TABLE 1.
Efficacy, side effects, clinical evidences supported in various treatment options in AGA
| Treatment | Clinical evidence (weak, moderate, strong) | Side effects, short‐term | Side effects, long‐term | Likelihood of patient compliance (low, moderate, high, extremely high) | Monthly cost ($ ≤ $100; $$ = $100‐$1000; $$$ = $1000‐$5000; $$$$ = $5000‐$15000; $$$$$ ≥ $15000; ? = unknown number of treatments (final cost)) | 5 year cost ($ ≤ $100; $$ = $100‐$1000; $$$ = $1000‐$5000; $$$$ = $5000‐$15000; $$$$$ ≥ $15000; ? = unknown number of treatments (final cost)) | Special considerations |
|---|---|---|---|---|---|---|---|
| Topical minoxidil | Strong, multiple RCTs | Unlikely, scalp irritation | Rare, dizziness, cardiac arrhythmia | Low to moderate | $ | $$ | Hair growth in undesired locations. May leave residue on hair which interferes with styling. |
| Topical finasteride | Weak | Unlikely, skin erythema, contact dermatitis | Rare | High | $ | $$ | May be used as a maintenance therapy |
| Oral finasteride | Strong, multiple RCTs | Uncommon | Post‐finasteride syndrome | High | $ | $$ | Avoid in females of childbearing potential |
| Oral minoxidil | Moderate, mainly retrospective case reviews | Unlikely | Rare, unless patients with cardiovascular comorbidities. Weight gain | High | $ | $$ | Hair growth in undesired locations |
| Spironolactone | Weak, but commonly used by clinicians | Rare, possible SE include postal hypotension, electrolytic disturbance | Rare, unless patients with renal failure. | High | $$ | $$ | Contraindicated in males, pregnant females, and individuals with renal failure |
| Flutamide & bicalutamide | Weak | Hepatic injury | Flutamide has black box warning of hepatic failure | Moderate to high | $ | $$ | Potential interaction with other medications |
| Platelet‐rich plasma | Strong | Unlikely, scalp pain | Rare | Moderate | $$ | $$$$ | Avoid in patients with bleeding disorder, lack of standardized protocol |
| Exosomes | Moderate | Unlikely, scalp pain | Rare | Moderate | $$$ | ? | Lack of standardized protocol |
| Microneedling | Weak to moderate | Unlikely, scalp pain | Rare | Moderate | $$ | $$$ | Lack of standardized protocol |
| Oral nutraceutical supplement containing Synergen Complex® | Moderate | Unlikely | Rare | PO BID, high compliance | $ | $$$ | Four capsules daily |
| Marine complex supplement | Moderate | Unlikely | Rare | PO BID, high compliance | $ | $$$ | Fishy taste for oral supplement |
| Serenoa repens | Weak | Unlikely | Rare | PO BID, high compliance | $ | $$$ | Possibility of missing early detection of prostatic cancer |
| Light devices | Strong | Unlikely | Rare | Daily, high compliance | $$ | $$ or $$$ | Noninvasive, convenient to use at home |
| Hair transplant | Strong | Infection, scarring, pain, itching, swelling, bleeding | Rare | Permanent, one‐time treatment | $$$$ | ? | May need concurrent medical treatment |