Table 1.
Summary of treatments for androgenetic alopecia
| Therapy | Mechanism | Dosage | Adverse effects | Price | M/F/B |
|---|---|---|---|---|---|
| Topical | |||||
| Minoxidil | Arteriolar vasodilation, inducing cell proliferation; increase vascular endothelial growth factor | 2–10%; QD, BID | Headaches, hypertrichosis, irritation, contact dermatitis | $ | B |
| Finasteride | 5-alpha-reductase inhibitor—blocks formation of DHT | 0.25% spray, 1% gel; QD, BID | Irritation, erythema, contact dermatitis | $ | M |
| Latanoprost | Prostaglandin analog—prolong anagen (growth) phase | 0.1% QD | Irritation, hypertrichosis | $ | B |
| Oral | |||||
| Finasteride | Type II 5-alpha-reductase inhibitor—blocks formation of DHT | 1 mg, 5 mg; QD | Sexual dysfunction, altered libido, gynecomastia, mood changes | $$ | M |
| Dutasteride | Type I and II 5-alpha-reductase inhibitor—blocks formation of DHT | 0.5 mg, 1 mg, QD | Sexual dysfunction, altered libido, gynecomastia, mood changes | $$ | M |
| Minoxidil | Arteriolar vasodilation, inducing cell proliferation; increase vascular endothelial growth factor | 0.625–10 mg | Dizziness, hypertrichosis, lower leg swelling | $ | B |
| Hormonal | |||||
| Oral spironolactone | Antiandrogen—effectively decreases testosterone | 12–200 mg QD | Postural hypotension, electrolyte imbalances | $ | F |
| Oral flutamide | Antiandrogen—effectively blocks testosterone | 62.5–250 mg QD | Elevated liver enzymes, bloating, headache, breast tenderness | $ | F |
| Oral bicalutamide | Antiandrogen—effectively blocks testosterone | 12.5–50 mg 3–5 times weekly | Elevated liver enzymes, bloating, headache, breast tenderness | $$ | F |
| Oral cyproterone acetate | Antiandrogen—blocks gonadotropin-releasing hormone and androgen receptors | 2 mg QD (often combined with ethinyl estradiol) | Weight gain, breast tenderness, decreased libido | F | |
| Topical clascoterone | Topical androgen receptor inhibitor | 5% solution QD, BID | Mild dryness, erythema, hypertrichosis | $$$ | F |
| Injectables | |||||
| Botulinum toxin A | Interferes with the suppressive effect of DHT on the hair follicle | Mild discomfort, temporary drooping of nearby muscles, transient headache, nausea | $$$ | B | |
| Dutasteride | Type I and II 5-alpha-reductase inhibitor—blocks formation of DHT on the hair follicle (local) | Injection every 3 months | Pain | $$$ | M |
| Nonsurgical nondrug | |||||
| Platelet-rich plasma | Contains concentrated platelets, growth factors, and cytokines that aid in hair regrowth | Every 1–6 months | Scalp pain, pinpoint bleeding, headache, and burning sensation | $$$$ | B |
| Low-level light therapy | Upregulation of endogenous growth factors and nitric oxide leading to cellular proliferation and vasodilation | Three times a week/daily | Scalp tenderness, paresthesia, and mild urticaria | $$$ | B |
| Exosomes | Contain cytokines and growth factors that aid in hair regrowth | Pain, bruising, or swelling at the injection site | $$$$ | B | |
| Microneedling | Releases growth factors that promote angiogenesis | Pain, bruising, discomfort at site | $$ | B | |
| Supplementation | |||||
| Vitamins/minerals | Certain micronutrients are necessary for hair growth (vitamins C and D, iron, folate, selenium) | Daily as needed | $ | B | |
| Nutrafol | Contains 21 phytocompounds and other ingredients that support hair growth | Daily as needed | $$ | B | |
| Viviscal | Marine complex supplement that consists of several vitamins/minerals that support hair growth | Daily as needed | $ | B | |
| Caffeine | Increases cyclic adenosine monophosphate and cell metabolism leading to cellular proliferation | Daily as needed | $ | B | |
| Rosemary oil | Contains caffeic acid, rosmarinic acid, camphor, and 12-methoxycarnosic acid that work together to reduce inflammation and infection | Daily as needed | $ | B | |
| Pumpkin seed oil | Contains various saturated and unsaturated fatty acids has been hypothesized to inhibit 5-alpha-reductase and thus reduce levels of DHT | Daily as needed | $ | B | |
| Saw palmetto | Competitively inhibits both types of 5-alpha-reductase at multiple sites and thus reduces binding of DHT to the androgen receptor | Daily as needed | Cold feeling, burning sensation | $ | B |
| Surgical treatments | |||||
| Hair transplant | FUT and FUE. FUT uses individual hair follicles that are transplanted on the alopecic areas. FUT involves a single-strip method of donor hair using an elliptical incision followed by suturing. | Pain, bleeding, edema, pruritis | $$$$ | B |
QD daily, BID twice daily, FUT follicular unit transplantation, FUE follicular unit extraction, M male, F female, B both