If you notice your hairline starting to recede and a full head of hair starting to grow thin, it is easy to stress over what is causing it to happen. Is it job stress? An unhealthy diet? The reality is that a majority of hair loss in men is primarily caused by Androgenetic Alopecia, or Male Pattern Hair Loss.
It can start as early as the late teens and gradually gets worse with age. When it occurs, it can negatively affect self-esteem and confidence as the loss of hair is perceived to affect the elderly, and makes one seem older than their actual age.
Male Pattern Hair Loss is characterised by receding hairline and loss of hair at the top and front of the head. It affects almost all men at some point in their lives. It is due to a combination of male hormones (androgens) and genetics i.e. it tends to run in the family, hence the name Androgenetic Alopecia.
DHT, or dihydrotestosterone, is a hormone produced as a byproduct of testosterone. It is a powerful male hormone which is selectively found more in the hair follicles, prostate and skin. And when it binds to susceptible hair follicles, it causes the follicles to weaken, shrink and eventually die.
Interestingly, while DHT destroys hair on our scalp, it also causes hair growth in some other parts of our bodies such as the chest, back and other areas. This is the reason why many hairy men are also bald.
Thankfully, there are effective medications available that can reduce, and even reverse the progression of Male Pattern Hair Loss. This means that hair loss can be reduced and hair growth can be promoted in certain cases.
Search for information about hair loss medications, you will likely see two treatment options readily: Minoxil and Finasteride. Do these treatments work? Let’s go into more details about each medication.
Minoxidil solution is a vasodilator i.e. it works by dilating small blood vessels and promotes the flow of oxygen and nutrients to the scalp, encouraging hair regrowth. We recommend applying it twice a day to the scalp for a minimum of 6 months. Increased hair growth is usually seen after 4 months of continued use. If it is effective, it should be continued long term.
Technically, Minoxidil does not stop hair loss. Instead, it actively promotes the growth of hairs by causing hairs in a resting state (telogen phase) to shed and replace them with new hairs in the growing phase (anagen phase).
Because of this, rapid hair loss can occur initially but this is a temporary effect that happens as the resting hairs shed. Once they are replaced with hairs in the growing phase, you will notice thicker, fuller hair.
Minoxidil is available in strengths of 2% and 5%. 5% is more effective than 2%, hence it should be the starting concentration used but if it causes scalp irritation, the 2% concentration can then be tried.
Side effects include scalp irritation, manifesting as itching or stinging. Unwanted hair growth may occur, such as on the forehead if the application is not precise. As there is very little absorption into our system beyond the scalp, internal side effects are not likely although rarely, hair growth in other sites have been reported.
If the treatment is stopped, loss of the newly grown hair will occur in 3-4 months.
Interesting fact: Minoxidil was originally used as a high blood pressure tablet, but caused unwanted hair growth as a side effect. This prompted scientists to develop it as a topical medication to treat hair loss!
Oral Finasteride works by blocking 5-alpha reductase, the enzyme that converts testosterone into dihydrotestosterone (DHT). DHT, a potent version of testosterone, contributes to hair loss by selectively damaging hair follicles. Finasteride reduces the levels of DHT in the scalp, hence reducing the harmful effect of DHT on hair follicles. I recommend taking Finasteride 1 mg once a day, with or without food, any time of the day.
Studies have shown that daily Finasteride halts hair loss or regrows hair in 9 out of 10 men taking it long term. Daily use for a minimum of 3 months may be necessary before a patient will notice prevention of further hair loss or increased hair growth. Finasteride should be continued long term.
Finasteride is generally well tolerated in the clinical trials, with most patients reporting no serious side effects. Very rarely, Finasteride can cause decreased sex drive (1.8% in those taking Finasteride vs 1.3% in placebo group), decreased volume of ejaculate (0.8% vs 0.4%) and male breast enlargement. All side effects resolved with discontinuation of medication, also in many men who continued with therapy.
Clinical trials have shown that Finasteride and Minoxidil are safe to take together. In fact, many studies have been conducted using Finasteride and Minoxidil together to prevent hair loss and to regrow new hair. A 2015 study shows that use of both Finasteride and Minoxidil together helps maintain a good hair density level, although interestingly, topical Finasteride was used in the study.
Data from another big study in 2017 shows that Finasteride, in combination with Minoxidil, is the most effective treatment available for slowing and stopping Male Pattern Hair Loss.
They are completely different medications that work via different pathways. While both reduces hair loss and promotes hair growth, one does it at the surface level while the other is a hormonal medication that works from within. Because Finasteride markedly reduces DHT production, most medical professionals will recommend it as a first line treatment before using Minoxidil. However, both drugs are also commonly used together to get a better result.
Stop using Minoxidil and tell your doctor immediately if you have any serious side effects, including:
Tell your doctor if you notice these temporary side effects with Minoxidil:
A very serious allergic reaction to Finasteride is unlikely, but seek immediate medical attention if any of the following occurs: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Some of the side effects of Finasteride are harmless and temporary, while others may persist even after stopping. Tell your doctor if you notice any of the following:
Pre-treatment instructions: Always inform your doctor of all medications, including supplements you may be taking as well as your medical history.
Post-treatment instructions: Monitor if any of the side effects described to you by the doctor occurs then let your doctor know about them. You may be asked to lower the dosage or to completely stop treatment.
Finasteride is suitable for any healthy male looking to prevent further hair loss and increase hair growth. Minoxidil is suitable for any healthy adult looking to control further hair loss and promote hair growth.
Minoxidil is unsuitable for those with a heart condition or with unrealistic expectations such as complete reversal of hair loss and/or prevention of hair loss.
Finasteride may unsuitable for the following circumstances:
[10 Mar 2020] Written by Dr. Gabriel Wong
Having graduated from the Yong Loo Lin School of Medicine – Dr Gabriel Wong worked in several hospitals in Singapore where he honed his medical acumen.
Fate was at work when he met Dr Kelvin Chua, which sparked his interest in aesthetic medicine.
Growing from strength to strength under the tutelage of Dr Chua, Gabriel developed an eye for detail and beauty – perfectly in tune with aesthetic medicine, a confluence of art and science.
He applies this in a range of non-invasive procedures such as Botox treatments, soft tissue augmentation (Dermal Fillers with the Cannula Method), skin rejuvenation with lasers (Fotona5D Laser Lift), and effective acne and acne scar treatments (Fractional CO2 Laser, subcision).
In his free time, Gabriel loves to travel in search of that perfect snapshot. His works of art have won praises by many patients.
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