Finasteride

  • Finasteride is FDA approved as an oral medication to treat androgenetic alopecia (Propecia).
  • It functions to block the conversion of Testosterone to Dihydrotestosterone (DHT) at the hair follicle, which is thought to be the major contributor to androgenetic alopecia.
  • Finasteride has not been FDA approved for topical use, but is commonly used off-label in topical preparations for hair loss.
  • Even when used topically, there are rare and uncommon side effects that you should be aware of including sexual side effects (such as decreased libido or erectile dysfunction) and psychological side effects (such as depression, anxiety, or brain fog). These side effects have been demonstrated to resolve when the medication is discontinued but in very rare cases may be long lasting. If you have a history of severe depression or currently have untreated depression, we advise consulting with a mental health professional prior to starting therapy.
  • PREGNANCY: Women who are actively planning to get pregnant, are pregnant or breastfeeding should avoid contact with Finasteride. For males, if you are planning pregnancy there is some evidence that finasteride may reduce the quality/quantity of sperm but no definitive evidence of reduced fertility has been found. Finasteride may be excreted in very small amounts in semen but there have been no reports of birth defects from this type of exposure. If you have concerns, please reach out to discuss adjusting your therapy.
  • PSA TEST: Patients above 40: If you are planning to get a PSA test, please discuss with your healthcare provider that you are using Finasteride, as Finasteride has been shown to affect PSA lab results. If you have a history of prostate cancer, please discuss with your urologist prior to starting Finasteride as there is some evidence that finasteride may impact the long term risk for prostate cancer.
  • https://www.pdr.net/drug-summary/Propecia-finasteride-378.609

Dutasteride:

  • Dutasteride is FDA approved as an oral medication for the treatment of benign prostatic hyperplasia and is commonly used off-label in oral and topical forms to treat androgenetic alopecia.
  • It functions to block the conversion of Testosterone to Dihydrotestosterone (DHT) at the hair follicle, which is the major contributor to androgenetic alopecia.
  • Dutasteride has the same mechanism of action as Finasteride but has a stronger ability to block the conversion of DHT and it also has a longer half life (stays in your body longer). Dutasteride can be administered orally and topically.
  • Even when used topically, there are rare and uncommon side effects that you should be aware of including sexual side effects (such as decreased libido or erectile dysfunction) and psychological side effects (such as depression, anxiety, or brain fog). These side effects have been demonstrated to resolve when the medication is discontinued but in very rare cases may be long lasting. If you have a history of severe depression or currently have untreated depression, we advise consulting with a mental health professional prior to starting therapy.
  • PREGNANCY: Women who are actively planning to get pregnant, are pregnant or breastfeeding should avoid contact with Dutasteride. For males, if you are planning pregnancy there is some evidence that finasteride may reduce the quality/quantity of sperm but no definitive evidence of reduced fertility has been found. Dutaseride may be excreted in very small amounts in semen but there have been no reports of birth defects from this type of exposure. If you have concerns, please reach out to discuss adjusting your therapy.
  • PSA TEST: Patients above 40: If you are planning to get a PSA test, please discuss with your healthcare provider that you are using Dutasteride as it has been shown to affect PSA lab results. If you have a history of prostate cancer, please discuss with your urologist prior to starting Dutasteride as there is some evidence that finasteride may impact the long term risk for prostate cancer.
  • https://www.pdr.net/drug-information/avodart?druglabelid=176

Minoxidil

  • is FDA approved as a topical treatment for hair loss (also called Rogaine). Minoxidil is also FDA approved as an oral medication to lower blood pressure, but is commonly prescribed off-label to treat hair loss. When taken orally or applied topically, it functions to directly stimulate hair growth at the follicle by promoting vasodilation, increasing scalp. Potential for short-term increase in hair shedding while hair transitions from resting phase to growth phase
  • Side effects may include low blood pressure, dizziness, rapid irregular heartbeat, swelling of hands/feet, rapid weight gain/fluid retention, headache, nausea, flushing and hair growth on areas other than the scalp. If side effects do occur please report them to your doctor and stop taking the medication until advised further.
  • Please inform me if you have any major cardiac conditions such as heart failure, arrhythmias, recent stroke, ongoing chest pain, a history of pericarditis, or any liver or kidney disease, as you may not be a good candidate for Minoxidil.
  • https://www.pdr.net/drug-summary/Minoxidil-minoxidil-774

Spironolactone

  • Spironolactone is an FDA approved oral medication for treating fluid retention/high blood pressure, which is used off-label to treat hair loss because it can reduce the impact of hormones on the hair follicles.
  • When taken orally or applied topically, Spironolactone acts to block Dihydrotestosterone (DHT), a common factor in hair loss. This medication is most often used in women because it can decrease systemic levels of testosterone which is typically an unwanted side effect for men.
  • May cause lowered blood pressure, dizziness, lightheadedness/fainting, increased urination, increase in potassium levels in the blood, headaches. Some may experience changes in hair texture/color.
  • In women: irregular periods or lack of menstrual periods, breast enlargement, breast tenderness.
  • In men: when taken orally may cause decreased systemic levels of testosterone which can lead to feminizing effects such as gynecomastia and lowered libido/sexual dysfunction. When used topically the systemic exposure is expected to be minimal but no controlled studies have been done on topical spironolactone to determine its specific side effect risk profile in men. If spironolactone has been recommended as a treatment option for you but you are not comfortable with these potential side effects, please reach out to your physician to discuss alternatives.
  • It is very important that you inform your physician if you have a history of kidney disease/dysfunction, adrenal gland disorder or heart disease because this medication may not be safe for you.
  • Topical preparations may have a distinct smell
  • https://www.pdr.net/drug-information/aldactone?druglabelid=978

Caffeine

  • There is growing evidence from clinical studies that topical caffeine may have a beneficial effect on hair growth.
  • This ingredient is not currently FDA approved for the treatment of hair loss.
  • May cause mild redness, irritation, peeling/flaking of the skin or localized swelling.
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804833/

 

Dutasteride

  • Blocks 5 alpha reductase type I and II enzyme
  • Inhibits conversion of testosterone to dihydrotestosterone Lowers dihydrotestosterone levels in serum and scalp Contraindicated in patients who are pregnant or plan on becoming pregnant
  • Gubelin Harcha W, Barboza Martínez J, Tsai TF, Katsuoka K, Kawashima M, Tsuboi R,Barnes A, Ferron-Brady G, Chetty D. A randomized, active- and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol. 2014Mar;70(3):489-498.e3. doi: 10.1016/j.jaad.2013.10.049. Epub 2014 Jan 9. PMID: 24411083.

 

Ketoconazole

  • Antifungal that can address dandruff and dermatitis
  • Attacks fungi and yeast growth on scalp
  • Reduces testosterone production in skin
  • Common side effects: itching, dryness of scalp and hair
  • Fields JR, Vonu PM, Monir RL, Schoch JJ. Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review. Dermatol Ther. 2020 Jan;33(1):e13202. doi: 10.1111/dth.13202. Epub 2020 Jan 2. PMID: 31858672.

 

Latanoprost

  • Mimics naturally derived prostaglandins
  • Stimulates hair follicle activity via unknown mechanism
  • May increase hair density
  • Jiang S, Hao Z, Qi W, Wang Z, Zhou M, Guo N. The efficacy of topical prostaglandin analogs for hair loss: A systematic review and meta-analysis. Front Med (Lausanne). 2023 Mar 14;10:1130623. doi: 10.3389/fmed.2023.1130623. PMID: 36999072; PMCID: PMC10043424.

 

Melatonin

  • Neurohormone and strong antioxidant
  • Though not as common with topical application, melatonin can cause drowsiness, and some people report mild headaches.
  • Modulates hair growth, pigmentation, and shedding
  • Fabbrocini G, Cantelli M, Masarà A, Annunziata MC, Marasca C, Cacciapuoti S. Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol. 2018 Jun 19;4(4):203-211. doi: 10.1016/j.ijwd.2018.05.001. PMID: 30627618;PMCID: PMC6322157.

 

Spironolactone

  • Slows androgen production, decreasing testosterone
  • May act as combined or solo therapy for androgenic alopecia
  • Avoid in patients who are pregnant or plan on becoming pregnant
  • Topical preparations may have a distinct smell
  • Burns LJ, De Souza B, Flynn E, et al. Spironolactone for the treatment of female pattern
  • hair loss. J Am Acad Dermatol 2020;83:276-8. Searle TN, Al-Niaimi F, Ali FR. Spironolactone in dermatology: uses in acne and beyond. Clin Exp Dermatol. 2020 Dec;45(8):986-993. doi: 10.1111/ced.14340. Epub 2020 Aug 26. PMID: 32844462.

Tretinoin

  • Promotes and regulates skin cell development
  • This creates a favorable environment for hair growth
  • Thought to work synergistically with minoxidil
  • May penetrate hair follicle better when in combination
  • Potential side effects: redness and peeling
  • Bazzano GS, Terezakis N, Galen W. Topical tretinoin for hair growth promotion. J Am Acad Dermatol. 1986 Oct;15(4 Pt 2):880-3, 890-3. doi: 10.1016/s0190-9622(86)80024-x. PMID:

Vitamin D 

  • By promoting the proper cycling of hair follicles, Vitamin D helps minimize excessive hair shedding.

 

Vitamin E

  • Neutralizes free radicals, which helps protect hair follicles from oxidative damage.
  • Potential side effects: Itchiness on scalp. Dryness of hair.