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Baldness Treatments
 Minoxidil for pattern baldness
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 Minoxidil for male baldness
 Finasteride for male baldness
 Finasteride for female baldness
 Tretinoin for pattern baldness
 Diazoxide for pattern baldness
 Ketoconazole for pattern baldness
 Antiandrogens for pattern baldness
 Contraceptives for female baldness
 Spironolactone for female baldness
 Flutamide for female baldness
 Cyproterone acetate for baldness

Finasteride, a synthetic 4-azasteroid compound, reduces the dihydrotestosterone (DHT) production which in turn limits the action of DHT on scalp hair follicles. It is used primarily by men older than 18 years old diagnosed with male pattern hair loss.

Finasteride acts as a potent 5 -reductase inhibitor without the help of any androgenic, antiandrogenic, or other steroid hormone activities. Androstenedione conversion to 5a-androstanedione and the formation of potent DHT from testosterone is prompted by the microsomal enzyme steroid 5 -reductase. It was found out that Finasteride has a higher affinity for the 5 -Reductase – 2 (5 R-2) compared to 5 -Reductase – 1 (5 R-l).

Clinical trials in male pattern hair loss

There are documented effects of Finasteride that usually acts by reversing the pathogenesis of hair loss in male pattern baldness. Majority of these studies showed the effects of Finasteride in the stimulation of a substantial amount of hair re-growth, reaching the highest effectivity of the treatment after one year as it eventually slowed down the rate of hair loss progression.

  • The three clinical trials that involved placebo-controlled double blinds conducted recently has shown that taking 1mg Finasteride daily for at least 12 months prevents the progression of hair loss. It has also been seen to produce greater increase in hair counts compared to the results noted with placebo on men with mild to moderate hair loss. 48% of the subjects showed clinical improvement in the 1 year treatment compared to the 7% of the subjects undergoing placebo treatment as the photographs had indicated. The figures increased to 66% at the end of the second year.
  • Macrophotographs measured increasing total hair counts, increased anagen hair count, and increased anagen to telogen ratio in a study that used Finasteride as a treatment. The same study showed that the probability that Finasteride is the agent responsible for the stimulation of conversion of hair follicles into the anagen phase, through reversion of the decrease in the anagen phase and increase in the lag phase, is strong.
  • The stimulation of an increase in terminal count and the decrease in the vellus hair count was found to be caused by Finasteride in one study of scalp biopsy.
  • An objective measurement of hair count and hair weight was used in one study to the demonstration that both hair count and hair weight increases exponentially (with a larger increase on hair weight) upon treating pattern baldness with Finasteride. It asserts the ability of the drug to reverse miniaturization process, production of longer hair and volume, and a possibility of high growth rate.
  • The efficiency of Finasteride as an alternative mode of administration has also been studied. When 0.05% Finasteride solution was applied to the scalp, it had no direct effect on hair growth although it was well absorbed by the scalp and was able to produce 40% production in serum DHT. This could be because a reduction in circulating DHT is necessary in addition to the local blockade of 5a-reductase at the hair follicle for Finasteride to take effect.
  • There are concurrent evaluations of the effects of 1mg Finasteride in older men with extensive hair loss as well as those with pattern baldness.

Efficacy in Men

1mg a day of Finasteride was approved for treating male patients with pattern baldness in the US and in several European countries. Doses of oral Finasteride at 1mg and 5mg a day were able to suppress serum DHT at 71.4% and 72.2% respectively. It was also found out that scalp DHT suppression at 64.15 and 69.4% resulted from the same doses. The period of visibility for the treatment to occur is at least six months although its effects is more apparent on vertex balding than in frontal hair loss (although the medication increases re-growth in the frontal area as well.

Finasteride is available in the market as Propecia and had been proven to maintain or increase hair count in men. This drug was developed to treat pattern baldness in the vertex and anterior mid-scalp area.

Combined use of Finasteride and topical Minoxidil

Studies on small-scale variably-controlled experiments using combination of Finasteride and Minoxidil that showed effectivity when the two are combined compared to any drug alone were conducted on a primate model with pattern baldness as well as on young men with mild to moderate male pattern hair loss. Although the success of this study had been verified, there is still a need for further investigation to sustain the theory.

Side effects in Men

Decreased libido, decreased semen volume, and erectile dysfunction are some of the common side effects experienced by men on Finasteride treatment. All of these occur in less than 2% of men younger than 41 and relatively more often occurring in older men. However, a study conducted by Overstreet et al showed that Finasteride 1mg daily for 48 weeks does not affect spermatogenesis (semen production) in men aged 19 to 41 years.

Finasteride for men had been in medical use for over 10 years, suggesting its safety in use. A considerable number of elderly men using this drug were using 5mg a day and no evidences were found having negative effects of long term use on bone mineral density. Reversible painful gynaecomastia (abnormal enlargement of the male mammary glands) had been reported and the significant percentage of the incidence is at 0.001%. The adverse effects in men using Finasteride were resolved while they are still under medication and all other remaining adverse effects vanished when the intake was terminated.

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