The best way to combat hair loss in men

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THURSDAY, Feb. 10, 2022 (HealthDay News) — Nearly every man sees a receding hairline or a bald patch at some point in his life. For those looking to slow down the passing of time, a new study helps determine which hair loss medications work best.

The analysis, of 23 previous studies, ranks the available hair loss medications from most effective to least.

Experts said the list is useful. the drugs- dutasteride, finasteride Y minoxidil – have been used for a long time, but there has been little information on how they compare to each other in effectiveness.

“We don’t have any trials comparing these drugs directly,” said Dr. Anthony Rossi, a dermatologist who was not involved in the research.

That has left doctors without a solid answer to the inevitable question, which option works best?

The new research will help fill that gap, according to Rossi, of Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, both in New York City.

The highest-ranking treatment was dutasteride capsules (Avodart), at a dose of 0.5 milligrams daily. On average, it produced the greatest increase in total hair count after six months of use. That means men who use it can expect more hair to grow where there wasn’t, though that includes smaller “peach fuzz” hair.

Then came finasteride (Propecia) pills, which were taken at a dose of 5 mg each day, followed by the same dose of oral minoxidil (Rogaine).

Not surprisingly, dose and administration mattered, the analysis found. A lower dose of finasteride (1 mg daily) ranked fourth, followed by two topical formulations of minoxidil, with the higher dose (5%) working better than the lower (2%).

At the bottom was low-dose oral minoxidil, taken as 0.25 mg per day.

However, effectiveness is only part of the story, Rossi noted.

“Dutasteride may outperform the others, but it may also have more side effects,” he said. “And we have to counsel patients about that.”

Dutasteride can cause loss of libido, erectile dysfunction and breast tenderness, as well as a form of low blood pressure called orthostatic hypotension. In rare cases, men can have serious drug reactions that require medical attention, including peeling skin, swelling of the face, and difficulty breathing.

Finasteride can also lower libido or cause breast tenderness, but only in a minority of patients, said Dr. Amy McMichael, a professor of dermatology at Wake Forest Baptist Medical Center in Winston-Salem, NC.

Whenever a healthy person has Hair lossthe goal is to increase hair density while maintaining good health, said McMichael, who was not involved in the study.

“In general, topical minoxidil, oral finasteride, and oral minoxidil are well tolerated by most patients and do not cause side effects,” he said.

But any oral drug can cause problems like diarrhea or a rash, McMichael noted, and even topical minoxidil has downsides: It can be a burden to apply daily and sometimes irritates the scalp, leading to flaking or flaking.

Ultimately, both doctors said, men should discuss the pros and cons of each option with their dermatologist.

The findings were published online February 2 at JAMA Dermatology. They are based on 23 clinical trials, most of which compared drugs with a placebo (an inactive substance).

All three drugs were originally developed for purposes other than hair loss. Oral minoxidil was first used as a blood pressure medication; the topical formulation was created after doctors realized that men taking the drug showed increased hair growth, according to Dr. Kathie Huang, who wrote a editorial published with the study.

Meanwhile, both dutasteride and finasteride were first used to treat urinary symptoms caused by an enlarged prostate. The drugs block an enzyme that converts testosterone to dihydrotestosterone, the main hormonal factor that contributes to male pattern baldness, according to Huang, a dermatologist at Brigham and Women’s Hospital in Boston.

Finasteride is approved by the US Food and Drug Administration to treat hair loss in men; dutasteride is not, but doctors can prescribe it”without brand” For that purpose.

In the real world, most hair loss patients end up needing a combination of treatments.

“Most of the time, the backbone of treatment is the combination of finasteride and 5% topical minoxidil,” McMichael said. “But patients often get the best results with even more added to this backbone.”

That could include low-level laser light or platelet-rich plasma injected into the scalp. That plasma (the liquid portion of the blood) is taken from the patient’s own blood sample.

Rossi agreed that finding the best treatment can be a process.

“It’s important to be realistic,” he said. “Often, you won’t hit a home run with just one option.”

He also recommended that men seeking help for hair loss see a dermatologist for a “full work-up.” That is, in part, to find out if there is an underlying condition causing the hair loss, such as a thyroid disorder or nutritional problem.

More information

The American Academy of Dermatology has more on male pattern hair loss.

SOURCES: Anthony Rossi, MD, assistant professor, Memorial Sloan Kettering Cancer Center, and assistant professor, Weill Cornell Medical College, New York City; Amy McMichael, MD, professor and director of dermatology, Wake Forest Baptist Medical Center, Winston-Salem, NC; JAMA Dermatology, Feb 2, 2022, online

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