Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

This Decision Point is for people with inherited hair loss (androgenetic alopecia) only. If your hair loss has another cause, talk with your hair professional about your treatment choices.

Key points in making your decision

Everyone has some hair loss every day. But for some, hair loss becomes excessive, and treatment with medicines may slow hair loss and help to regrow hair. Consider the following when making your decision:

• You may not get as much hair growth as you expect.
• You must take the medicines over the long term or any regrown hair will fall out.
• Your insurance probably will not cover the medicine, and the medicines can be expensive.
• You may have side effects not yet known from taking these medicines long-term. It may be very dangerous to take these medicines if you are pregnant or if you have certain health conditions, such as heart problems.
• You may feel that the possibility of regrowing hair and feeling better about your appearance is more important than the limitations of hair loss treatment.

Medical Information

What medicines are available to treat inherited hair loss?

Medicine for treating inherited hair loss slows thinning of the hair and increases coverage of the scalp by growing new hair and enlarging existing hairs.

Currently, medicines used to treat hair loss caused by heredity include:

• Minoxidil. Minoxidil (Rogaine) is available without a prescription and is sprayed on and/or rubbed into the scalp twice a day.
• Finasteride. Finasteride (Propecia), which is available by prescription, is a pill taken once daily. Finasteride has not been proved effective in women and is not approved for women by the U.S. Food and Drug Administration (FDA).¹ Finasteride should never be taken or handled by women who are or may become pregnant, because it can cause birth defects.

With these medicines, hair coverage tends to improve on the top of the head but not on the forehead area.

How effective are these medicines in treating inherited hair loss?

The effectiveness of finasteride or minoxidil depends on your age and the location of the hair loss. These medicines do not work for everyone, and you should not expect to regrow a full head of hair.

These medicines slow thinning of the hair and increase coverage of the scalp by growing new hair and enlarging existing hairs. They need to be taken every day, and if you stop taking them, any hair that has grown in will gradually be lost. Within 6 to 12 months, your scalp will most likely appear the same as it did before treatment.

Both medicines must be taken daily. It may take 6 months of treatment before you see results.

Minoxidil

Minoxidil slows hair loss and grows new hair. In men, the 5% solution appears to be more effective than the 2% solution, but it costs more and may have more side effects.²

Minoxidil seems to work best on people younger than 30 years of age who have been losing hair for fewer than 5 years.³

Finasteride

Finasteride is recognized as a successful therapy for inherited hair loss for men. Research reports that it slows hair loss on the scalp and helps regrow hair.^{3, 4, 5} But bald spots may not be completely covered, and visible results may take from a few months to a year.

Finasteride has not been proved effective in women and is not approved for women by the FDA.¹

What are the side effects of these medicines?

Side effects of minoxidil include skin irritation, dandruff, and an itchy scalp. In women, minoxidil may cause facial hair growth, especially on the forehead and cheeks. If you have heart problems, ask your doctor about using this medicine.

Finasteride should not be taken or handled by women who are or may become pregnant, because it can cause birth defects. Possible side effects in men include sexual problems, such as difficulty getting an erection.

What are the disadvantages of taking these medicines?

The disadvantages of taking these medicines for hair loss include:

• The medicines may not work. You should not expect to regrow a full head of hair. Visible results may take from a few months to a year.
• You must take the medicine every day. If you stop, any regrown hair will fall out, and you may actually end up with less hair than when you started treatment.
• The medicines are expensive and usually are not covered by insurance.

What are the risks of not taking these medicines?

There are no risks to your health if you decide not to take medicine for hair loss. But for some people, there may be a risk to their well-being and self-esteem if they feel that hair loss has affected their appearance.

The risk of not taking medicine is that your hair loss will probably continue. But medicine is not always effective, and hair loss may continue despite treatment with medicine.

If you need more information, see the topic Hair Loss.

Your Information

Your choices are:

• Use medicine to help stop hair loss and possibly regrow new hair.
• Do not use medicine to treat hair loss.
• Have hair transplantation surgery or other surgeries to regrow hair.

The decision about whether to take medicine to treat hair loss takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about treating hair loss with medicine. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medicine to treat hair loss.

Check the box below that represents your overall impression about your decision.

Return to the topic Hair Loss.

References

Citations

1. Springer K, et al. (2003). Common hair loss disorder. American Family Physician, 68(1): 93–102.

2. Olsen EA, et al. (2002). A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. Journal of the American Academy of Dermatology, 47: 377–385.

3. Habif TP (2004). Hair diseases. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 4th ed., pp. 834–863. Philadelphia: Mosby.

4. Whiting DA, et al. (2003). Efficacy and tolerability of finasteride 1 mg in men aged 41 to 60 years with male pattern hair loss. European Journal of Dermatology, 13(2): 150–160.

5. Finasteride Male Pattern Hair Loss Group (2002). Long-term (5-year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia. European Journal of Dermatology, 12(1): 38–49.