It is very important to understand that male pattern baldness is a progressive condition, and hence patients need a combination of drugs in addition to Hair Transplantation. Otherwise, fresh areas will become bald in future. Presently, there are different options like:
a) Minoxidil lotions 2%, 3, 5, 7, 10, 12.5% – it has to be applied twice daily over the affected area.
b) Finasteride 1mg tablets (Propecia) – one tablet daily for 3-4 years; this is more effective over the vertex.
c) Combination of minoxidil with other drugs such as Retinoic Acid, Azelaic Acid
d) Peptides, which are new drugs
Minoxidil, a locally applied lotion (either as 2% or 5%) may provide moderate hair growth in 50-60% of cases. The drug is beneficial in preserving existing hair and thickening the miniature hairs. It, however, is not very effective in producing new hair on a completely bald area. The benefit lasts only as long as the topical drug is applied (i.e. hair falls out upon discontinuation) and the drug has to be applied twice daily. Scalp itching and irritation are possible side effects of this drug treatment. Minoxidil can be used in conjunction with hair transplantation by those who wish to continue this treatment once they begin their hair transplant surgery.
Finasteride is the first approved prescription pill to grow hair. It may produce visible hair growth in half of the cases of those who try the drug, although the cosmetic benefit of this hair growth is quite variable and is not predictable. It works best for the earliest stages of hair loss, and growth occurs better over the crown of the scalp than at the frontal receding hairline and temples. It must be used daily for 3-6 months before you can properly assess whether it works, and it has not yet been approved for use by women. As with minoxidil, the hair grown by this treatment will also fall out once the drug is stopped.
These drugs are of great value in preventing future baldness and therefore, in all young people with early hair loss, they are needed to be taken. Most young patients with early and moderate baldness need drugs, even after they do transplantation. Otherwise, they will lose their existing hairs and need further sessions of transplantation.
How long to take these drugs?
There is no fixed period and course, as there is no curative effect of these drugs. The drugs need to be taken as long as one wants to maintain hair. For most people, this usually means till they marry, establish their careers, and settle down.
Do these drugs have side effects?
This is the most frequently asked question; there is a lot of misinformation and exaggeration about the side effects. The patients need to understand that:
a) Any drug that has an effect will always have a side effect; there is no drug, which has no side effects.
b) So the real question should be: are these side effects serious, are they permanent and are they treatable?
Minoxidil cause minor itching; otherwise it is safe. Finasteride is currently the best drug for treating baldness. There is an exaggerated fear about its side effects viz. impotence and infertility. This has been researched in detail in several studies- and has been found that at the dosage at which it is given for baldness, which is 1 mg daily or 5 mg weekly, it has been found to be relatively safe. The side effects which have happened in 2% of patients include sexual side effects such as sexual dysfunction, impotence. Even these have been found to be temporary and reversible in most patients. So the patient can stop them at any time he/she wants to, around marriage time or pregnancy time. The United States Food and Drug Administration(US FDA) has concluded that there is NO CAUSAL relationship between the drug and the side effects.
Instructions for Minoxidil application
1 mL of minoxidil lotion is around 10-12 drops of the lotion. Put these drops over the top and front of the scalp, but not for the back of the scalp. Apply only to the scalp; do not apply to the length of the hair. After each drop, the lotion has to be spread gently onto the surrounding area so that the solution does not run out. 1 mL of the lotion has to be applied both in the morning & at night. Apply minoxidil lotion after head bath in the morning, after drying your hair. Minoxidil lotion (MINTOP, HAIR 4 U, COVERIT, TUGAIN, MX-5) & oil should not be applied together. There should be a gap of atleast 2 hours between the Minoxidil application and oil application.
What is our experience and position?
In our experience, we have found the drug to be safe. As a matter of caution, we use the drug at half the recommended dose i.e. 1 tablet every alternate day and have found it to be effective and safe. We recommend that the drug be taken without any hesitation. At the same time, we recognize the rights of a patient. In case the patient is not willing to take the drug, we emphasize that the patient should understand:
a) There are only two proven drugs for treating pattern hair loss.
b) The intake of drugs is not compulsory, but entirely voluntary. These are not life saving drugs; therefore, a doctor does not force any patient to take them.
c) If out of any fear, improper evidence, patient decides not to take them, it is entirely his decision – however, there are no other proven drug alternatives and therefore he should accept future hair loss, and further sessions of transplantations.
The patient is referred to the guidelines for use of finasteride drafted by Dr Venkataram Mysore at
Mysore V, Shashikumar B M. Guidelines on the use of finasteride in androgenetic alopecia. Indian J Dermatol Venereol Leprol 2016;82:128-34
Other non-drug options include Platelet Rich Plasma, micro needling and low-level laser. These are second line options and are used when drugs don’t work well.
About The Doctor
Dr. Aniketh Venkataram was trained in Hair Transplantation by Dr. Venkataram himself. He is an expert in FUE and has contributed chapters to Dr. Venkataram’s books as well as presented numerous talks on the subject.