Topical finasteride for male balding

Topical finasteride: how effective? how safe? how smart?

Anecdotal reports of possible persistent side effects of finasteride have caused many physicians and patients to change their views on the drugs and some to even abandon it.  The FDA  has modified its labelling of the drug to convey the uncertainties to the public. 


Topical Finasteride: Is it safe? effective?

Topical finasteride is not FDA approved for hair loss in men. Any use of topical finasteride in men is "off label". All discussions here are limited to men as use in women is not FDA  approved for the oral form. 

 Does topical finasteride get absorbed?

Topical finasteride gets absorbed into the blood. Any discussion that topical finasteride is too big of a molecular to get into the skin is wrong. Topical finasteride enters into the blood. And yes - it lowers DHT levels. 

But any discussion of topical finasteride must focus on the dose. 2  % finasteride topical solution is going to have different effects than an 10 % solution.  0.25 % finasteride is going to be different yet! If I were to make up 0.0000000001% finasteride topical solution, it would likely be quite safe with little if an absorption. However, it probably wouldn't do anything for patients with hair loss. So it comes down to dose. Plain and simple. One should not talk about topical finasteride unless they are prepared to talk about the dose

Studies of topical finasteride: Important Lessons

A recent study of 0.25 % topical finasteride showed that it reduced DHT levels to the same amount as standard 1 mg finasteride pills. We don't yet have any data to know if this translates into topical finasteride working just as good or being just as effective, worse or better. 

What about side effects?

We don't yet understand the side effects of topical finasteride. It's likely that 10 % topical finasteride is going to have more side effects than 1 % topical finasteride. But those studies need to be done and confirmed. If sexual performance and mood levels are related to DHT in the blood,  then it's pretty likely that lots of men using topical finasteride would be expected to have side effects too. These studies have not been done and so we don't know. 

For hair loss in men, it appears that getting a good benefit from finasteride ultimately comes down to inhibiting DHT. Inhibit it more and you'll get a better outcome for hair loss. You'll get more side effects too.


Topical finasteride doesn't just stay in the scalp. It gets into the blood and inhibits DHT. Side effects are possible with topical finasteride. We need to be very careful assuming topical means safer. The scalp is a very good way to get drugs into the body. 


1. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers.Caserini M, et al. Int J Clin Pharmacol Ther. 2014.

2. modified from article 


Using Cholesterol Medications to Treat Alopecia


Alopecia areata is considered an autoimmune condition. Medications that diminish the effects of the immune system are often used to treat alopecia areata. This includes treatments such as steroid injections, topical steroids, diphencyprone (DPCP), anthralin, or  immunosuppressive pills such as methotrexate, sulfasalazine and prednisone.  These all affect the immune system in some way or another.

New research suggests that cholesterol lowering medications may also be helpful. Interestingly, in addition to the ability of these medications to lower cholesterol levels, these drugs also reduce inflammation. The reduction of inflammation is a key step in treating alopecia areata.


What are statin medications?

The ‘statins’ are a well-known group of medications used to treat elevated cholesterol.  In fact,  it is estimated that about 3 millions Canadians and 30 millions Americans use statins to control their cholesterol.  Ezetimibe is a second type of cholesterol lowering medication and works by blocking the absorption of cholesterol.


In a new study, 19 patients with advanced alopecia areata were treated with two cholesterol medications – simvastatin and ezetimibe for 24 weeks.  Remarkably, after 24 weeks, 14 of 19 patients (nearly 75% of patients) were found to regrow hair so some extent. The majority of those who continued the drug after then 24 week period maintained their hair and the majority of stopped the drug after then 24 week period lost their hair again.




This is a tremendously exciting study, opening the doors to even larger studies of the use of these cholesterol lowering drugs in the treatment of alopecia areata. These drugs are well known in the population as cholesterol lowering drugs and so we have many years of experience with these drugs. Although side effects such as muscle pains, muscle damage, diarrhea, irritation of the liver, and a rise in blood sugars can occur with these medications – these are relatively infrequent. 



Study: Lattouf C and colleagues. Treatment of alopecia areata with simvastatin/ezetimibe. J Am Acad Dermatol 2015; 72: 359


Scalp Cooling helps Prevents Chemotherapy Hair Loss

Hair Loss from Chemotherapy

Hair loss from chemotherapy is one of the most distressing side effects. There has been a lot of  research looking into how to prevent hair loss from chemotherapy - or what is called "chemotherapy induced alopecia." A  Korean research team recently looked at every single study that has been published so far - in order to get a better sense of what works best.


So - what works best to prevent hair loss from chemotherapy?

Scalp cooling by far. 

In order to come to this conclusion, the authors looked at nearly 700 articles, of which a total of 8 randomized controlled trials and 9 controlled clinical trials involving about 1100 participants were reviewed. Scalp cooling came out as the most effective. Other treatments like scalp compression, a combination of cooling and compression, topical minoxidil, and Panicum miliaceum didn't seem to help much (or not at all).


What is scalp cooling?

Scalp cooling (also called scalp hypothermia) is a new treatment option that is being explored. Cooling the scalp reduces the amount of chemotherapy to the scalp. The technique is used in Canada (by some hospitals) and Europe but not in the USA. It is currently undergoing study in the US and may be approved in the USA in the near future.  The two scalp cooling agents to be on the lookout for are the Penguin Cold Cap and Dignicap. 



Shin et al. Efficacy of Interventions for Prevention of Chemotherapy-induced alopecia: A Systematic Review and Meta-Analysis. Int J Cancer. 2014 Aug 1. doi: 10.1002/ijc.29115. [Epub ahead of print]



Voriconazole: New study suggests hair shedding likely

Hair loss from Voriconazole

Voriconazole is used to treat serious fungal infections. A study Michigan which showed that the antifungal drug voriconazole caused hair loss in 82 % of 152 users and was rated as severe in 15 %. In most patients the hair grew back once the drug was stopped and even in some when another antifungal drug was substituted. 

This comes as a surprise given that hair loss occurred in only 2 % of users in the premarketing clinical trials. More study is needed to better define the risks but all users of voriconazole should be advised about the side effect of hair loss. 



Malani et al. Alopecia and nail changes associated with voriconazole therapy. Clin Infect Dis. 2014 Aug 1;59(3):e61-5. 

Can Topical Finasteride Reduce DHT Levels

Topical Finasteride for Hair Loss

Finasteride pills (Propecia etc) are FDA approved for the treatment of male balding. The drug reduces blood DHT and stops hair loss in 90 % of men. Side effects are the main limitation of finasteride.

In a new study about a topical formulation of finasteride for hair loss, DHT levels were reduced by similar amounts compared to finasteride pills. Will side effects be similar? Nobody knows. It's likely that side effects will be present. The only benefit of a topical formulation would be if side effects were lower. 



A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Caserini et al. Int J Clin Pharmacol Ther. 2014 Jul 30. 

PRP for Treating Hair Loss

PRP for Hair Loss: One More Study to Add to the List


PRP for Hair Loss

Platelet rich plasma or "PRP" for hair loss refers to the injection of a patient's platelets into the scalp in attempt to stimulate hair growth. In order to perform PRP, a small amount of a patients blood is taken (similar to getting a blood test done), and the blood is processed in a PRP machine in order to isolate the platelets.

A number of recent publications support the role of PRP in the treatment of genetic hair loss. In addition, some authors  showed that pretreatment of follicular units with PRP before transplantation resulted in improved hair growth and density.

In a new study, published in the journal Biomedical Research International, researchers from Italy performed a study in 10 men. One side of the scalp was treated with platelet rich plasma and the other side was treated with placebo (saline). Results were compared at 14 weeks, 6 months and 1 year. 


What are the results?

The results of the study showed a significant increase in hair count for the treatment area after just 3 months. There was an increase total hair density of 27.7 hairs per  square cm compared to baseline.  In addition, terminal hair density improved significantly by 27.0 ± 15.3 (number of hairs/cm2) in the treatment area, while decreasing by 2.1 ± 12.4   in the control area of the scalp.



We are no longer in the era where we "wonder" if PRP works to help those with hair loss. Rather we have moved into the era where we know if helps and now need to determine what is the best way to perform PRP.

What is the best machines to use to prepare PRP (what machine should physicians buy)?

What is the optimal amount of PRP to inject (is too much going to be bad)? 

What is the optimal frequency to repeat PRP injections for those with hair loss (1 month 4 months, 6 months)?


However, this Italian study adds to a growing list of studies showing that PRP is a bonafide treatment for hair loss.  





Cervelli et al. The Effect of Autologous Activated Platelet Rich Plasma (AA-PRP) Injection on Pattern Hair Loss: Clinical and Histomorphometric Evaluation. Biomed Res Int. 2014; 2014: 7  


Other References:

1. Takikawa M, Nakamura S, Nakamura S, et al. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth. Dermatologic Surgery. 2011;37(12):1721–1729. [PubMed]

2. Li ZJ, Choi H-I, Choi D-K, et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatologic Surgery. 2012;38(7, part 11):1040–1046. [PubMed]

3. Uebel CO, da Silva JB, Cantarelli D, Martins P. The role of platelet plasma growth factors in male pattern baldness surgery. Plastic and Reconstructive Surgery. 2006;118(6):1458–1466. [PubMed]

4. Trink A, Sorbellini E, Bezzola P, et al. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. British Journal of Dermatology. 2013;169(3):690–694. [PubMed]

Breast cancer and the use of hair loss drugs: New research finds no association

Finasteride (Propecia) and dutasteride (Avodart) are prescribed for the treatment of male pattern baldness. 

Finasteride and dustasteride belong to a group of drugs called "5 alpha reductase inhibitors." They block the enzyme 5 alpha reductase and decrease the levels of the potent androgen hormone DHT (dihidrotestosterone). In addition to reducing DHT, the drugs increase the levels of estrogen slightly which has raised questions from physician and researchers around the world as to whether these drugs increase the risk of breast cancer in men.

US researchers set out to examine the relationship between the use of 5 alpha reductase inhibitors and male breast cancer. They studied men using the higher 5 mg dose of finasteride used in prostate enlargement (rather than the 1 mg dose used in hair loss) and the 0.5 mg dose of dutasteride.  They looked at the use of these drugs in 339 men with breast cancer and 6,780 men without breast cancer.

What were the findings and conclusions from the study?

The authors did not find an association between using 5 alpha reductase inhibitors and the development of breast cancer in men. Overall, the authors concluded that the "development of breast cancer should not influence the prescribing of 5 alpha reductase inhibitor therapy."



Bird ST et al. Male breast cancer and 5 alpha reductase inhibitors finasteride and dustasteride. J Urology; 190:1811-4


Low-level light therapy (LLLT) for hair loss

Low-level light therapy (LLLT) has been used in the treatment of genetic hair loss for a few years now.  Some previous research studies with LLLT devices showed that these devices can increase hair density or hair caliber in a small target area following treatment,  but other studies did not. In some studies, this translated into patients or clinicians detecting an improvement in hair density with use of LLLT, whereas in other studies these improvements were not seen.

A research study from South Korea evaluated the efficacy and safety of a LLLT device that is worn on the scalp as a helmet. (Oaze, Won Technology, Daejon, Korea) The researchers conducted a 24-week randomized, double-blind study with use of a sham device.  The primary endpoint of the study was the change in hair density in a 70- mm2 target area from baseline to 24 weeks. Secondary endpoints included changes in the hair shaft size and the satisfaction of the subjects.

A total of 29 subjects finished the study, including 15 in the LLLT group and 14 using the placebo device.  The device was safe  and there was no documentation of severe adverse reactions.  Subjects using the LLLT device had a greater increase in hair density (approximately 19 hairs/cm2) and thickness  (approximately 9 μm) compared to those using the sham device.  Investigators detected a statistically significant increase in hair density in those using the LLLT device compared to those using the sham device. However, there was no difference in subjects’ perception of improvement or satisfaction ratings between LLLT and sham users.

Comment: LLLT users didn’t feel that his or her hair looked better with use of the device. Further well designed studies are need as we continue to explore how well LLLT therapy works for patients with hair loss



Kim H et al. Low-Level Light Therapy for Androgenetic Alopecia: A 24-Week, Randomized, Double-Blind, Sham Device-Controlled Multicenter Trial. Dermatol Surg 2013; 1177-83.


Recently, we've been hearing a lot about a group of hair growth drugs that affect "prostaglandins".  Several recent blogs of mine have discussed the role of prostaglandin F2a analogues in stimulating eyelash growth.  A few months ago a major buzz was created in the hair world when Dr. Cotsarelis at the University of Pennsylvania showed that blocking the prostaglandin D2 pathway might be relevant to the treatment of androgenetic alopecia.

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Minoxidil is a topical medication that is FDA approved for treating genetic hair loss (sometimes referred to as androgenetic alopecia). If you pick up a bottle of minoxidil it will state that it is to be used for hair loss in the crown in men and may not benefit other areas of hair loss. The original studies of minoxidil focused on the crown and did not address the benefit in the front of the scalp.

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About 50 percent of men will be affected by male pattern balding throughout their lifetime. The medical term for male balding is "androgenetic alopecia."

Which men will developing balding and which will not? Well there are still some things we need to learn about balding. But in general, male balding is influenced by genetics, hormones and occurs with advancing age. Prostate cancer is one of the most common cancer in men. It  too is influenced by genetics, hormones and occurs with advancing age.

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