March 21, 2023


Well hey guys get excited in this video we’re going to be going over the results of a recent study that ranks hair loss treatments different medications for hair loss if you are new here welcome my name is andrea i’m a board-certified dermatologist i upload skin care and quite a bit of hair care content here on youtube if that is of interest to you consider

Subscribing hit the bell notification that lets you know when my videos go live if you prefer short form content make sure and follow me over on tik tok or instagram i’m pretty consistent on those platforms too androgenetic alopecia is a type of hair loss that commonly affects both men and women it’s frequently referred to as pattern hair loss like male pattern

Baldness or female pattern hair loss and it basically has to do with a sensitivity of the hair follicle to the androgen hormones there’s an enzyme in our hair follicle that converts testosterone to a more potent form of testosterone dihydrotestosterone and that is what is responsible for converting the hair into a baby hair resulting in decreased hair density

Thickness and ultimately thinning out of the hair and balding and there are medications that target the enzyme 5 alpha reductase to treat pattern hair loss these include most commonly prescribed for male pattern hair loss is finasteride but there’s a similar compound dutasteride it is prescribed less frequently but we’re going to see how it stacks up in this

Video now in addition to finasteride and dutasteride there is minoxidil probably what you’re most familiar with this is used in both men and women commonly you can buy it in the drugstore it is a topical treatment that you put on the scalp we don’t actually know how it works but there are some ideas it appears to increase blood flow stimulating restoration of

The hair follicles getting the hairs to go into the growing phase there’s also oral minoxidil pill that you take by mouth it’s actually a blood pressure medication but at low low doses it helps to treat hair loss in both men and women if you’re curious about minoxidil oral make sure you check out my video on it i go into detail i’ll link it down below if you’re

Not familiar with finasteride it is a medication that is mostly used to treat male pattern hair loss it works again by inhibiting that enzyme 5 alpha reductase and it’s relatively effective however there are some side effects that can occur it can lead to mood changes depression and it also can cause sexual dysfunction poor libido erectile dysfunction in some

Cases gynecomastia which is the development of breast tissue in men the depression with finasteride is interesting it appears to be dose-independent so it doesn’t matter the dose of finasteride some people do go on to develop mood changes including depression it’s thought to be related to a lowering of something called neurosteroid aloe pregnant alone which is a

Hormone that is thought to have natural antidepressant effects when you go on five alpha reductase inhibitor that can lower that and that may be associated with the depression symptoms in some people it doesn’t happen in everyone it’s more common actually in men under the age of 45. finasteride should also be used with caution and people who have underlying liver

Disease as it is metabolized through the liver it’s fda approved to treat male pattern hair loss but what about using it in women can it be prescribed for female pattern hair loss it can unfortunately it is absolutely contraindicated if a woman plans to become pregnant because it does cause birth defects but it is used off-label meaning it’s not fda approved but

We try it out anyway it is used off-label in some women because finasteride does disrupt the balance between estrogen and testosterone in women it could in theory slightly increase the risk for breast cancer so if there’s a family history of breast cancer you know you may be counseled against using it what about do taste right similar medication to finasteride

Inhibits that five alpha reductase enzyme what about that that’s mostly been used in men and it’s not as commonly used it still can cause low libido and it still can cause erectile dysfunction mood changes but the side effect profile is not as well described as for finasteride in terms of treating androgenetic alopecia and dutasteride also can cause gynecomastia

Just like finasteride and then there’s minoxidil which you guys you know i’ve got a lot of videos on minoxidil something that you put on the scalp we don’t know entirely how it works but it does have some side effects it can be very irritating in the beginning it causes the hairs to shed that’s expected but it can be very annoying to deal with and then the hairs

Start growing after around three months and as soon as you stop it the hair that you grew while you were on minoxidil will just fall out you kind of go back to where you would have been had you never used it so people get frustrated with it because it’s something you have to put on every day and you have to use it pretty much indefinitely and you go through the

Shedding phase which is frustrating that being said there is a oral pill version of it that is actually pretty effective especially when used at low doses at the lower doses it’s effective but there are fewer side effects because minoxidil is a blood pressure medication one of the side effects that you would be worried about is low blood pressure it’s not as much

Of a risk factor though at the lower doses other adverse effects that can occur with taking oral minoxidil include excessive hair growth and so when we’re talking about treating women with oral minoxidil you’re talking about hair growth where you don’t want it facial hair growth and that’s not desirable and at very high doses it can cause heart problems it can

Cause fluid around the heart and then there is actually topical finasteride that you can apply to the scalp and that’s actually showing some really good results and we’ll get into into that in a moment and the advantage there is that less risk of side effects in comparison to taking finasteride by mouth now aside from finasteride dutasteride and minoxidil there

Are a variety of other treatments that are offered for either men or women going through androgenetic alopecia i’ve got a lot of videos on one of my favorite adjuncts low level laser therapy that certainly can be really helpful to use alongside these treatments or in those who don’t care for minoxidil i mean it’s a great option and in women there’s also the oral

Medication spironolactone so i’ve got a specific video on spironolactone i’ll link that down below but the study we’re going to be talking about today it was a meta-analysis analysis done pretty recently and this meta-analysis it was looking to determine kind of the rank order of efficacy for finasteride both oral and topical as well as dutasteride and oral and

Topical minoxidil at a few different doses so the meta-analysis include included 23 studies 21 of which were randomized control trials and included men only so this is only looking at efficacy in men ages 22 to around 41 so young men and they looked at end points of number of hairs per centimeter square of surface area so they’re doing hair counts they did hair

Counts at 24 and 48 weeks at 24 weeks due to astronaut half a milligram per day was a clear cut winner with much greater hair counts per centimeter square in comparison to the other treatments 23.7 more versus minoxidil 0.25 milligrams per day taken by mouth dutasteride beat out minoxidil half a milligram per day by 15 hairs per centimeter square dutasteride 0.5

Milligrams per day beat out two percent minoxidil solution applied to the scalp by eight and a half hairs per day and it beat out uh finasteride one milligram per day by 7.1 hairs per centimeter square so it appears as though at 24 weeks dutasteride was advantageous as far as oral minoxidil at 24 weeks the higher dose was better so five milligrams per day got

Better results than 0.25 milligrams per day 43.6 hair hairs per centimeter square difference that is actually very substantial between those two doses and at 24 weeks five milligrams per day of minoxidil was superior to one milligram per day of finasteride and that’s important too because in young men who maybe have risk factors for an underlying mood disorder

Depression or maybe they’re concerned about the impact on libido oral minoxidil may be a better option for them and it appears as though it’s actually more effective at this earlier time point than oral finasteride at one milligram per day but overall how did these stack up against one another we’re gonna rank them right now from worst to best um the worst was the

0.25 milligrams per day of oral minoxidil number six was two percent topical minoxidil so the minoxidil you apply your scalp number five was five percent uh topical minoxidil so you got a little bit better with the five percent number four was one milligram per day of oral finasteride number three was five milligrams per day of oral minoxidil so five milligrams

A day of minoxidil is better than one milligram a day of finasteride number two was five milligrams per day of oral finasteride and the number one was actually the five milligrams per day of due tastergride so it seems as though dutasteride is the superior option now there’s some limitations here with how the study was done hair counts per centimeter square so

It’s not giving you a complete picture of the hair loss and it’s looking at certain areas of the scalp so it doesn’t really give you an idea overall and it does doesn’t necessarily take into account hair thickness it’s just hair count which is a you know something else that’s really important for people because you can have very thin downy hairs but that may not be

The goal that you’re looking for so why might do taste right be more effective than these other treatments possibly related to its uh longer half-life dutasteride has a pretty long half-life of five weeks versus six hours for finasteride so it stays in the system much longer what about topical finasteride did they take that into account yes they did interestingly

Topical finasteride was similar to one milligram per day of oral finasteride so that’s important you know i get a lot of comments from men who are not you know they want to avoid taking finasteride by mouth they want to know how topical stacks up this meta analysis suggests that one percent finasteride applied to the scalp is as effective as one milligram per day

Of oral finasteride again with the limitations in the study and the fact that we’re only looking out to um 48 weeks so it doesn’t really give you a picture long term how they stack up but if you’re somebody who is looking to maybe avoid the risks of impact on libido gynecomastia mood changes especially if you have a history of mood problems you’re under the age

Of 45 you may really want to talk to your doctor about the option for topical finasteride over the oral pill what about in women you know this study was all looking at data in males what about in women we don’t really have the comparative studies in women can we assume that the same will hold true for women we can female pattern hair loss while the effects of five

Alpha reductase and testosterone dihydrotestosterone likely do play a role it may not be the only driving factor when it comes to female pattern hair loss but these treatments they are effective options for women and how they stack up to one another and women unfortunately we don’t have that information women who have high levels of androgens and they have a lot

Of skin and hair complications like acne hirsutism hair loss oral finasteride is certainly an option honestly i haven’t seen much in the way of topical finasteride for women that’s definitely an interesting avenue to consider in the future it’d be great if we had this kind of information on female pattern hair loss that also included the medication spironolactone

Which helps to treat female pattern hair loss as well but we don’t we just have this newer meta analysis which i think does shed a lot of light on how these medications stack up at the end of the day it’s really about balancing some of the risks to benefit profile and that’s going to vary from person to person like i said if you have a history of mood disorders or

You’re concerned about developing gynecomastia if you’re a male or you’re worried about libido effects if you’re a male you may want to shy away you know you may be interested in shying away from oral finasteride and this study would suggest that at least the one milligram per day dosage of oral finasteride you can get similar results with the topicals for those

Of you who are motivated to use the over-the-counter minoxidil this meta-analysis further illustrates that five percent gets you results faster better hair counts than the lower percentages now that is in men in contrast with women we do know that two percent minoxidil women tend to respond better to that than men do men need the higher the higher minoxidil

Now when it comes to topical minoxidil it actually requires an enzyme to convert it to its active form the enzyme it resides in the hair follicle some people don’t have adequate levels of that so they are very poor responders to minoxidil these folks often add on like low-level laser therapy to get better results or they you know they end up bailing on minoxidil

It’s just not a good option for them so that’s another thing to to factor in like are you a minoxidil non-responder or do you get good results with minoxidil and you don’t mind using it all right you guys i hope this video was helpful and kind of sharing with you guys the latest research kind of rank ordering these different medications again this is not by any

Means a comprehensive list of treatments for androgenetic alopecia definitely check out my videos on minoxidil on spironolactone for female pattern hair loss and on low level laser therapy and other hormonal therapies for female pattern hair loss that were not included in this meta analysis and again to reiterate the analysis was done taking research papers and

Research studies that were using men as participants so whether or not these findings translate to women we can’t really say but i do have you know a male audience too so i know a lot of you guys watch me for hair related content so i hope this was informative to you let me know in the comments if you have tried any of these medications with your doctor and i

Know they’re really popular nowadays there are a lot of direct to consumer services that provide these medications after seeing you know having a health visit let me know if that is something you have utilized on the end slate i’m going to put my video on hair loss treatments that actually work so check that out if you are dealing with pattern hair loss but if you

Like this video give it a thumbs up share it with your friends and as always don’t forget sunscreen and subscribe i’ll talk to you guys tomorrow bye you

Transcribed from video