Treatment of Androgenetic Alopecia

Pharmacological Treatment

The American Academy of Dermatology recommends initiating treatment with oral finasteride and topical minoxidil for androgenetic alopecia, as these are the only FDA-approved pharmacological treatments proven to halt progression and stimulate regrowth, with finasteride working by inhibiting 5-alpha reductase and minoxidil promoting hair growth 1
Platelet-rich plasma (PRP) injections can be considered as adjunctive therapy for androgenetic alopecia, with protocols recommending 3-5 sessions at 1-month intervals, then maintenance every 6 months, and evidence showing improvement in hair count 1

Confirm diagnosis of male pattern baldness with temporal, vertex, or mid-frontal scalp involvement, and initiate combination therapy with oral finasteride 1 mg daily and topical minoxidil 5% twice daily 2
The British Association of Dermatologists notes that alopecia areata presents with patchy hair loss and has entirely different treatment, such as intralesional corticosteroids and contact immunotherapy 3, 4

The British Association of Dermatologists and American Academy of Dermatology do not recommend saw palmetto as a treatment option for hair loss, citing a lack of robust high-quality data 5, 6, 7

For androgenetic alopecia, spontaneous improvement is rare, unlike alopecia areata where 80% of limited patchy cases remit spontaneously within one year 7
Delaying effective treatment with finasteride and minoxidil while trying unproven supplements like saw palmetto may result in irreversible hair loss 6

The American Academy of Dermatology recommends using standardized photographs to compare baseline to follow-up, as an objective measure to track treatment response in patients with male androgenetic alopecia 8
Patient satisfaction questionnaires are also used to track treatment response, as a key indicator of positive response in patients with male androgenetic alopecia 8
The Hamilton-Norwood classification is used to document the extent of hair loss in male androgenetic alopecia, with preferential involvement of temples, vertex, and mid-frontal scalp 9

Male androgenetic alopecia presents with characteristic patterns, including preferential involvement of temples, vertex, and mid-frontal scalp, with preserved occipital and lateral scalp hair 9
If hair loss is patchy rather than patterned, consider alopecia areata, which requires entirely different treatment, such as intralesional corticosteroids or contact immunotherapy 10

The British Journal of Dermatology recommends distinguishing androgenetic alopecia from alopecia areata, as the latter requires different treatment, such as intralesional corticosteroids or contact immunotherapy, and presents with patchy loss and exclamation mark hairs 11
For patients with suboptimal response to finasteride and minoxidil, the Periodontology 2000 guidelines suggest considering platelet-rich plasma (PRP) injections as adjunctive therapy, which involves a treatment phase of 3-5 sessions at 1-month intervals using 5-7 mL PRP, and a maintenance phase of 1 session every 6 months 12

The Periodontology 2000 guidelines recommend a PRP protocol involving treatment with 5-7 mL PRP at 1-month intervals, with injections administered at a 90-degree angle, 2-4 mm depth, and 1 cm apart in areas of hair loss, and a maintenance phase of 1 session every 6 months 12
The British Journal of Dermatology advises against using potent topical corticosteroids for androgenetic alopecia, as they are ineffective and indicated only for alopecia areata, and instead recommends alternative treatments such as PRP or hair transplantation 11

The British Journal of Dermatology suggests considering hair transplantation (follicular unit extraction) for patients with inadequate response to medical therapy, especially when combined with PRP pre-treatment and follicle soaking, and notes that wigs provide immediate cosmetic benefit but are rarely natural-appearing for men 11
The Periodontology 2000 guidelines recommend considering PRP injections as an adjunct to hair transplantation, which can improve outcomes and increase patient satisfaction 12