Medications are available to treat male pattern baldness

Your doctor will need to determine if your hair loss is caused by androgenic alopecia or by an underlying illness. If hair loss is caused by iron deficiency or thyroid insufficiency, treatment of the underlying condition is the best way to stop the hair loss. There are a number of systemic causes of hair loss including stress, shock loss or new medications. For most people the pattern of hair loss is the biggest indicator of the cause. If it looks like male pattern baldness, it probably is. Androgenic alopecia tends to have identifiable and reproducible patterns. In cases of androgenic alopecia the Food and Drug Administration have approved two medications for treatment:

Minoxidil (Rogaine)

Originally Minoxidil was a medicine used to treat high blood pressure. In a fortunate coincidence many men taking this oral medication started growing hair on their scalp.  It was later demonstrated that applying Minoxidil topically could also stimulate hair growth.

Minoxidil does not require a prescription.  It can be found on the shelves in many pharmacies in the shampoo aisle. Unlike Propecia, Rogaine can be used by both men and women. Rogaine was more effective in stopping hair loss in the crown and vertex than in the temples.  Rogaine takes longer than Propecia to create a noticeable effect and most people require at least four months of use before noticing a difference. Rogaine requires daily usage to retain benefits.

All medicines have risks of side effects or unwanted outcomes. The most common side effect of topical Minoxidil is scalp irritation. There can also be unwanted hair growth on the adjacent skin of the face (forehead and periorbital areas). There can be changes to the heart rhythm and blood pressure. For most patients, topical Minoxidil does not cause systemic side effects.

Minoxidil is available in generic form and under the brand name Rogaine. The 2% shampoo is available for both men and women. The stronger 5% is recommended only for use in men. Minoxidil is more effective in stopping hair loss in men than it is in women. 

Finasteride (Propecia)

Propecia is a 1 mg dose of Finasteride taken orally. This prescription drug is available only to men and should not be handled by women. It’s taken daily in pill form. The primary goal of Propecia is to stop or slow the hair loss. Some men may even experience regrowth of hairs in certain areas.  Hair follicles that are in a telogen phase may regenerate their life cycle.  Once a hair follicle dies there are no medical or laser treatments that can restore hair.  Only hair transplantation will regrow hair in that area of baldness.  Propecia can have many systemic side effects and you need to keep taking the medicine to suppress hair loss medicine

Propecia has a long track record of success and this medicine received it’s FDA approval in 1997 for treatment of androgenic alopecia in men. Propecia is much more effective than Rogaine for treatment of male pattern baldness.  For many men the primary concerns of Propecia are related to the cost of the medicine and the potential for systemic side effects.  

Finasteride is a medicine that works by preventing conversion of testosterone into dihydrotestosterone (DHT).  Finasteride’s biochemical classification is a Type II 5-alpha-reductace inhibitor (5-ARI). Dihydrotestosterone is potent androgen and is more associated with male pattern baldness than testosterone.  When used appropriately Propecia can effectively lower DHT levels by as much as 60%.  DHT is the hormone that causes susceptible hair follicles to shed their hafts, regress and die. The greater the number of follicles possessing a DHT receptor the greater the pattern of baldness in androgenic alopecia.  

In clinical trials Propecia was shown to stop the progression of hair loss in 86% of men.   Propecia was more effective in stopping hair loss in the crown and vertex than in the temples.  

Rogaine Vs Finasteride: Which Is Right For Me?

Rogaine and Propecia are very different medicines with different levels of effectiveness and toxicity. Both are used to treat male pattern baldness. When Minoxidil and Finasteride are used at the same time they can produce a synergistic effect.  During your consultation Dr. Kolstad can help guide you to determine a strategy that is best for you. Below is a basic summary of the medications:


For Men with Androgenic Alopecia: Both Minoxidil 2% and 5% shampoo and Finaseteride 1 mg.

For Women with Androgenic Alopecia: Only Minoxidil 2% shampoo.


Minoxidil: Up to 62% of men experienced a slowing / stopping of hair loss.

Finasteride: Up to 86% of men experienced a slowing / stopping of hair loss.

Anecdotal evidence would suggest that Finasteride is much more effective than Minoxidil. 


Minoxidil:Generally limited to topical skin irritation but can lead to hypotension in some cases.

Finasteride:The risk of systemic side effects are much greater than Minoxidil. Reversible gynecomastia and irreversible erectile dysfunction have been reported. 


Propecia is much more expensive than Rogaine. Propecia requires a prescription and Minoxidil can be obtained over the counter.

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