Treatment review for male pattern hair-loss

madman

Super Moderator
ABSTRACT

Introduction: Androgenetic alopecia is a common hair loss disorder affecting up to 80% of males by the age of 80. It is characterized by androgen-related progressive thinning of hair in a defined pattern. It results in diminished self-esteem, reduced confidence, and distress in affected men, irrespective of age or stage of baldness. Effective treatment for hair baldness is needed.

Areas covered: In androgenetic alopecia, hair follicles undergo progressive miniaturization. Genetic factors and androgens are key role players in disease pathogenesis. Herein the authors review the pharmacologic treatment of androgenetic alopecia, which involves 5 alpha-reductase inhibitors, minoxidil, and prostaglandins. Non-pharmacologic approaches are also explored.

Expert opinion: Androgenetic alopecia progresses over time and although the currently available medical treatments like finasteride and minoxidil are effective in arresting the progression of the disease, they allow only partial regrowth of hair at its best. Early treatment achieves a more optimal outcome. Non-pharmacologic treatments like PRP can be considered in patients refractory to medical treatment.




5. Conclusion

Patients with MPHL can have varied responses to treatment. Oral finasteride and topical minoxidil are both FDA-approved for the treatment of MPHL and have been the mainstay of treatment to date.
However, significant developments in hair research have resulted in a number of new pharmacotherapeutic and procedural treatments for hair growth promotion. Actively recruiting clinical trials aims to explore novel treatments in AGA. Single-agent treatment may not be sufficient to produce the desired outcome long-term. Overall, combination therapy incorporating systemic pharmacotherapy with procedural modalities may be the way to produce sustainable results.
 

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6. Expert opinion

AGA occurs universally in all adult men and severity progresses with age. Twin studies have confirmed that the age of onset, severity, rate of progression and pattern of hair loss are all influenced by inherited factors. Heredity is thought to contribute more than 80% to the AGA phenotype, while environmental factors account for less than 20%. AGA is inherited as a complex polygenic trait. Genome wide association studies have identified over 190 genes that are thought to be involved in AGA, however the first gene associated with AGA, the androgen receptor gene, is thought to account for over 60% of the heredity of AGA.
 

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Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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