Male pattern baldness or male androgenetic alopecia is a very common form of hair loss, affecting up to 50% of men before the age of 50. Despite high prevalence, hair loss is very treatable with a wide array of treatments available. Two of the most effective hair loss treatments consist of oral prescription medication and topically applied (applied directly to the skin/scalp) solution. The efficacy of both types of treatment are very similar, however, the way they are used and how they work are very different…therefore, having a thorough insight is essential to ensure you select treatment that works best for you.
If you’re thinking of trying a hair loss treatment for the first time or thinking of trying a new hair loss treatment; you may find this guide useful.
What is Male Androgenetic Alopecia (MAA)
MAA is the most common form of male hair loss; hereditary tendency is attributable for up to 80% of predisposition indicating that for a significant proportion of men, the onset of MAA is unavoidable. Symptoms of MAA consist of receding, thinning hair which can occur in specific areas of the scalp lending to the term ‘pattern baldness’. MAA is caused by changes to the hair follicle lifecycle, whereby the anagen phase (hair growth phase) decreases, until the hair follicle growth length is insufficient to extend beyond the surface level of the scalp. So what are the most popular treatment options and how do they effectively treat MAA?
Oral Hair Loss Medication
The oral prescription drug Finasteride is a very effective medication to treat hair loss. Dihydrotestosterone (DHT) is the male hormone (androgen) that is significantly detrimental to head hair growth. Research highlights high enzyme concentrations of 5a-Reductase in men with bald scalps, emphasising the detrimental role of 5a-Reductase for DHT production and subsequent hair growth irregularity. The active ingredient Finasteride (brand name Propecia) works by inhibiting the enzyme 5a-Reductase which is responsible for converting testosterone into DHT.
Finasteride is effective at reducing the production of DHT by approximately 60% – 75%. Significant hair regrowth and hair loss prevention results are both observable in the short term (6 months) in approximately 60% of men and the long term (5 years) in approximately 90% of men. It is important to note that the continued use of Finasteride is crucial to maximise the likelihood of hair regrowth as Finasteride is only effective whilst active in the body. Despite the promising efficacy of taken Finasteride, it is unable to target specific regions of the scalp and is only effective at treating partial hair loss, not complete hair loss.
Topical Hair Loss Treatment
As well as taking medication orally, medicated solution can also be applied topically (directly to the skin surface) to promote hair growth and hair loss prevention.
REGAINE® Extra Strength Foam and REGAINE® Extra Strength Solution are popular products containing the active ingredient Minoxidil 5%, which is responsible for increasing blood flow to hair follicles, stimulating the anagen hair growth phase and strengthening existing hair. REGAINE® foam and solution don’t differ in efficacy, just in application and the excipients. REGAINE® foam has been clinically proven to be effective in approximately 90% of men, hair growth can be observable in as little as 8 weeks in some instances emphasising it’s short term efficacy. The strength of the active ingredient Minoxidil is available in the weaker 2% concentrations, however, the stronger 5% strength has been reported to be significantly more effective at inducing hair regrowth compared to 2% concentration.
Alpecin (Caffeine Solution)
Alpecin Caffeine Shampoo, Alpecin Double Effect Caffeine Shampoo and Alpecin Liquid Hair Energizer are all effective products at encouraging hair regrowth. Alpecin contains caffeine which is clinically proven to stimulate hair roots and prolong the hair growth phase. Research indicates that caffeine based solutions and products are effective at reducing the rate of hair loss and improving hair health and tensile strength; satisfaction rates from one study approximated 83% after a 4 month period
Can oral and topical treatments be used in combination?
Yes, oral and topical treatments can be used in synergy to maximise hair regrowth. Research investigating the combined use of topical and oral treatments is well established, one study investigating Finasteride and Minoxidil 5% found that Finasteride was superior to Minoxidil but their combined use was recommended for optimal efficacy.
Alpecin can be used alongside both REGAINE® (Minoxidil) and Finasteride as they work in different ways. However, it is important to wait at least 15 minutes before washing out REGAINE® with Alpecin, this is necessary to ensure the active ingredient Minoxidil present in REGAINE® has sufficient time to increase cutaneous blood flow.
What about other types of available hair loss treatments?
Other hair loss treatment options are available, however, disadvantages regarding practicality, feasibility and efficacy are more prominent:
- Low-Level Laser Therapy
- Alternative Natural Treatments
- Hair Transplant Surgery
Low-Level Laser Therapy
Low-Level Laser Therapy (LLLT) is an alternative hair loss treatment, which involves near-infrared non-thermal light to stimulate inactive hair follicles to encourage hair regrowth. Whilst evidence for the efficacy of LLLT is limited, there is evidence for improvements in hair density with LLLT inducing significant long term hair regrowth results.
Alternative Natural Treatments
Whilst the empirical evidence is limited, there are a range of natural remedies available to encourage hair growth which may work well in conjunction with more established hair growth treatments:
Fish oil supplement
Hair density and diameter can be improved with the supplementation of omega fatty acids and antioxidants, furthermore, the additional overall health benefits of omega supplementation is widely reported (enhanced immune health).
Interestingly, regular scalp massaging can help to increase blood flow and stimulate hair follicles, more specifically the dermal papilla cells which are linked to improved hair growth and thickness.
Topically applied rosemary oil can offer similar hair growth results to weaker concentrations of minoxidil such as minoxidil 2% solution. It is reported that rosemary oil improves microcapillary perfusion of blood flow, which is an essential mechanistic necessity for topically applied treatments when targeting hair regrowth.
Hair Transplant Surgery
Hair transplants consist of Follicular unit transplantation (FUT, or strip method) and Follicular unit extraction (FUE) procedures. Both procedures involve surgery to take grafts from the back of the head to be transplanted into the scalp to enable the growth of hair with results observable in 6 months. Whilst hair transplant surgery is effective, there are many drawbacks such as a cost of up to £30,000, a particularly invasive procedure with a healing time of roughly 2 weeks and the risk of possible scarring.
When factoring in practicality, cost and efficacy; it is evident that oral prescription medication (Finasteride) and topical based treatments (Minoxidil and Caffeine based treatments such as REGAINE® and Alpecin) are most suitably applicable. It is really important to try both treatment types for an extended period of time to see how you respond and which treatment type or combination works best for you moving forward.
REGAINE® and Alpecin may offer promising short term results whilst Finasteride may offer increasingly promising long term results; utilising these treatments together in combination may offer optimal hair growth and hair loss prevention results.
Should more conventional treatments be unsuccessful, alternative treatments such as LLLT, naturally based treatments and surgery may offer effective results worthwhile exploring.