Medical Treatment Options for Male Baldness

Medical Treatment Options for Male Baldness

Medically Reviewed On: March 15, 2001

Webcast Transcript:

Here to discuss the latest in hair loss treatment are two experts.  First is Dr. Neil Sadick.  He's a dermatologist and cosmetic surgeon at the Weill Cornell Medical College.  Welcome.

NEIL SADICK, MD:  Hi, David.  Thank you.

DAVID R. MARKS, MD:  Next to him is Dr. Michael Reed, also a dermatologist and a hair transplant surgeon at NYU.  Thanks for being here.

MICHAEL REED, MD:  Thank you very much.

DAVID R. MARKS, MD:  Why don't you start us off by telling us what the medical treatment options are for men who are losing their hair?

MICHAEL REED, MD:  The medical treatment options have never been better, and I think we have the first generation of young men who don't have to go bald without a real fight along the way, and we can slow it down.  We can arrest it and even reverse it in some of these young men.  There's topical and there's oral medication that are both even FDA approved to help baldness.  Topically there is topical minoxidil, which is available over the counter in a 2 and 5% concentration under the name Rogaine.

DAVID R. MARKS, MD:  Let's talk about how that one works before we move on.

MICHAEL REED, MD:  It's still up in the air as to the exact mechanism.  It used to be thought that it worked by increasing blood flow to the hair root, giving it a hypernutrition or hyperoxygenation to keep it in the growing phase longer.  Now we believe maybe it's a direct effect on the hair root itself, keeping the cells dividing and preventing them from resting.  But regardless of which it is, it does keep the hair in the growing phase.  It keeps them from resting so it doesn't fall out, so the root gets larger, deeper and it makes a finer product, which is the hair shaft, ergo, more hair on the head.

DAVID R. MARKS, MD:  The other medical treatment may work even better.  What is it?

NEIL SADICK, MD:  The other medicine, David, is called Propecia, and it's the first drug that really interferes with the enzyme 5 alpha reductase that is felt to play a major role in genetic male pattern hair loss, and we know that this drug can slow down hair loss.  Two-year studies have now shown that men who take the drug maintain their hair over a prolonged period of time.

DAVID R. MARKS, MD:  Does it work indefinitely?

NEIL SADICK, MD:  It's only been around now for three-plus years in terms of the clinical investigation, but at least the long-term studies by the company that produces the drug have shown that men do maintain the hair growth that they're able to achieve utilizing this new medication.

DAVID R. MARKS, MD:  Does it work in all patterns of hair loss, front and back?

NEIL SADICK, MD:  The studies to date have shown that Propecia works best in men that have posterior hair loss.  There is some effect anteriorly, as well, but not as effective in men with posterior thinning.

DAVID R. MARKS, MD:  How does one decide which treatment to use?

MICHAEL REED, MD:  First of all, if one's going to do these things, probably a dermatologist is the one to see to decide which is best for the given patient.  If the patient is of a temperament that they like to do conservative things, then they'll probably want to start topically, since generally speaking topical medications are believed to be safer than oral medications.  So that's probably where the conservative patient who's a bit anxious would start.  The patient who wants to get better fast who doesn't get side effects and also likes convenience will probably go for the oral medication.

There's some evidence that the combination has an additive effect, and so some people who want to get the most effect might actually use both at the same time.  That's not necessarily bad, either, although it's easier to add than subtract medications.

DAVID R. MARKS, MD:  How long does it take to see an effect?

NEIL SADICK, MD:  It can take up to six months before you see an effect with any of these biologic modifiers.  I think that most physicians feel that Propecia is the drug of choice in men with genetic hair loss, and it should be started during the early phases of hair loss.

DAVID R. MARKS, MD:  Are there any side effects to these medications?

NEIL SADICK, MD:  Topical minoxidil can cause some irritation of the scalp in a small percentage of individuals.  In Propecia, the major side effect that has been reported is a slight decrease in sexual libido.  However, in the very low dose of this drug, compared to the prostate dosage, which is also utilized, there really has been a minimal number of side effects that have been associated concerning decreased sexual drive.

DAVID R. MARKS, MD:  That's your experience also?

MICHAEL REED, MD:  My experience is that the side effects are minimal compared to the perceived and objective benefits of these medications, and I don't think anyone, unless they're uninformed or misinformed, who doesn't want to lose their hair would skip the medicines because of a realistic fear of side effects.

DAVID R. MARKS, MD:  Is there anyone who really shouldn't take these medications?  Maybe it's not indicated for them because of a medical condition?

NEIL SADICK, MD:  There really is no contraindication to these medications.  The only issue in men who are taking Propecia is that it can lower the test that's utilized to screen for prostate cancer, so particularly in men taking this drug, if they're going to have a urologic examination, they should let the urologist know that they're on this particular drug.

MICHAEL REED, MD:  We tell people that if they get a so-called PSA level, which is prostate-specific antigen, as a screen for prostate cancer, they should double it to get the real value.  That test, by the way, is not a substitute for a proper examination for prostate problems.

DAVID R. MARKS, MD:  What are the other options for people who are losing their hair?

MICHAEL REED, MD:  Surgery.

NEIL SADICK, MD:  We've really come a long way in terms of improving results with hair transplantation.  Utilization of single hair and micro, minigraft hair transplantation now allows us to transplant an entire scalp with an extremely natural cosmetic type of result.

DAVID R. MARKS, MD:  But if someone doesn't want surgery and doesn't want to take pills, there are some options for them, too?

MICHAEL REED, MD:  There's always cosmetic options of hair styling, hair body builders, hair replacement systems, hair cosmetics.  There are medications that are made of keratin fibers that can be sprinkled on the scalp that add bulk to the hair.  Those are basically the cosmetic systems.

The two medicines that we mentioned, though, are the only real medicine where there's real evidence, hard scientific evidence from proper studies in peer-reviewed journals that is legitimate.  Everything else that you hear on the radio is pretty much either unproved or some kind of phony scientific research is behind it.  Every time I look into it, I'm more and more amazed that these people are not arrested for what they advertise to be true.

And remember this rule:  Any medicine that works has to have side effects in some people sometimes.  If you see any medicine that says it works with no side effects, either it doesn't work or they didn't figure out what the side effects are yet.

DAVID R. MARKS, MD:  So if it sounds too good to be true, it probably is?

MICHAEL REED, MD:  Correct.

DAVID R. MARKS, MD:  Okay.  We'll leave it at that.  Thank you both for being here.  Thank you for joining our webcast.  I'm Dr. David Marks.  Goodbye.