Male pattern baldness is thought to come from an excess of the male hormones called androgens. Specifically, DHT, which is an androgen produced by the conversion of testosterone via an enzyme called 5 alpha reductase, binds to the follicle causing it to shrivel away.
There are some over the counter remedies for baldness. Minoxidil was one of the first compounds found to protect the follicles and keeping them healthy. Minoxidil is the main active ingredient in “Rogaine” and increases the blood flow to our follicles. It is much less expensive nowadays and can be bought in bulk at Costco or by having a compounding pharmacy make it. It should be noted that this needs to be applied twice a day for about 6 months before any real gains are made.
Finasteride (the brand name is Propecia) inhibits the 5 alpha reductase enzyme thus preventing DHT from being formed. It is available in pill form that needs to be taken once daily. Finasteride, like Minoxidil, works by helping the remaining follicles stay healthy and not by stimulating hair growth in those shriveling follicles. Finasteride does have some adverse effects such as decreasing the sensitivity of the penis and decreasing libido. It does decrease prostate cancer risk as it lowers the levels of DHT. Speak with your physician about the use of finasteride and its risks and benefits.
Ketoconazole is an antifungal that has been shown to reduce testosterone and DHT. It is found in some dandruff shampoos. When I have a patient, male or female, with complaints of thinning or balding hair, I tend to compound a formula that they can apply topically to prevent some of the side effects associated with oral medications. My compound contains minoxidil, topical finasteride, tretinoin (a strong form of vitamin A ) and ketoconazole. I want my patients to have all 4 of those components in an easy to apply formula. It should be noted that the topical hair formula may be used in both men and women as the causes are similar.
Before I prescribe that formula I tend to measure thyroid function as an imbalance in the thyroid can cause thinning hair. Once medical causes are ruled out the patient can start on therapy. In the event the topical therapy is not working or if the patient has already had too much hairloss I educate them on alternative options such as hair transplants or hair systems. Transplants use healthy hair from the back of the head and these are transplanted in the area of thinning hair or baldness. They are expensive and do not always result in satisfaction. However, they do not require the maintenance that many hair systems required. Hair systems do require regular maintenance and are expensive but tend to address the issue in a quicker and more dramatic fashion. They have made great advances in hair systems and I often refer my patients out to a reputable company if I think they need it. Discuss these areas with your physician so you may come up with an individual recommendation that is tailored to you.
