ANDROGENETIC ALOPECIA IN A MALE

Androgenetic Alopecia in a man (AAM) causes the typical bitemporal recession (receeding hairline) and a balding vertex (bald spot). The hairs gradually miniaturize and finally are lost. Typical onset is anytime after age 30 although it may occur earlier.

• Male pattern hair loss is the most common hair loss in men.
• Its incidence increases with age. Beyond 70 years of age, about 80% of men are affected.
• Vertex pattern AAM of all ages is associated with an increased risk of prostate cancer.
• Male hormones drive this condition with dihydrotestosterone (DHT) being the principal androgen that causes the condition.
• There is increased 5 alpha-reduction of testosterone to DHT leading to miniaturization of the hair.
  

Treatment

• Minoxidil, oral and topical
• Finasteride
• Dutasteride
• Toupees/hair pieces
• Hair transplant
• Platelet-rich plasma

It should be noted at the outset that the first goal of treatment is to stop hair loss. Growing new hair is an added bonus. Unfortunately, where the skin has lost hair completely, treatment is usually ineffective. Photographs can be helpful in documenting treatment outcomes.

Minoxidil

Topical minoxidil is available without a prescription and is usually used as a 5% solution or foam applied twice a day to the affected areas. One may need to wait 4-6 months to see its effect. If a benefit is seen, the medication should be continued indefinitely. Oral minoxidil may be best for those who prefer oral therapy, or for those who are either intolerant or fail topical minoxidil. Minoxidil, both topical and oral may be combined with oral finasteride or dutasteride as they have different mechanisms of action. See minoxidil for more information.

Dutasteride

Dutasteride is only FDA-approved for benign prostatic hypertrophy. However several clinical studies have showed that oral dutasteride 0.5 mg per day is superior to finasteride 1 mg per day at improving AAM and has a similar side effect profile. Sexual dysfunction (e.g. impotence) is a potential side effect.

Finasteride

Finasteride (1 mg/d) is FDA-approved for the treatment of male androgenetic alopecia. Sexual dysfunction and depression are potential side effects.

Both dutasteride and finasteride are sometimes given topically.

Platelet-Rich Plasma

Platelet-rich plasma (PRP) injections have been investigated as a treatment for hair loss, with some studies showing promising results. PRP contains growth factors and other bioactive proteins that promote cell regeneration and tissue healing. When injected into the scalp, these factors may stimulate hair follicles, improve blood flow, and reduce inflammation, potentially leading to increased hair growth.

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