Hair Loss Drugs
There are many so called "remedies" for hair loss but only a few that are effective at slowing or stopping hair loss.
Hair loss drugs should always be taken under the care of a physician and directions should be followed closely for maximum benefit. The following medications are proven effective, backed by clinical data. Patients who are going to be receiving a hair transplant may want to strongly consider using hair loss drugs so that they can keep the hair they have and mitigate the necessity for further hair transplant surgeries.
In 1997, the FDA approved a 5% solution which was shown to provide even greater hair growth stimulation for men (studies show 45% greater hair growth).
In women, a 2% topical solution is most often used to minimize side-effects (women seem more susceptible to Minoxidil's side-effects than men).
Minoxidil is often the choice of treatment for female pattern hair loss (androgenetic alopecia) and alopecia areata in women because Finasteride is not recommended due to the potential for birth defects. Minoxidil's effectiveness depends on the extent of hair loss and cannot restore full hair in those cases where hair loss is severe. Milder cases often see a greater improvement with treatment than severe cases.
Minoxidil 2% solution is available over-the-counter. Minoxidil 5% solution is available over-the-counter in the USA but by prescription only in Canada.
Finasteride is administered orally. Studies indicate that Finasteride is an effective hair loss medication, slowing hair loss in addition to stimulating hair growth. Finasteride is best used to slow hair loss as soon as it is noticed, though is also effective in slowing hair loss detected at later stages.
Finasteride is available by prescription only.
Both Minoxidil (for men and women) and Finasteride (for men only) are often suggested as an ancillary treatment to those receiving hair transplants.
Rogaine, the brand name for minoxidil, was the first FDA approved medication for the treatment of hair loss. Rogaine is a topical solution that is applied directly to the scalp. It can now be purchased without a prescription and in generic formulations in concentrations of 5% (for men) and 2% (for women).
Rogaine was developed from the oral blood pressure medication minoxidil (Loniten). Minoxidil taken orally has potential serious side effects on the heart and circulatory system and is used only when other blood pressure medications have been unsuccessful. It was observed that patients who were taking minoxidil began growing body hair and it was reasoned that applying minoxidil directly to a bald scalp might cause hair to grow in this area as well. Studies showed that this was indeed the case, although the growth was generally modest.
The original studies on Rogaine were performed on the crown, so there is a misconception that it only works in this area. Although minoxidil usually works best in the crown, it also works to a lesser degree in other areas, such as the front of the scalp, as long as there is some fine (miniaturized) hair in the area. It does not work when the area is totally bald. The greatest benefit from the medication is seen from 5 months to 2 years, with a gradual decrease in effectiveness after that. Those using minoxidil long-term will continue to lose hair, but at a somewhat slower rate.
Minoxidil increases the duration of the hair follicle growth cycle (called anagen). This improves the quality of the hair by increasing the diameter and length of fine (miniaturized) hair. It can also induce a new anagen cycle to begin. Minoxidil is a direct stimulator of follicular growth (via VEGF and prostaglandin synthetase1) and also stimulates the proliferation of dermal papilla cells2. Unlike finasteride, its effects are not related to androgens. The simultaneous use of minoxidil and finasteride, which directly inhibits the formation of DHT, may have some synergistic benefit in the treatment of hair loss, although finasteride is significantly more effective.
The 5% formulation is twice as effective as the 2% solution, but contains propylene glycol, a compound that can irritate the scalp and can make the hair feel sticky and difficult to manage. If this is a problem, one should consider using the 5% solution at bedtime and the 2% solution (which is alcohol based and less sticky) in the morning. When using minoxidil, it may take 6-12 months before any results are seen. The majority of patients who see an effect from minoxidil experience a delay, or decrease, in the rate of hair loss. The drug also serves to thicken already existing hair, but most patients who do have results, grow only short, thin fuzz. It will not grow any new hair on a bald scalp.
Rogaine Foam is a new form of 5% Minoxidil in a glycerin and alcohol base. The foam technology is a convenient way of delivering minoxidil to the scalp without the sticky and often irritating effects of propylene glycol, the delivery compound used in the original 5% solution. When released from the canister, the new product seems like a shaving foam, but it rapidly “melts” when it reaches skin temperature. Applying Rogaine as a foam allows convenient application to the scalp without dripping or running down the forehead or neck, and without leaving a sticky residue in the hair.
Once a day topical use of Rogaine (topical minoxidil 2% and 5%) seems to be almost as effective as using it twice a day. The reason is, that although minoxidil has a relatively short half-life of several hours when given orally, when topically applied, it has a half-life of 22 hours in the skin. This suggests that once a day dosing is a reasonable option. It is important to realize that Pfizer, the company that now makes Rogaine, specifically states that it will be less effective if used only once a day.
If minoxidil is discontinued, the effects of the drug wear off within three months and the previous pattern of hair loss resumes. When minoxidil is restarted, one generally does not regain the hair that was lost, so it is best not to stop and start the mediation, but to use it regularly.
Minoxidil has been prescribed (off-label) in conjunction with other medications, such as topical retinoic acid (Retin-A), to enhance its penetration into the skin and thus increase its effectiveness. This combination of medications, however, can greatly increase the absorption of minoxidil into the bloodstream and may increase the risk of potential side effects, including changes in blood pressure and severe scalp irritation that has led to scarring.
An annoying local reaction that women sometimes get from topical minoxidil is the development of facial hair. Although the facial hair slowly resolves when the medication is discontinued, at times the hair may need to be removed. Carefully trying to avoid the medication dripping down onto the temples and forehead seems to reduce, but not totally prevent, this problem. There is a significantly greater incidence of these side effects if the 5% solution is used.
Men
Minoxidil solution comes in a generic formulation and can be purchased over the counter. The foam is available in brand only (Rogaine Foam).Hair loss drugs should always be taken under the care of a physician and directions should be followed closely for maximum benefit. The following medications are proven effective, backed by clinical data. Patients who are going to be receiving a hair transplant may want to strongly consider using hair loss drugs so that they can keep the hair they have and mitigate the necessity for further hair transplant surgeries.
Minoxidil
The hair loss medication Minoxidil was approved in 1988 for the treatment of pattern hair loss. Early studies showed significantly improved hair counts in both men and women using a 2% minoxidil solution.In 1997, the FDA approved a 5% solution which was shown to provide even greater hair growth stimulation for men (studies show 45% greater hair growth).
In women, a 2% topical solution is most often used to minimize side-effects (women seem more susceptible to Minoxidil's side-effects than men).
Minoxidil is often the choice of treatment for female pattern hair loss (androgenetic alopecia) and alopecia areata in women because Finasteride is not recommended due to the potential for birth defects. Minoxidil's effectiveness depends on the extent of hair loss and cannot restore full hair in those cases where hair loss is severe. Milder cases often see a greater improvement with treatment than severe cases.
Minoxidil 2% solution is available over-the-counter. Minoxidil 5% solution is available over-the-counter in the USA but by prescription only in Canada.
Propecia & Proscar (Finasteride)
Finasteride is approved for use in men only. Women should not use Finasteride, or handle tablets, doing so could cause birth defects in a male fetus.Finasteride is administered orally. Studies indicate that Finasteride is an effective hair loss medication, slowing hair loss in addition to stimulating hair growth. Finasteride is best used to slow hair loss as soon as it is noticed, though is also effective in slowing hair loss detected at later stages.
Finasteride is available by prescription only.
Both Minoxidil (for men and women) and Finasteride (for men only) are often suggested as an ancillary treatment to those receiving hair transplants.
Rogaine, the brand name for minoxidil, was the first FDA approved medication for the treatment of hair loss. Rogaine is a topical solution that is applied directly to the scalp. It can now be purchased without a prescription and in generic formulations in concentrations of 5% (for men) and 2% (for women).
Rogaine was developed from the oral blood pressure medication minoxidil (Loniten). Minoxidil taken orally has potential serious side effects on the heart and circulatory system and is used only when other blood pressure medications have been unsuccessful. It was observed that patients who were taking minoxidil began growing body hair and it was reasoned that applying minoxidil directly to a bald scalp might cause hair to grow in this area as well. Studies showed that this was indeed the case, although the growth was generally modest.
The original studies on Rogaine were performed on the crown, so there is a misconception that it only works in this area. Although minoxidil usually works best in the crown, it also works to a lesser degree in other areas, such as the front of the scalp, as long as there is some fine (miniaturized) hair in the area. It does not work when the area is totally bald. The greatest benefit from the medication is seen from 5 months to 2 years, with a gradual decrease in effectiveness after that. Those using minoxidil long-term will continue to lose hair, but at a somewhat slower rate.
Minoxidil increases the duration of the hair follicle growth cycle (called anagen). This improves the quality of the hair by increasing the diameter and length of fine (miniaturized) hair. It can also induce a new anagen cycle to begin. Minoxidil is a direct stimulator of follicular growth (via VEGF and prostaglandin synthetase1) and also stimulates the proliferation of dermal papilla cells2. Unlike finasteride, its effects are not related to androgens. The simultaneous use of minoxidil and finasteride, which directly inhibits the formation of DHT, may have some synergistic benefit in the treatment of hair loss, although finasteride is significantly more effective.
Using Minoxidil
Minoxidil should be applied to the scalp twice a day. The medication only works if it is in direct contact with the scalp (not the hair) and only works in areas where it is applied. Therefore, it is important to use the medication in the front part of the scalp if this is an area of thinning.The 5% formulation is twice as effective as the 2% solution, but contains propylene glycol, a compound that can irritate the scalp and can make the hair feel sticky and difficult to manage. If this is a problem, one should consider using the 5% solution at bedtime and the 2% solution (which is alcohol based and less sticky) in the morning. When using minoxidil, it may take 6-12 months before any results are seen. The majority of patients who see an effect from minoxidil experience a delay, or decrease, in the rate of hair loss. The drug also serves to thicken already existing hair, but most patients who do have results, grow only short, thin fuzz. It will not grow any new hair on a bald scalp.
Rogaine Foam is a new form of 5% Minoxidil in a glycerin and alcohol base. The foam technology is a convenient way of delivering minoxidil to the scalp without the sticky and often irritating effects of propylene glycol, the delivery compound used in the original 5% solution. When released from the canister, the new product seems like a shaving foam, but it rapidly “melts” when it reaches skin temperature. Applying Rogaine as a foam allows convenient application to the scalp without dripping or running down the forehead or neck, and without leaving a sticky residue in the hair.
Once a day topical use of Rogaine (topical minoxidil 2% and 5%) seems to be almost as effective as using it twice a day. The reason is, that although minoxidil has a relatively short half-life of several hours when given orally, when topically applied, it has a half-life of 22 hours in the skin. This suggests that once a day dosing is a reasonable option. It is important to realize that Pfizer, the company that now makes Rogaine, specifically states that it will be less effective if used only once a day.
If minoxidil is discontinued, the effects of the drug wear off within three months and the previous pattern of hair loss resumes. When minoxidil is restarted, one generally does not regain the hair that was lost, so it is best not to stop and start the mediation, but to use it regularly.
Minoxidil has been prescribed (off-label) in conjunction with other medications, such as topical retinoic acid (Retin-A), to enhance its penetration into the skin and thus increase its effectiveness. This combination of medications, however, can greatly increase the absorption of minoxidil into the bloodstream and may increase the risk of potential side effects, including changes in blood pressure and severe scalp irritation that has led to scarring.
Use in Women
Only the 2% concentration of minoxidil is approved for use in women. Women are generally more sensitive to the side effects of minoxidil in decreasing blood pressure (hypotension) and may get light-headed from the medication. Women also have an increased risk of developing allergic skin reactions (contact dermatitis).An annoying local reaction that women sometimes get from topical minoxidil is the development of facial hair. Although the facial hair slowly resolves when the medication is discontinued, at times the hair may need to be removed. Carefully trying to avoid the medication dripping down onto the temples and forehead seems to reduce, but not totally prevent, this problem. There is a significantly greater incidence of these side effects if the 5% solution is used.
Men
Minoxidil only works where you apply it. Apply it to all areas that are thinning.
- Minoxidil can work anywhere there is miniaturized hair (where the area is not totally bald)
- Minoxidil will work in the front part of the scalp and temples if these areas are just starting to thin – so it is important to apply it to the front part of your scalp and hairline if you are thinning in these areas.
- Minoxidil 5% solution is the most effective if you have some hair, as the solution will be easier to apply to the scalp.
- If the 5% solution is irritating to your scalp, try the 5% Foam which does not contain propylene glycol, the most common irritant.
- If the 5% solution is too greasy and you find you are not using it, switch to the foam.
- Many patients find applying the medication once a day at bedtime to be the most convenient way to use it.
- When using minoxidil once a day, use at least double the recommended dose, so that it will be applied to the entire area of thinning.
For minoxidil to be effective it must be used continually and regularly. Do not stop and start it. You may experience shedding during the first 3-6 months of treatment. This generally is an indication that the medication is working, so unless you are having side effects, do not stop the medication. If you do stop the medication, you will lose all of its benefits (although you will not be any worse off than if you had never used it).
Minoxidil works best when used with finasteride (Propecia). Of the two medications, finasteride is more effective.
Women
Minoxidil solution comes in a generic formulation and can be purchased over the counter. The foam is still available in brand only.Minoxidil is generally prescribed as a 2% solution for women to be used twice a day. If twice a day is inconvenient, then use the 5% men’s formulation just once a day.
Minoxidil can cause increased facial hair. Although the 5% is more likely than the 2% to cause this, when the 5% is used one a day, the side effects seem to be about the same.
Minoxidil only works where you apply it. Apply it to all areas that are thinning.
- Minoxidil can work anywhere there is miniaturized hair (where the area is not totally bald).
- Minoxidil will work in the front part of the scalp and temples if these areas are just starting to thin.
- Minoxidil solution is the most effective if you have some hair, as the solution will be easier to apply to the scalp.
- If the solution is irritating to your scalp, try the Foam which does not contain propylene glycol, the most common irritant.
- If the solution is too greasy and you find you are not using it, switch to the foam.
- Many patients find applying the medication once a day at bedtime to be the most convenient way to use it.
- When using minoxidil once a day, use double the recommended dose, so that it will be applied to the entire area of thinning.
For minoxidil to be effective it must be used continually and regularly. Do not stop and start it. You may experience shedding during the first 3-6 months of treatment. This generally is an indication that the medication is working, so unless you are having side effects, do not stop the medication. If you do stop the medication, you will lose all of its benefits (although you will not be any worse off than if you had never used it).
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