Treatment of Male Pattern Baldness (Androgenetic Alopecia)

First-Line Medical Treatments

The American College of Dermatology recommends starting with topical minoxidil 5% twice daily as the baseline treatment, and adding oral finasteride 1 mg daily if faster and more complete results are desired, particularly for crown hair loss 1
Topical minoxidil 5% must be continued indefinitely, as all hair regrowth will be lost if treatment is stopped 1, 2
Minoxidil 5% provides superior hair regrowth compared to the 2% formulation 3
Finasteride demonstrates superior efficacy compared to minoxidil alone in head-to-head trials 1

The American Academy of Dermatology suggests adding PRP therapy if first-line treatments produce suboptimal results after 6-12 months, while continuing topical minoxidil 1, 4
Nonactivated PRP shows 31% greater improvement in hair density compared to activated PRP 1, 4
Initial improvements with PRP are visible at 2-3 months, with 25% improvement at 2 months predicting sustained response at 6 months 4
Combination PRP plus minoxidil 5% produces a 57% median increase in terminal hair density versus 48% with minoxidil alone at 32 weeks 2

The treatment algorithm recommends starting with topical minoxidil 5% and considering adding oral finasteride 1 mg daily for superior results, or adding after 4 months if minoxidil response is inadequate 1
If response remains suboptimal after 6-12 months of combination medical therapy, PRP injections should be added while continuing minoxidil 1, 4

The International Society of Hair Restoration Surgery recommends evaluating treatment efficacy using multiple methods, including standardized before-and-after photographs, trichoscopy, hair pull test, patient self-assessment questionnaires, and terminal versus vellus hair ratio 2, 5

Never discontinue minoxidil once started, as all gains will be lost within months 1, 2
Never activate PRP, as activation reduces efficacy by 31% 1, 4
Never use PRP as monotherapy, always combine with topical minoxidil for optimal outcomes 1, 4
Insufficient treatment duration leads to suboptimal outcomes, some patients require extended therapy beyond initial 6 months 2