Most men deal with some form of hair loss, at some point in their lives. When it comes to prevention, is it a losing battle? Balancing results with harsh side effects may be difficult.
A new meta-analysis of 23 existing studies was published last week in JAMA Dermatology to determine the most effective way to fight androgenetic alopecia (the scientific term for male-pattern baldness). Even the usually buttoned-up medical journal had some fun with its headlines; one of the articles associated with the study was titled “Hair Are The Rankings.”)
Researchers carefully examined the results of three common medications used to stave off baldness: minoxidil (sold under the brand name Rogaine), dutasteride (Avodart), and finasteride (Proscar and Propecia). They looked for the most dramatic change in both total hair count and terminal hair count after both 24 and 48 weeks of treatment.
Terminal hair is thick hair that can grow long, like the hair that grows out of most people’s heads. Some human body hair is vellus hair, which is very thin and often translucent, and sometimes referred to as peach fuzz, or baby hair. To complicate things, some vellus hair can become terminal hair — during puberty, for instance, previously vellus hair on the chest and legs becomes terminal hair.
Each of the three medications had specific benefits at different times. But the study concluded that making five milligrams a day of oral dutasteride “has the highest probability of being the most efficacious treatment.”
The only problem is that dutasteride also has the most severe side effects, several of them sexual, including loss of sexual arousal, inability to keep an erection, and problems with ejaculation. It can also cause headaches, backaches, diarrhea, and dizziness. And along with finasteride, Health Canada says that dutasteride may increase the risk of high grade prostate cancer.
The next most effective treatment was five milligrams a day of oral finasteride. In addition to the prostate cancer risk, it also has the same sexual side effects around arousal, keeping an erection and ejaculation, as well as skin rashes.
Five milligrams of oral minoxidil came in third place, and while it may not be as effective as the other two treatments, its side effects are rare and less severe. It’s also generally the easiest medication to access, as it’s sold as an ingredient in shampoos and topical creams (although those are less effective than the oral medication).
Male pattern baldness is hereditary, and can start as early as adolescence. By age 50, the vast majority of men — 85 per cent — have significantly thinner hair than they used to, according to the American Hair Loss Association. Women can also experience androgenetic alopecia, or female pattern baldness, but the hair loss tends to occur in different areas.