Research lists best treatments for male hair loss

The hairline receding. A failure in hair spreading over the top of the head. Painfully thin strands of hair that are mostly noticeable where the hair splits. About 90% of men will suffer some form of loss of hair throughout life, often leading to symptoms of low self-esteem, anxiety and depression.

Studies of which nonsurgical treatments work best for male pattern baldness are limited, leaving men unsure of the most effective solution.

Now, a new meta-analysis of 23 studies sheds light on this question. Published Wednesday in the journal JAMA Dermatology, the study analyzed research on the impact on loss of hair male with the use of various dosages of the three oral and topical medications – minoxidil, dutasteride and finasteride – for two to four months.

“This meta-analysis is important. We don’t have randomized controlled trials that compare these drugs for male pattern baldness, which would be ideal,” said dermatologist Dr. Anthony Rossi of Memorial Sloan Kettering Cancer Center in New York. He was not involved in the study.

better performance: The analysis found that taking 5 milligrams a day of oral dutasteride was most likely to reduce loss of hair masculine.

Dutasteride is a prescription drug approved by the US Food and Drug Administration (FDA) control agency for the treatment of prostate enlargement in men. It is also used to treat male pattern baldness, but this use is considered “off-label” as dutasteride does not have FDA approval as a hair loss treatment.

Off-label use is quite common in medicine, Rossi said. “Many drugs are used off-label, but there is usually enough evidence to explain why we believe these drugs will work,” he added.

Dutasteride, however, has more serious side effects than many other treatments, including loss of sex drive and the ability to get and maintain an erection.

Second place: Taking 5 milligrams a day of oral finasteride ranked second in terms of effectiveness, according to the study. Finasteride, another prescription drug that is in the same chemical family as dutasteride, is also used to treat an enlarged prostate. The drug received FDA approval as a hair loss treatment.

Finasteride also produced the biggest increase in total hair count at 48 weeks. A total count of hair is exactly what it sounds like – a count of all the different types of hair on a head, including even baby hairs that are finer, also called “fluff”.

Third place: The third most successful treatment for male pattern baldness it was a pill containing 5 milligrams of oral minoxidil. This pill produced the biggest increase in terminal hair counts at the end of two months, much stronger than the lowest dose.

“Terminal” strands are the more mature hairs on the head (compared to new, fine baby strands) and are more likely to create that “bulky hair” effect that many seek, Rossi said.

Fourth place: Taking a reduced dose of finasteride, just one 1-milligram pill a day, ranked fourth in its ability to reduce male hair loss, the study found. However, it showed the biggest increase in mature hair counts at 48 weeks.

Fifth and below: The use of topical 5% minoxidil solution on the scalp ranked fifth in terms of effectiveness, followed by topical 2% minoxidil solution. Last in effectiveness, according to the study, was a much lower dosage of oral minoxidil — just 0.25 milligrams a day.

one caveat: While the study ranked the treatments in descending order, each had different benefits at different times during the 24- and 48-week cycle, and each comes with its own unique set of troubling side effects.

“In general, topical medications will have fewer systemic side effects than oral medications, but topical treatments can be more labor-intensive to use,” said Dr. Amy McMichael, professor of dermatology at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. She did not participate in the study.

“The best medication is the one the patient will adhere to, as we are still much better at keeping the hair they have than trying to revert to what it was,” she said via email.

Insufficient effective treatments

Stopping male hair loss — rather than replacing it with expensive hair implants and other invasive surgical techniques — is the holy grail of treatment goals. Unfortunately, there is no better option, experts say.

Over-the-counter (and therefore over-the-counter) minoxidil is the best-known treatment for both men and women, and is available in liquid, foam, and shampoo forms. Minoxidil requires an application to the scalp in the morning and at night, and some complain that it can make hair sticky and difficult to style.

Side effects can include an itchy or burning sensation on the scalp, as well as dryness, flakiness, and dandruff. It takes several months for the positive effects to appear, and hair loss quickly returns when use is stopped.

Dutasteride can have brutal side effects in some men, Rossi said, including loss of libido, erectile dysfunction and a form of low blood pressure called orthostatic hypotension.

On rare occasions, there may be more severe reactions to dutasteride. Call your doctor or go to the emergency room if you experience peeling skin, swelling of your face, tongue or throat, difficulty breathing or swallowing, or any changes in your breasts, such as an increase in size, lumps, nipple pain or discharge, say doctors. experts.

Older men should talk to their doctors about their risk of prostate cancer before starting dutasteride, experts say, because taking the drug can increase their risk of high-grade prostate cancer, which spreads and grows faster than than other forms of prostate cancer.

Finasteride can also affect male sexual abilities, but it is less potent than its cousin dutasteride, so it may be a better choice for some men.

Consider consulting a dermatologist who specializes in hair loss treatment who can help you navigate the confusing world of hair loss treatment options, Rossi said. Often, he said, your doctor will suggest you start slowly.

“Many people take a gradual approach,” he said. “They can start on finasteride and, if they don’t improve on finasteride, move on to dutasteride. Or they can start with topical minoxidil and, if not doing well, progress to oral minoxidil.”

Finally, a word of caution: None of the study results should apply to women with thinning hair, McMichael emphasized. About 50% of women experience hair loss at some point in their lives.

“The studies of all these drugs in women have been much less extensive and there is no basis for saying that the effectiveness would be the same,” she said. “In clinical practice, many of these drugs are used off-label in women, but there are some very real concerns.”

None of the oral medications are acceptable for women of childbearing age, for example, because of the chance of pregnancy, McMichael said.

“The only drugs evaluated here that have been approved for use in women are minoxidil 2% and 5%, and between the two, we know that 5% works better than 2%,” she said. “I would not extrapolate the findings discussed in this article to women.”

Source: CNN Brasil

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