Hair Loss Medications

With at least forty treatments for thinning hair patented last year and 200 million dollars budgeted for clinical trials in the near future, there is no mystery why there is so much confusion regarding the treatment of hair loss.  However, of all the hundreds of shampoos, ointments, herbal supplements, gimmicks, etc. there are only two medications that meet the strict standards set forth by the FDA. Only Rogaine (minoxidil) and Propecia (finasteride) may state in their advertising and/or labeling that their product promotes hair growth or prevents the loss of hair. All the rest of the products many of whose effectiveness are exposed to minimal, if any, clinical trials should be purchased judicially.   

Propecia is the latest medication to be approved by the FDA for the treatment of hair loss.  Researchers have recently discovered that men who suffer from male pattern hair loss have increased levels of dihydrotestosterone (DHT). DHT is produced from testosterone through the activity of 5-alpha-reductase enzyme. Propecia inhibits 5-alpha-reductase, thus blocking the formation of DHT. This  interrupts a key element in the development of male pattern hair loss. 

Clinical studies were conducted in men aged 18 to 41 with mild to moderate degrees of androgenic alopecia.  All individuals treated with Propecia received a tar-based shampoo (Neutrogena T/Gel shampoo) and were instructed to wash their hair at least once per day.  Clinical improvements were seen as early as three months into the treatment with Propecia.  In men with vertex hair loss, global photographs revealed hair re-growth in 66 percent of the men.  Furthermore, hair counts with these men indicated that 83 percent of the recipients had no further hair loss over the two-year clinical period. 

Propecia is for the treatment of male pattern hair loss in men only.  Women who are or may potentially be pregnant must not use Propecia and should not handle crushed or broken tablets of Propecia because it may cause potential risk to the development of the male sex organs. Propecia tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablet has not been broken or crushed.

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Minoxidil was first approved by the FDA in 1979 has hypertensive medication.  However, some individuals began to develop hair everywhere.  So Upjohn went back to the lab and developed a topical version of the medication. Ten years later minoxidil was re-introduced has Rogaine.  The mechanism of action of Rogaine is basically unknown. The medication is known to be vasodilator, however, other medications that dilate the blood vessels do not stimulate hair growth.  Rogaine is believed to work in part by partially enlarging miniaturized follicles and reversing the miniaturization process.  This supposedly prolongs the growth phase of the hair cycle, allowing the hair to become thicker and longer.

Clinical trials have shown with the 2% solution that 26 percent of men ages 18-49 reported moderate to dense hair re-growth following four months of treatment. An additional 33 percent had minimal hair re-growth.  Approximately 20 percent of women between the ages of 18-45 had moderate re-growth, while an additional 40 percent minimal re-growth. The new extra strength 5% Rogaine solution has demonstrated slightly improved results as compared to the 2% solution in men.  Currently, the extra strength 5% solution is not recommended for women.  

Side effects associated with Rogaine are minimal. The most common side effects reported during clinical trials were itching of the scalp and other skin irritations in the treated areas.  These side effects are not serious and will cease upon discontinuation of the medication.  Well-controlled clinical studies have not been conducted in pregnant or nursing women, therefore, the medication should not be used during these conditions.

There are some other topical treatment options that warrant some discussion at this time. Please keep in mind before you rush out to purchase any of the following products that there has been limited clinical testing concerning hair loss on these treatments.

Retinoic Acid was first FDA approved for acne under the trade name RETIN-A. Since then it has been discovered that retinoic acid can be used for several medical conditions, including hair loss. Retinoic acid is known to increase the absorption of other medications through the skin, therefore it is hypothesized that the retinoic when used in conjunction with minoxidil should increase the amount of minoxidil reaching the hair follicles. There is also some experimental evidence that indicates that retinoic acid may play a role in hair growth by presently unknown mechanisms. There have been case reports where the use of retinoic acid alone induced a significant amount of hair growth.

However, retinoic acid, does have some unwanted side effects associated with its use including: itchiness and flaking of the scalp (further contributing to dandruff), increased sensitivity to the sun, and similar to the use of minoxidil, a small percentage of patients may experience an initial increase of hair loss at the onset of treatment. However, usually this resolves with time. When first starting the formulation, start using it every other night for one week, then increase to ever night for one week, and finally increase to twice a day. This method of use will decrease the unwanted side effects.

Azelaic acid is a naturally occurring dicarboxylic acid found in whole grain cereals and animal products. The medication is FDA approved as a topical preparation to treat acne vulgaris. It is also used by dermatologist to lighten hyperpigmented skin. However, there is some scientific evidence that azelaic acid is a competitive inhibitor of Alpha-5 Reductase. Inhibiting Alpha-5 Reductase decreases the levels of DHT (dihydrotestosterone) in the scalp. Side effects associated with azelaic acid include: itchiness, tingling, or stinging sensation occurring in 1-5% of patients, redness, dryness and peeling of the skin seen in less than 1% of patients, some patients have noted a lightening of the skin.

Spironolactone is a "Potassium Sparing Diuretic" that has been used for decades to treat high blood pressure and fluid retention.  However, there is also some scientific data suggesting a beneficial effect of spironolactone on hair loss. Spironolactone has been noted to have anti-androgen activity.  Androgenetic alopecia (male and female patterned baldness) is heavily influenced by androgens (most specifically- DHT). Spironolactone binds to the receptor sites on the hair follicles which blocks DHT from having its deleterious affect on the hair follicle. Side effects associated with spironolactone are minimal now that spironolactone has been made into a topical solution, instead of a pill. Rarely, a patient will develop a rash from the spironolactone solution, which resolves upon dicontinuation of the lotion. The product also has a malodorous scent which is increased if spironolactone is combined in the same container with other chemicals (i.e.- minoxidil, retinoic acid).  Sprironolactone solution is be applied to the balding scalp twice a day. It should be applied and allowed to dry (few minutes) before placing on the minoxidil solution.