Skip to main content
SpringerLink
Log in

Medical Treatments for Androgenetic Alopecia

  • Chapter
  • First Online:
Hair Transplant Surgery and Platelet Rich Plasma

  • 564 Accesses

Abstract

Androgenetic alopecia (AGA) remains the most common etiology of hair loss as it affects up to 50% of men and women over the age of 40 years. Despite its prevalence, the FDA has currently approved only three medical treatments for AGA, including topical minoxidil, oral finasteride, and most recently, low-level laser therapy (LLLT). Although supported by less robust studies, other evidenced-based, off-label treatments available in the United States include oral dutasteride, oral flutamide, oral spironolactone, oral minoxidil, topical ketoconazole, and topical latanoprost. This chapter subsequently discusses the mechanism of action, indication, efficacy, adverse events profile, dosing, administration, and other considerations for both FDA and non-FDA-approved medical treatments for AGA.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Otberg N, Shapiro J. Chapter 88. Hair growth disorders. In: Fitzpatrick’s dermatology in general medicine, 8e | AccessMedicine | McGraw-Hill Medical [Internet]. 8th ed. New York: The McGraw-Hill Companies; 2012. [cited 6 Sep 2018]. Available from: https://accessmedicine-mhmedical-com.ezp-prod1.hul.harvard.edu/Content.aspx?bookId=392&sectionId=41138795.

    Google Scholar 

  2. Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol. 2004;150:186–94.

    Article  CAS  PubMed  Google Scholar 

  3. Lachgar S, Charveron M, Gall Y, Bonafe JL. Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells. Br J Dermatol. 1998;138:407–11.

    Article  CAS  PubMed  Google Scholar 

  4. Li M, Marubayashi A, Nakaya Y, Fukui K, Arase S. Minoxidil-induced hair growth is mediated by adenosine in cultured dermal papilla cells: possible involvement of sulfonylurea receptor 2B as a target of minoxidil. J Invest Dermatol. 2001;117:1594–600.

    Article  CAS  PubMed  Google Scholar 

  5. Olsen EA, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002;47:377–85.

    Article  PubMed  Google Scholar 

  6. van Zuuren EJ, Fedorowicz Z, Schoones J. Interventions for female pattern hair loss. Cochrane Database Syst Rev. 2016;(5):CD007628.

    Google Scholar 

  7. Bergfeld W, Washenik K, Callender V, Zhang P, Quiza C, Doshi U, et al. A phase III, multicenter, parallel-design clinical trial to compare the efficacy and safety of 5% minoxidil foam versus vehicle in women with female pattern hair loss. J Drugs Dermatol. 2016;15:874–81.

    CAS  PubMed  Google Scholar 

  8. Ebner H, Müller E. Allergic contact dermatitis from minoxidil. Contact Dermatitis. 1995;32:316–7.

    Article  CAS  PubMed  Google Scholar 

  9. Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges. 2011;9(Suppl 6):S1–57.

    Article  PubMed  Google Scholar 

  10. Olsen EA, Messenger AG, Shapiro J, Bergfeld WF, Hordinsky MK, Roberts JL, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. 2005;52:301–11.

    Article  PubMed  Google Scholar 

  11. Rittmaster RS. Finasteride. N Engl J Med. 1994;330:120–5.

    Article  CAS  PubMed  Google Scholar 

  12. Price VH. Treatment of hair loss. N Engl J Med. 1999;341:964–73.

    Article  CAS  PubMed  Google Scholar 

  13. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998;39:578–89.

    Article  CAS  PubMed  Google Scholar 

  14. Leyden J, Dunlap F, Miller B, Winters P, Lebwohl M, Hecker D, et al. Finasteride in the treatment of men with frontal male pattern hair loss. J Am Acad Dermatol. 1999;40:930–7.

    Article  CAS  PubMed  Google Scholar 

  15. Price VH, Roberts JL, Hordinsky M, Olsen EA, Savin R, Bergfeld W, et al. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. J Am Acad Dermatol. 2000;43:768–76.

    Article  CAS  PubMed  Google Scholar 

  16. Yeon JH, Jung JY, Choi JW, Kim BJ, Youn SW, Park KC, et al. 5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss. J Eur Acad Dermatol Venereol. 2011;25:211–4.

    Article  CAS  PubMed  Google Scholar 

  17. Carmina E, Lobo RA. Treatment of hyperandrogenic alopecia in women. Fertil Steril. 2003;79:91–5.

    Article  PubMed  Google Scholar 

  18. Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G. Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review. Arch Dermatol. 2010;146:1141–50.

    Article  PubMed  Google Scholar 

  19. Samplaski MK, Lo K, Grober E, Jarvi K. Finasteride use in the male infertility population: effects on semen and hormone parameters. Fertil Steril. 2013;100:1542–6.

    Article  CAS  PubMed  Google Scholar 

  20. Rahimi-Ardabili B, Pourandarjani R, Habibollahi P, Mualeki A. Finasteride induced depression: a prospective study. BMC Clin Pharmacol. 2006;6:7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. D’Amico AV, Roehrborn CG. Effect of 1 mg/day finasteride on concentrations of serum prostate-specific antigen in men with androgenic alopecia: a randomised controlled trial. Lancet Oncol. 2007;8:21–5.

    Article  CAS  PubMed  Google Scholar 

  22. Lubart R, Eichler M, Lavi R, Friedman H, Shainberg A. Low-energy laser irradiation promotes cellular redox activity. Photomed Laser Surg. 2005;23:3–9.

    Article  CAS  PubMed  Google Scholar 

  23. Eells JT, Wong-Riley MTT, VerHoeve J, Henry M, Buchman EV, Kane MP, et al. Mitochondrial signal transduction in accelerated wound and retinal healing by near-infrared light therapy. Mitochondrion. 2004;4:559–67.

    Article  CAS  PubMed  Google Scholar 

  24. Pastore D, Greco M, Passarella S. Specific helium-neon laser sensitivity of the purified cytochrome c oxidase. Int J Radiat Biol. 2000;76:863–70.

    Article  CAS  PubMed  Google Scholar 

  25. Arany PR, Nayak RS, Hallikerimath S, Limaye AM, Kale AD, Kondaiah P. Activation of latent TGF-beta1 by low-power laser in vitro correlates with increased TGF-beta1 levels in laser-enhanced oral wound healing. Wound Repair Regen. 2007;15:866–74.

    Article  PubMed  Google Scholar 

  26. de Lima FM, Villaverde AB, Albertini R, Corrêa JC, Carvalho RLP, Munin E, et al. Dual effect of low-level laser therapy (LLLT) on the acute lung inflammation induced by intestinal ischemia and reperfusion: action on anti- and pro-inflammatory cytokines. Lasers Surg Med. 2011;43:410–20.

    Article  PubMed  Google Scholar 

  27. Mafra de Lima F, Villaverde AB, Salgado MA, Castro-Faria-Neto HC, Munin E, Albertini R, et al. Low intensity laser therapy (LILT) in vivo acts on the neutrophils recruitment and chemokines/cytokines levels in a model of acute pulmonary inflammation induced by aerosol of lipopolysaccharide from Escherichia coli in rat. J Photochem Photobiol B. 2010;101:271–8.

    Article  CAS  PubMed  Google Scholar 

  28. Sakurai Y, Yamaguchi M, Abiko Y. Inhibitory effect of low-level laser irradiation on LPS-stimulated prostaglandin E2 production and cyclooxygenase-2 in human gingival fibroblasts. Eur J Oral Sci. 2000;108:29–34.

    Article  CAS  PubMed  Google Scholar 

  29. Leavitt M, Charles G, Heyman E, Michaels D. HairMax LaserComb laser phototherapy device in the treatment of male androgenetic alopecia: a randomized, double-blind, sham device-controlled, multicentre trial. Clin Drug Investig. 2009;29:283–92.

    Article  PubMed  Google Scholar 

  30. Jimenez JJ, Wikramanayake TC, Bergfeld W, Hordinsky M, Hickman JG, Hamblin MR, et al. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study. Am J Clin Dermatol. 2014;15:115–27.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Frequently Asked Questions [Internet]. HairMax. Available from: https://hairmax.com/pages/faq-1.

  32. Amory JK, Wang C, Swerdloff RS, Anawalt BD, Matsumoto AM, Bremner WJ, et al. The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men. J Clin Endocrinol Metab. 2007;92:1659–65.

    Article  CAS  PubMed  Google Scholar 

  33. Olsen EA, Hordinsky M, Whiting D, Stough D, Hobbs S, Ellis ML, et al. The importance of dual 5alpha-reductase inhibition in the treatment of male pattern hair loss: results of a randomized placebo-controlled study of dutasteride versus finasteride. J Am Acad Dermatol. 2006;55:1014–23.

    Article  PubMed  Google Scholar 

  34. Eun HC, Kwon OS, Yeon JH, Shin HS, Kim BY, Ro BI, et al. Efficacy, safety, and tolerability of dutasteride 0.5 mg once daily in male patients with male pattern hair loss: a randomized, double-blind, placebo-controlled, phase III study. J Am Acad Dermatol. 2010;63:252–8.

    Article  CAS  PubMed  Google Scholar 

  35. Paradisi R, Porcu E, Fabbri R, Seracchioli R, Battaglia C, Venturoli S. Prospective cohort study on the effects and tolerability of flutamide in patients with female pattern hair loss. Ann Pharmacother. 2011;45:469–75.

    Article  CAS  PubMed  Google Scholar 

  36. Cusan L, Dupont A, Gomez JL, Tremblay RR, Labrie F. Comparison of flutamide and spironolactone in the treatment of hirsutism: a randomized controlled trial. Fertil Steril. 1994;61:281–7.

    Article  CAS  PubMed  Google Scholar 

  37. Euflex (flutamide 250 mg tablets) package insert from Merck Canada Inc. [Internet]. 2011. Available from: https://hemonc.org/docs/packageinsert/flutamide.pdf.

  38. Goto K, Koizumi K, Takaori H, Fujii Y, Furuyama Y, Saika O, et al. Effects of flutamide on sex maturation and behavior of offspring born to female rats treated during late pregnancy. J Toxicol Sci. 2004;29:517–34.

    Article  CAS  PubMed  Google Scholar 

  39. Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology. 1998;196:474–7.

    Article  PubMed  Google Scholar 

  40. Hugo Perez BS. Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men. Med Hypotheses. 2004;62:112–5.

    Article  CAS  PubMed  Google Scholar 

  41. NIZORAL® (KETOCONAZOLE) 2% SHAMPOO package insert from Janssen Pharmaceuticals [Internet]. 2013. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019927s032lbl.pdf.

  42. Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. 2012;66:794–800.

    Article  CAS  PubMed  Google Scholar 

  43. Sasaki S, Hozumi Y, Kondo S. Influence of prostaglandin F2α and its analogues on hair regrowth and follicular melanogenesis in a murine model. Exp Dermatol. 2005;14:323–8.

    Article  CAS  PubMed  Google Scholar 

  44. Xalatan® latanoprost ophthalmic solution 0.005% (50 μg/mL) package insert from Pfizer Inc [Internet]. 2011. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020597s044lbl.pdf.

  45. Emer JJ, Stevenson ML, Markowitz O. Novel treatment of female-pattern androgenetic alopecia with injected bimatoprost 0.03% solution. J Drugs Dermatol. 2011;10:795–8.

    PubMed  Google Scholar 

  46. Lueangarun S, Panchapreteep R, Tempark T, Noppakun N. Efficacy and safety of oral minoxidil 5 mg daily during 24-week treatment in male androgenetic alopecia. J Am Acad Dermatol. 2015;72:AB113.

    Google Scholar 

  47. Sinclair RD. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol. 2018;57:104–9.

    Article  CAS  PubMed  Google Scholar 

  48. Loniten® minoxidil tablets, USP package insert from Pfizer Inc [Internet]. 2015. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/018154s026lbl.pdf.

  49. Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005;152:466–73.

    Article  CAS  PubMed  Google Scholar 

  50. Shannon F, Christa S, Lewei D, Carolyn G. Demographics of women with female pattern hair loss and the effectiveness of spironolactone therapy. J Am Acad Dermatol. 2015;73:705–6.

    Article  PubMed Central  Google Scholar 

  51. Rathnayake D, Sinclair R. Innovative use of spironolactone as an antiandrogen in the treatment of female pattern hair loss. Dermatol Clin. 2010;28:611–8.

    Article  CAS  PubMed  Google Scholar 

  52. Aldactone® spironolactone tablets, USP package insert by Pfizer Inc [Internet]. 2008. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf.

  53. Rushton DH, Futterweit W, Kingsley D, Kinglsey P, Norris M. Quantitative assessment of spironolactone treatment in women with diffuse androgen-dependent alopecia. J Soc Cosmet Chem. 1991;42:317–25.

    Google Scholar 

  54. Azarchi S, Bienenfeld A, Lo Sicco K, Marchbein S, Shapiro J, Nagler AR. Androgens in women: hormone modulating therapies for skin disease (part II). J Am Acad Dermatol. 2018;80:1509.

    Article  CAS  PubMed  Google Scholar 

  55. Carr BR. Uniqueness of oral contraceptive progestins. Contraception. 1998;58:23S–7S.

    Article  CAS  PubMed  Google Scholar 

  56. Ho A, Shapiro J, Sukhdeo K. Ranking oral contraceptives for pattern hair loss: use of the androgen index (abstract). 2018.

    Google Scholar 

  57. Manson JE, Bassuk SS. Vitamin and mineral supplements: what clinicians need to know. JAMA. 2018;319:859–60.

    Article  PubMed  Google Scholar 

  58. Rautiainen S, Manson JE, Lichtenstein AH, Sesso HD. Dietary supplements and disease prevention – a global overview. Nat Rev Endocrinol. 2016;12:407–20.

    Article  CAS  PubMed  Google Scholar 

  59. Ablon G, Kogan SA. Six-month, randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of a nutraceutical supplement for promoting hair growth in women with self-perceived thinning hair. J Drugs Dermatol. 2018;17:558–65.

    PubMed  Google Scholar 

  60. The FDA warns that biotin may interfere with lab tests: FDA safety communication [Internet]. US Food Drug Adm. 2017. Available from: https://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm586505.htm.

  61. Ardabilygazir A, Afshariyamchlou S, Mir D, Sachmechi I. Effect of high-dose biotin on thyroid function tests: case report and literature review. Cureus. 2018;10:e2845.

    PubMed  PubMed Central  Google Scholar 

  62. Lipner SR. Rethinking biotin therapy for hair, nail, and skin disorders. J Am Acad Dermatol. 2018;78:1236–8.

    Article  PubMed  Google Scholar 

  63. Thompson JM, Mirza MA, Park MK, Qureshi AA, Cho E. The role of micronutrients in alopecia areata: a review. Am J Clin Dermatol. 2017;18:663–79.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006;54:824–44.

    Article  PubMed  Google Scholar 

  65. Rushton DH, Ramsay ID. The importance of adequate serum ferritin levels during oral cyproterone acetate and ethinyl oestradiol treatment of diffuse androgen-dependent alopecia in women. Clin Endocrinol. 1992;36:421–7.

    Article  CAS  Google Scholar 

  66. Soleymani T, Lo Sicco K, Shapiro J. The infatuation with biotin supplementation: is there truth behind its rising popularity? A comparative analysis of clinical efficacy versus social popularity. J Drugs Dermatol. 2017;16:496–500.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA, USA

    Dustin H. Marks & Jean-Phillip Okhovat

  2. MGH Hair Loss Clinic; Hair Academic Innovative Research (HAIR) Unit, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Maryanne Makredes Senna

Authors
  1. Dustin H. Marks
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Phillip Okhovat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maryanne Makredes Senna
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maryanne Makredes Senna .

Editor information

Editors and Affiliations

  1. Facial Plastic and Reconstructive Surgery, Assistant Professor, Harvard Medical School, Massachusetts Eye and Ear, Associate Chief of Plastic Surgery, Harvard Vanguard Medical Associates, Boston, MA, USA

    Linda N. Lee

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Marks, D.H., Okhovat, JP., Senna, M.M. (2020). Medical Treatments for Androgenetic Alopecia. In: Lee, L.N. (eds) Hair Transplant Surgery and Platelet Rich Plasma. Springer, Cham. https://doi.org/10.1007/978-3-030-54648-9_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-54648-9_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-54647-2

  • Online ISBN: 978-3-030-54648-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation