Dr. Ahmed Mostaque
In our last article, we mentioned male pattern hair loss and what causes baldness in men. In this section, we’ll discuss the therapy and medicine available for male pattern baldness, as well as the things we know as medical experts that affect hair in people with male pattern baldness.
Hair Loss Treatments
Medication for hair loss is a bit different from any other disease. People try different therapies to get their hair back and sometimes they are disappointed when these medications don’t work for them. They become impatient and look for other ways to restore their hair.
Well, the first thing you should know is “what to expect from this medication” and “how hair loss medication functions”. There are several drugs and therapies available for male pattern baldness (MPB), each with a unique mode of action. Depending on the medicine you’re taking, you should figure out what function it plays in androgenetic alopecia and how your body reacts to it.
When you are on medication for a while and you feel it’s not responding ask yourself:
- Did your hair get worse when you take hair loss medicine
- Are you still noticing continuous hair shedding
- Is your hair getting thinner
- Are you noticing any regrowth
And when you stop taking your medicines, are you noticing more hair fall? And remember, shedding is not the same as hair loss. So if you are losing about 50-120 hair each day, that’s normal shedding. If you are not noticing any bald patches on your upper scalp or your hair getting thinner that is a sign of progress.
So, what counts as improvement in terms of hair loss?
The objective is to keep a progressive hair loss condition from worsening. That is, you want to stabilize the hair loss, so you don’t lose any more hair. When you can stop or delay the falling out of your hair, you can consider it the first level of success.
Understanding Male Pattern Hair Loss
Androgenetic alopecia is the most common kind of hair loss in men. Men who suffer from male pattern hair loss will see their hair thinning and eventually falling out. According to statistics, one out of every two people in their 40s will experience hair loss. There is no cure for male pattern baldness. But fortunately, there are treatments that may help you stop hair loss and, in some cases, expect some hair regrowth.
Male pattern hair loss (MPHL) is triggered by genetics and male sex hormones. So when we talk about treatment for androgenetic alopecia, we are talking about fighting our genes and hormones. Even though male pattern baldness is hereditary it can be prevented with the right treatment.
When we discuss treatment, we are not always stressing hair regrowth. What you should expect from your medicine is stability, which means no more hair loss. At first, you need to stop your hair from losing before you think about restoring your hairline.
If you notice that your hair isn’t getting any thinner and that you’re losing less hair, your medicine is probably working. In truth, many people respond to hair loss medication with reduced hair fall, and just a few are fortunate enough to experience hair regeneration.
Male pattern hair loss is a progressive problem. It gets worse over time. If you have male pattern hair loss today, there’s a strong probability that in a year or two, you’ll be worse off than you are now if you don’t start treatment.
If you think you are losing more hair than normal shedding, you should consult a dermatologist as soon as possible. This will help you diagnose the problem and you can start medication based on the diagnosis.
Treatment For Male Pattern Balding
The primary and most important goal of hair loss treatment is to prevent the progression of pattern balding. We should try to stop the hair fall and save the hairline from getting worse.
Consider it a bucket of water with a hole at the bottom that will get larger over time. Pouring additional water into the bucket is pointless if it continues to leak. If you don’t initially address the leak, you’ll soon run out of water.
In this metaphor, the bucket of water represents the amount of hair on your head. Male pattern baldness is a little hole at the bottom of the bucket that grows larger with time. Instead of dumping additional water, your first concern should be to repair the leak. That is, instead of concentrating on hair regeneration, you should focus on preserving your current hair first.
It’s a success if you can save your hairline, and it’s a bonus if you notice new hair sprouting.
Previously, there were no medications available to prevent male pattern hair loss. But, fortunately, as medications like minoxidil and finasteride began to show effectiveness in treating male pattern baldness, more and more people with MPB started using them.
Finasteride For Hair Loss
In this part of the post, we are going to look at finasteride, a blocker that is supposed to be successful in lowering enzyme activity. So, if you recall from our last article on male pattern hair loss, we discussed an enzyme known as five alpha-reductase, which acts as a catalyst to convert the hormone testosterone into another form of testosterone known as Dihydrotestosterone, or DHT.
The issue with DHT is that too much of it will cause your hair to fall out if you have the hair loss gene. So the new targeted therapy for male pattern baldness is to limit part of the enzyme activity, which is where the medication finasteride comes into play.
Finasteride is one of the most popular medicines for treating male pattern baldness. It is a prescription drug but is also sold over the counter in some countries.
If you did some research on your own you probably already know about finasteride and how it is used, to treat hair loss in men. Finasteride can help stop balding and, in some cases, even grow back “lost” hair. Although its primary mode of action is to preserve the hair that you have left on your scalp, some people do experience hair regrowth.
Finasteride, unlike other hair loss treatments, takes time to show results. You will need to be patient with finasteride before you notice any visible results. It normally takes 6 months to see any noticeable difference in the density or thickness of your hair. However, depending on the stage of hair loss, it may take much longer. Sometimes it may even take a year or two for some men with significant hair loss to notice the effectiveness of finasteride.
How Does Finasteride Work?
Finasteride is a drug of a class known as 5-alpha-reductase inhibitors, or 5ARIs. It is also called a blocker because it is used for reducing the activity of the enzyme. Finasteride works by blocking the enzyme 5-alpha-reductase, which converts some of your body’s testosterone into the hormone dihydrotestosterone, or DHT.
The modern target therapy for male pattern baldness is to block some of the enzyme activity. It is a common misperception that finasteride is used to suppress DHT hormones. This is not correct. In reality, finasteride is used to block enzymes rather than hormones.
Finasteride is used to significantly lower DHT levels in the body. When testosterone does not convert into DHT, the amount of testosterone increases slightly. According to research, finasteride can reduce DHT levels by two-thirds while just mildly increasing testosterone levels by 10%.
Clinical Trials of Finasteride
So using finasteride you are not interfering with the hormones and you are certainly not becoming less of a man. What you are doing is simply altering the ratio of testosterone to DHT. Lowering DHT levels helps protect your hair follicles from DHT-related damage that can impact your hair. You can see a significant reduction in hair loss and some men also experience hair growth.
The end result is that if you can reduce DHT to a non-harmful level, you can attain stability and it’s proven in multiple clinical trials.
In one clinical trial, 86% of men who took finasteride at a specified dose of one milligram three times a week for one year exhibited no progression of their hair loss, indicating that they were stable at the end of one year and stopped hair loss.
After two years, the figure had reduced to 82%. So there was a minor decrease, but 82% of men remained steady after two years and were able to dramatically minimize hair loss. And there was a little greater reduction after five years, but the percentages remain at 67%, which implies that if you are male and take finasteride for five years, you have better than two out of three chances of retaining your hairline the way it is today.
You may still argue that 33% of patients with male pattern hair loss did not respond to the medication, but this is not the case. So keep in mind that lowering the DHT level by two-thirds may be enough to stabilize most individuals, but it does not completely stabilize them in others.
To return to the leak metaphor, with this group of people we haven’t entirely stopped the leak, but we have significantly slowed it, which means that the 33% of people who are taking the medication are likely to be better off than if they hadn’t. If they were not taking finasteride they would probably lose hair more rapidly.
Keep in mind that there is no cure for male pattern baldness. We are treating the condition with these medications, which implies that you must continue to take the drug in order to keep the benefit and preserve your hairline.
