What’s New in Therapy for Male Androgenetic Alopecia?

Male  androgenetic alopecia is a common condition and represents a major  concern for patients who experience this condition. While there are  different treatments to stop hair loss and improve hair density, the  5-alpha reductase inhibitors have demonstrated to be effective in  improving androgenetic alopecia in men and can maintain a positive  response for many years. Oral finasteride 1 mg is a US FDA-approved  option, but dutasteride 0.5 mg has been proven to induce better  responses, especially in the frontal area. Both have been shown to be  safe in clinical trials but there is widespread concern about sexual  adverse effects among patients. The use of topical finasteride has  increased during the last few years as a useful option to avoid systemic  therapy. The efficacy of topical finasteride 0.25% daily has been  demonstrated in clinical trials, with a less marked decrease in serum  dihydrotestosterone levels than with oral intake. Mesotherapy with  dutasteride has also become more widespread recently, although evidence  of its effectiveness is limited to retrospective studies in real  clinical practice. The use of oral minoxidil in androgenetic alopecia  has not been approved by the FDA, however several clinical studies have  shown that it is an effective treatment option. The initial dose  recommended to treat male hair loss is 2.5 mg daily, although the dose  is frequently increased to 5 mg daily. The main adverse effect of oral  minoxidil is hypertrichosis, followed by dizziness or lower limb edema,  which are much less common. Platelet-rich plasma is a  non-pharmacological option to treat male androgenetic alopecia, with  some clinical trials demonstrating an improvement in hair count after  several months. Among the published studies, the main limitation to  compare its efficacy is the heterogeneity of the procedure. The most  frequent regimens propose treatment every 4 weeks for 3 months initially  to assess the individual response. Another treatment alternative is the  use of light devices with wavelengths of between 630 and 660 nm, known  as low-level laser therapy. These devices can be used at home every day  for 15–30 min. Their efficacy has been shown in a limited number of  clinical trials; however, there is a lack of evidence about the efficacy  of these devices compared with other medical options or as a  complementary therapy in hair loss. The pipeline of potential new  treatments for male androgenetic alopecia is strong. Pyrilutamide and  GT20029 are being studied as topical antagonists of the androgen  receptor, while cetirizine is another topical option with some initial  promising results. Furthermore, according to isolated studies with  heterogeneous treatment schemes, the use of botulinum toxin in the scalp  might improve androgenetic alopecia, and lastly, scalp threading might  increase the total hair count as growth factors are released during  implantation.