hair Restoration.

Dutasteride (Brand Name Avodart)(1)

Oral: 0.5 milligram capsule.Dutasteride has not yet been approved for treatment of hair loss. Clinical trials are being conducted.
AvailabilityBy prescription. Avodart is approved by the FDA for treatment of benign prostatic hypertrophy (prostatic enlargement) in men. Clinical trials are underway to seek FDA approval of dutasteride for treatment of male-pattern hair loss. It is approved in Europe, at a different dose, for treatment of hair loss. Physicians in the U.S. sometimes prescribe Avodart “off-label” for treatment of male-pattern hair loss, if characteristics of an individual patient warrant such use of the drug.Mode of Action
Dutasteride, like finasteride, inhibits the activity of the enzyme that converts testosterone into dihydrotestosterone (DHT). Finasteride inhibits Type II of the enzyme 5-alpha reductase; dutasteride inhibits both Type I and Type II of the enzyme.
In clinical trials reported, dutasteride has shown a profile similar to that of finasteride in treatment of male-pattern hair loss.
Side Effects
As with finasteride, dutasteride should not be taken or handled by a women who is pregnant or who may become pregnant because of the drug’s potential for causing abnormal development of a fetus. Side effects of dutasteride are similar to those reported for finasteride—decreased libido (sex drive), erectile dysfunction, male breast enlargement and psychological depression.

Drug interactions reported from use of dutasteride include interference with some antibiotics, some anti-depression and anti-anxiety medications, and some drugs used to treat HIV/AIDS.

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