A review of the treatment of male pattern hair loss

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. An 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 current 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.Abbreviations: MPHL: male pattern hair loss; AGA: androgenetic alopecia; DHT: dihydrotestosterone; 5AR: 5-alpha-reductase; VEGF: vascular endothelial growth factor; PG’s: prostaglandins (PG’s); PGD2R: prostaglandin D2 receptor; VPA: valproic aid; SR: Serenoa Repens; PRP: platelet-rich plasma; PDGF: platelet derived growth factor; TGF: transforming growth factor; ERK: extracellular signal-regulated kinase; PKB: protein kinase B; LLLT: low-level laser therapy; ROS: reactive oxygen species; RCT: randomized control trial; SFRP1: secreted frizzled related protein 1; DP: dermal papilla; PDE5: phosphodiesterase 5

KEYWORDS:

• Androgenetic alopecia
• 5-alpha-reductase inhibitors
• finasteride
• male pattern hair loss
• minoxidil

Article highlights

• MPHL is an androgen dependent progressive patterned hair thinning occurring in genetically susceptible men

• The goal of treatment is to arrest miniaturisation and improve hair density.

• Historically, 5 alpha reductase inhibitors and topical minoxidil have been the mainstay of treatment

• A number of pharmacotherapeutic and procedural modalities have since emerged as new treatment options for MPHL.

• Multimodality therapy incorporating systemic pharmacotherapy with procedural modalities may help to achieve sustainable outcomes

Declaration of interest

R Sinclair is the principal investigator on the photon revian cap study. He is also a director at Samson Clinical and the inventor of patents on the use of oral minoxidil (Australian patent 2018250398 - promoting hair growth and treatment of hair loss and US patent 10,226,462B2 - Detection and treatment of excessive hair shedding). Finally, Dr Sinclair also declares that has served as a consultant for, acted as a paid speaker, or has participated in clinical trials sponsored by Leo Pharma, Amgen Inc, Novartis, Merck & Co., Celgene, Coherus Biosciences, Janssen Pharmaceuticals, Regeneron, MedImmune, GlaxoSmithKline, Cutanea, Samson Clinical, Boehringer Ingelheim, Pfizer Inc, Merck Sharp and Dohme, Oncobiologics, Roche, Eli Lilly and Company and Bayer Healthcare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This manuscript was not funded.