Should I treat inherited hair loss with medication?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

This Decision Point is for people with inherited hair loss (androgenetic alopecia) only. If your hair loss has another cause, talk with your hair professional about your treatment choices.

Key points in making your decision

Everyone has some hair loss every day. However, for some, hair loss becomes excessive, and treatment with medications may slow hair loss and help to regrow hair. Consider the following when making your decision:

• You may not get as much hair growth as you expect.
• You must take the medications over the long term or any regrown hair will fall out.
• Your insurance probably will not cover the medication, and the medications can be expensive.
• You may have side effects not yet known from taking these medications long-term. It may be very dangerous to take these medications if you are pregnant or if you have certain health conditions, such as heart problems.
• You may feel that the possibility of regrowing hair and feeling better about your appearance is more important than the limitations of hair loss treatment.

Medical Information

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What medications are available to treat inherited hair loss?

Medication for treating inherited hair loss slows thinning of the hair and increases coverage of the scalp by growing new hair and enlarging existing hairs.

Currently, medications used to treat hair loss caused by heredity include:

• Minoxidil. Minoxidil (Rogaine) is available without a prescription and is sprayed on and/or rubbed into the scalp twice a day.
• Finasteride. Finasteride (Propecia), which is available by prescription, is a pill taken once daily. Finasteride has not been proven effective in women and is not approved for women by the U.S. Food and Drug Administration (FDA).¹ Finasteride should never be taken or handled by women who are or may become pregnant, because it can cause birth defects.

With these medications, hair coverage tends to improve on the top of the head but not on the forehead area.

How effective are these medications in treating inherited hair loss?

The effectiveness of finasteride or minoxidil depends on your age and the location of the hair loss. These medications do not work for everyone, and you should not expect to regrow a full head of hair.

These medications slow thinning of the hair and increase coverage of the scalp by growing new hair and enlarging existing hairs. They need to be taken every day; and if you stop taking them, any hair that has grown in will gradually be lost, and within 6 to 12 months your scalp will most likely appear the same as before treatment.

Both medications must be taken daily. It may take 6 months of treatment before you see results.

Minoxidil

Minoxidil slows hair loss and grows new hair. In men, the 5% solution appears to be more effective than the 2% solution, but it costs more and may have more side effects.²

Minoxidil seems to work best on people younger than 30 years of age who have been losing hair for fewer than 5 years.³

Finasteride

Finasteride is recognized as a successful therapy for inherited hair loss for men. Research reports that it slows hair loss on the scalp and helps regrow hair.³ One study showed that finasteride may potentially improve hair loss on the forehead, which is usually less likely to respond to treatment than hair loss on the top of the head.⁴ However, bald spots will not be completely covered, and visible results may take from a few months to a year.

Finasteride has not been proven effective in women and is not approved for women by the FDA.¹

What are the side effects of these medications?

Side effects of minoxidil include skin irritation and an itchy scalp. In women, minoxidil may cause facial hair growth, especially on the forehead and cheeks. If you have heart problems, ask your health professional about using this medication.

Finasteride should not be taken or handled by women who are or may become pregnant, because it can cause birth defects. Possible side effects in men include sexual problems, such as difficulty getting an erection.

What are the disadvantages of taking these medications?

The disadvantages of taking these medications for hair loss include:

• The medications may not work. You should not expect to regrow a full head of hair. Visible results may take from a few months to a year.
• You must take the medication every day. If you stop, any regrown hair will fall out, and you may actually end up with less hair than when you started treatment.
• The medications are expensive and usually are not covered by insurance.

What are the risks of not taking these medications?

There are no risks to your health if you decide not to take medication for hair loss. But for some people, there may be a risk to their well-being and self-esteem if they feel that hair loss has affected their appearance.

The risk of not taking medication is that your hair loss will probably continue. However, medication is not always effective, and hair loss may continue despite treatment with medication.

If you need more information, see the topic Hair Loss.

Your Information

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Your choices are:

• Use medication to help stop hair loss and possibly regrow new hair.
• Do not use medication to treat hair loss.
• Have hair transplantation surgery or other surgeries to regrow hair.

The decision about whether to take medication to treat hair loss takes into account your personal feelings and the medical facts.

Deciding about treating hair loss

Reasons to treat hair loss with medication

Reasons not to treat hair loss with medication

You have begun to lose your hair, and you wish to prevent more hair loss. Regrowing your hair could help your self-esteem and make you feel better about your appearance. Are there other reasons you might want to treat hair loss with medication?

Your hair loss doesn't really bother you. You would only be satisfied with a full head of hair. Medications may have serious side effects when taken with other medications or if you are pregnant or have health conditions, such as a heart problem. Any hair regrown with the medications would be lost if you stop taking the medications. You may even end up with less hair than when you started treatment. Medications to treat hair loss are expensive and usually are not covered by insurance. Treatment may not work. Are there other reasons you might not want to treat hair loss with medication?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about treating hair loss with medication. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My hair loss causes me significant stress or unhappiness.	Yes	No	Unsure
I don't want to use medications every day.	Yes	No	Unsure
I'm worried about unknown side effects.	Yes	No	Unsure
A small improvement in hair coverage would be worth the time and money.	Yes	No	Unsure
I am pregnant.	Yes	No	NA*
I have a heart condition.	Yes	No	Unsure
I can afford to pay for the treatment over the long term.	Yes	No	Unsure
I realize that the treatment may not work.	Yes	No	Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medication to treat hair loss.

Check the box below that represents your overall impression about your decision.

Leaning toward treating hair loss with medication

Leaning toward NOT treating hair loss with medication

Return to the topic Hair Loss.

References

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Citations

1. Springer K, et al. (2003). Common hair loss disorder. American Family Physician, 68(1): 93–102.

2. Olsen EA, et al. (2002). A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. Journal of the American Academy of Dermatology, 47: 377–385.

3. Habif TP (2004). Hair diseases. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 4th ed., pp. 834–863. Philadelphia: Mosby.

4. Leyden JJ, et al. (1999). Finasteride in the treatment of men with frontal male pattern hair loss. Journal of the American Academy of Dermatology, 40(6, Part 1): 930–937.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Tracy Landauer
Associate Editor	Pat Truman
Primary Medical Reviewer	Patrice Burgess, MD - Family Medicine
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer	Randall D. Burr, MD - Dermatology
Last Updated	July 3, 2006