For many men—nearly half, actually—hair loss will be inevitable by age 50. The first sign? A receding hairline, which seems to creep back little by little until one day, it appears to change a man’s whole look. Over the years, there have been hundreds of studies conducted by medical professionals, hair-care brands and third parties to evaluate the efficacy of hair-loss drugs and products, but which one works best? According to a report by CNN, a new meta-analysis of 23 studies is now revealing which popular medication—topical minoxidil (think Rogaine and other similar products), oral minoxidil, oral dutasteride and oral finasteride (Propecia)—has the best track record when it comes to delivering results.
The new study, published last week in JAMA Dermatology, analyzed research on the impact of various dosages of the three oral and topical medications mentioned above on the impact of thinning male hair when taken for two to four months. “This meta-analysis is important,” New York dermatologist Anthony Rossi, MD told CNN (he was not involved in the study). “We don’t have randomized clinical trials that compare these medications for male pattern baldness against one another, which would be ideal.”
So which of the three tops the list for the highest probability of reducing male hair loss? Oral dutasteride in a dosage of 0.5 milligrams per day. New York dermatologist Doris Day, MD has been prescribing the FDA-approved drug to her male patients for several years. “It does work better than oral finasteride and topical minoxidil because it covers more receptors, but that also means the possibility of more side effects” she says. (Side effects can include loss of sex drive and erectile dysfunction.) “The way I use it to minimize side effects is that I have patients take 1 milligram of finasteride five days per week and dutasteride two days per week—Monday and Thursday, or other similarly divided days.”
Wayne, NJ facial plastic surgeon Jeffrey B. Wise, MD is also not surprised to see dutasteride at the top. “These findings come as no surprise, considering dutasteride has been demonstrated to successfully block the creation of DHT, the hormone that causes hair loss in androgenic alopecia,” he says. “In fact, it does so quite effectively. Dutasteride has not been studied as extensively for the treatment of hair loss, which is why it is not as commonly prescribed by hair surgeons. Established studies have shown that the side effects and adverse reactions from dutasteride use are comparable to those of finasteride and minoxidil, whereas the efficacy appears to be considerably more significant. I prescribe it for many of my patients, and as more data emerges, I will strongly consider it as a first-line pharmacologic treatment.”
For patients who are new to these treatments, Dr. Day advises her patients to start with finasteride, taking it for at least a year before adding dutasteride. “Or if they have a very strong male pattern hair loss, I may recommend starting the regimen sooner,” she adds. “I always recommend adding topical minoxidil to the regimen, too, because it enhances the benefits of both finasteride and dutasteride.” The drug is not intended or recommended for women either, especially if they are in child-bearing years, as it can cause birth defects.
FDA-approved oral finasteride in a dosage of 5 milligrams per day ranked second in the analysis, followed by 5 milligrams of oral minoxidil. And at the bottom of the list, topical minoxidil in both 5-percent and 2-percent strengths. It’s important to note, however, that each of these treatments revealed different benefits at various times throughout the testing cycles, and each one comes with its own set of side effects, so a dermatologist or plastic surgeon should be consulted before they are added to a routine.