Androgenetic alopecia treatment options are plentiful

Key Points

Androgenetic alopecia affects about 50 million American men. It is estimated that a man has a 50 percent chance of experiencing hair loss by age 50. This hereditary androgen dependent condition is characterized by a receding hairline as well as a loss of hair on top of the scalp, according to the American Academy of Dermatology.

"Typically, in my practice the patients who come to visit range in age from very young (with early onset at age 14 or 15) to those in their 30s and 40s. They are just starting to bald and hair loss might be something very prominent in their family, or they are coming in early and they just want to make sure that the thinning they are experiencing is male androgenetic alopecia and not something else," says Maria Hordinsky, M.D., professor and chairwoman, department of dermatology, University of Minnesota, Minneapolis.

"Most people who come in for an evaluation are coming in fairly early on," she says.

Available therapies

Treatment approaches vary depending on the patient, and range from pills and topical medications to devices and hair transplant procedures. Clinicians must conduct an evaluation before prescribing treatment, particularly for patients in their early teens.

"If a 15-year-old comes in with his mom and dad and he is experiencing hair thinning and hair loss, then the dermatologist has to evaluate if there is anything else going on that could explain the change in hair density," Dr. Hordinsky says.

For patients in the 18- to 35-year-old range, discussions should include topical treatments, such as minoxidil (Rogaine, McNeil-PPC), the prescription medication finasteride (Propecia, Merck) and the laser comb, such as the HairMax LaserComb (Lexington International), she says. Combination treatments are also commonly discussed.

Dr. Hordinsky says that for people in the 18- to 35-year-old group, there probably would not be a discussion about hair transplantation because the patient's hair loss is still evolving and the goal is to be able to treat and stop the process as best possible.

"At this point it starts to get individualized and dependent on what the patient wants," she says. "Do they want to take a pill, put something on their scalp either in the form of a liquid or foam twice a day, or do they want to try using the laser comb three times a week?"

Dermatologists can start working through what fits the person's lifestyle when determining the best treatment options, Dr. Hordinsky says.

Other approaches

When new drugs were being developed and being studied in clinical trials - such as when minoxidil or finasteride were being introduced - there were many more patients visiting dermatology offices for male androgenetic alopecia, she says.

"Overall there are fewer people being seen now for male androgenetic alopecia," Dr. Hordinsky says. "Rogaine and the laser comb are over-the-counter, so people can just go buy them and they do not have to see the dermatologist."

After patients try these options, their perception that the over-the-counter therapies don't work could bring them into the clinic, or they may feel they are missing something that needs to be investigated.

Patients with more extensive hair loss may benefit from hair transplantation.

"The medical dermatologist with an interest in hair diseases can partner with a hair transplant specialist, who does hair transplantation on a regular basis. For this group of patients, I partner with Ron Shapiro, M.D., an excellent hair transplant surgeon in our area and someone who is also on our adjunct faculty," she says.

A medical dermatologist should refer the patient, and the hair transplant surgeon can then conduct an assessment and discuss the procedure, cost and other details. The most popular type of hair transplant surgery today is follicular transplantation or transplantation of follicular units.

"This technique that has been around for quite some time and it is a very good technique with outstanding cosmetic results. Patients are very satisfied," Dr. Hordinsky says.