December 2, 2018
By Alpha Medical
Questionable cures for baldness have been purported since the dawn of medicine. For example, the ancient Egyptian medical text Ebers Papyrus dating back to 1550 B.C. offers a number of cures for hair loss including “a mixture of fats from a hippopotamus, crocodile, tomcat, snake and ibex; porcupine hair boiled in water and applied to the scalp for four days; and the leg of a female greyhound sautéed in oil with the hoof of a donkey.” Concern for the appearance of healthy hair growth was shared by every member of the ancient Egyptian public—even male and female royals were known to don wigs and fake beards.
Almost 3,000 years later, hair loss continues to plague us. In fact, male pattern baldness (more formally known as androgenetic alopecia) accounts for more than 95% of hair loss in men. According to the American Hair Loss Association, two-thirds of American men will experience some degree of appreciable hair loss by the age of thirty-five.
Fortunately for modern men everywhere, the medical world has made incredible advancements in drug and surgical treatment for hair loss. Living with the impacts of hair loss is no longer an inevitability.
However, given the sensitive nature of any health concern—hair loss included—and the lack of easily understandable resources surrounding research and treatment, an abundance of misleading information and fake treatment options continue to abound. While these products don’t contain fats from hippos and crocodiles, they’re every bit as good as ancient Egyptian snake oil
Perhaps you’ve seen them—hour-long infomercials touting miracle treatments and obscure web pages demanding your credit card information—just to name a couple. We’re here to tell you the majority of hair loss treatments being marketed today do not work as claimed and can even pose potential dangers to your health.
There are currently only two FDA approved drugs clinically proven to treat hair loss: finasteride and minoxidil.
For the treatment of hair loss, finasteride is the key ingredient in brand name drug Propecia. It is the only FDA-approved oral treatment for hair loss in men, and can only be obtained with a prescription from a certified medical professional.
Minoxidil is first medication approved by the FDA for the treatment of male pattern baldness and can be obtained over the counter without a prescription.
Finasteride and minoxidil approach hair loss differently—while the former helps stop hair loss and may promote hair growth by inhibiting DHT, the latter can help promote the growth of new and thicker hair at a faster rate.
To understand how finasteride works, it will help to first understand how male pattern baldness occurs.
Male pattern baldness is a resulting condition caused by the effects of the male hormone dihydrotestosterone (DHT) on genetically susceptible hair follicles. DHT causes the hair follicles to shrink over time, resulting in shorter and finer hair. The follicles eventually stop growing new hair.
Finasteride tackles DHT at its source by blocking type II 5-alpha reductase, the enzyme responsible for converting testosterone to the more potent androgen DHT. By inhibiting the enzyme, finasteride can cause a significant drop in levels of DHT.
Perhaps more fascinating than the effects of Finasteride is its origin.
In the early 1970s, researcher Julianne Imperato-McGinley traveled to a remote village in the Dominican Republic to find a group of "male pseudohermaphrodites," men born with genitalia so small that they were mistakenly raised as girls. As they went through puberty, their bodies eventually revealed they were biologically male. Their community called them “guevedoces,” translated to mean "penis at 12 [years of age]”.
In 1974, Imperato-McGinley went on to publish her landmark paper in which she explained the guevedoces lacked the enzyme 5-alpha reductase, which converts testosterone into DHT. Soon after the guevedoces’ story and the effects of 5-alpha reductase deficiency became clear, pharmaceutical company Merck seized on a key finding—in older men, DHT contributes to prostate growth and is toxic to hair follicles. Merck went on to develop finasteride to inhibit 5-alpha reductase and subsequently reduce levels of DHT.
In 1992, Merck Merck unveiled their first finasteride product, Proscar, to treat enlarged prostates. Six years later, Merck gave the public Propecia for hair loss.
Finasteride has been shown to reduce the risk of low-grade prostate cancer in men 55 and older. A phase III Prostate Cancer Prevention trial found a 25 percent reduction in the risk of developing prostate cancer with 5-αlpha reductase inhibitor chemoprevention. Long-term follow-up results continued to suggest that regular use of finasteride for up to 7 years decreased the risk of low-grade prostate cancer in men age 55 and older. While high-grade cancers were found to be more common in the finasteride test group, there was no negative impact on their survival rates compared to the placebo group.
Benign Prostatic Hypertrophy
Finasteride (brand name “Proscar”) can be used separately or in combination with doxazosin (brand name “Cardura”) to treat benign prostatic hypertrophy (BPH), informally known as an enlarged prostate. Finasteride may improve BPH associated symptoms such as frequent urination, difficulty urinating, and sudden inability to urinate. It may also lower the risk of or need for prostate surgery.
The use of finasteride for female pattern hair loss is controversial. However, it has been found to be effective in treating hirsutism, excessive male-pattern hair growth on a woman's face, chest, and back.
Transgender Hormone Therapy
The antiandrogenic effects of finasteride have been found to sometimes be helpful in hormone replacement therapy for transgender women. The Center of Excellence for Transgender Health at UCSF states “5-alpha reductase inhibitors may be a good choice for those unable to tolerate, or with contraindications to the use of spironolactone. 5-alpha reductase inhibitors may also be an option for use as a single agent in patients seeking partial feminization, or for those who continue to exhibit virilized features or hair loss after complete androgen blockade or orchiectomy.”