What are the alternatives to finasteride treatment for male pattern balding?
The main reason for male pattern hair loss, also known as Androgenetic Alopecia (AGA), is the excess of dihydrotestosterone in the blood stream. The excess DHT literally suffocates vulnerable hair follicles which are usually located at the top of the scalp. While finasteride, a DHT-lowering medication is the gold standard and treatment of choice for many male patients suffering from AGA, there are potential side effects associated (including sexual side effects). This may render finasteride unsuitable in such patients. On the other hand, some clients do not see as much results with finasteride, even if there is no side effects associated with it. Published data suggests that up to 1% of patients may see continued worsening of hair loss despite finasteride.
One of the most commonly discussed topics in my clinic, is whether there are alternative treatments for such scenarios where finasteride is not suitable or effective.
Topical Minoxidil
Minoxidil is a great remedy for those with mild to moderate hair loss. Minoxidil works by improving blood flow to the hair follicles and enhancing the micro-circulatory environment so hair follicles get a better supply of nutrients. It was approved by the US FDA in 1997 for hair loss.
It is cost effective, easy to use, with very low risks or issues. Minoxidil is mainly available as a topical hairspray or as a liquid applied with a dropper or as a foam (for sensitive scalp). The product is sprayed on the affected areas twice a day. Most of the time, the main issue is lack of discipline from the patient. They find that it gets tiring to spray the product twice a day indefinitely. Some patients do not see results and studies have shown it may be because they lack the activating enzyme sulfotransferase. That is where an oral minoxidil may be more suitable.
Oral minoxidil
Oral minoxidil has been in the market for decades. It is not a new medication but it was originally used for high blood pressure. It was later discovered to stimulate hair growth and it is used off-label for hair growth, at a much lower dose.
The advantage of oral minoxidil is the convenience over the spray version. Patients take it once a day. It is very affordable, with low risks of side effects and certainly does not cause sexual side effects like finasteride does. It is also more effective than the topical version and we see between 10 to 30% improvement with continued use. With oral minoxidil, one can expect to see hair growth from about the 4th month of use. Like most other hair products, the best response comes from treating the crown and the midscalp, but it is not so effective for a receded hair line.
Some patients report feeling giddy, an increased heart rate or ankle or face swelling (due to water retention). Unwanted hair growth on the face or body might also be one of the side effects. In such cases, we either lower the dose or stop the medication completely.
Scalp treatments
At Freia, we have a few scalp treatments that are designed to help clients with mild to moderate hair loss. As long as the follicles are still present, there is a good chance these follicles can be stimulated back to a healthier state. However, once the follicles are no longer there and the “pore is closed”, then it is unlikely to respond to such treatments.
Cellular Regen
Cellular regen is a dedicated scalp treatment that aims to cleanse the scalp of its impurities, dirt, dead skin cells, and excessive oil. It can also help sensitive scalp conditions like redness, sensitivity and flaking.
Cellular regen involves a cleansing step using our jet peel system which gently pushes away dirt with a jet of water. This is followed by using a microneedling system that opens tiny channels on the scalp skin for better absorption of the stem cell growth factors that is applied continuously on the scalp. The final step is a very relaxing scalp massage followed by LED red light therapy to promote blood circulation and recovery.
Patients who tried cellular regen feedback that they see less hair fall, hair growth and tend to repeat the treatment after the initial 6 weekly sessions.
Exosomes Hair Therapy
Exosomes are an emerging field in medicine. Exosomes are nanoparticles that are found outside of cells. They function as messengers that communicate between cells. And our exosomes are chosen for their ability to
- Reset strength of dermal papilla
- Remodel hair follicle microenvironment
- Nourish and moisturise the scalp
- Regulate hair growth cycles
- Regrow healthier, thicker and stronger hair
Oral supplements for hair growth
Healthy hair follicles start with proper nutrition. There are essential vitamins and minerals needed for the best hair growth.
There are many many hair supplements in the market and while they all claim to have benefits for hair, not every product has the science to back up their claims, or the data available is very weak. We are familiar with 2 types of hair supplements and anecdotal evidence shows that there is improvement in the hair with prolonged and consistent use of these supplements.
Nourkrin - proteoglycans that can help to promote hair growth in mild hair loss or as a maintenance treatment
- Induces and prolongs anagen (growth) phase
- Prevention of progression of catagen (hair loss ) activity
- Reduces inflammation on hair follicles
- Minimises negative effects of stress cortisols on hair growth cycles
Viviscal - AminoMar marine biocomplex that has been shown in some studies to promote hair growth, along with vitamins and nutrients to support a healthy hair scalp environment
- Contains AminoMar marine complex, which is shown in studies to support hair grown
- Biotin, an essential vitamin for healthy hair growth
There are other supplements in the market such as Miriqa, Pantogar, etc but we have no clinical experience with these.
Topical CG210
- Botanical extract hair spray, used twice a day
- Good for those with mild hair to moderate hair loss and not keen to use medicated products
- Continains Cellium from allium cepa (onion) bulb extract, citrus medica limon extract, paullinia cupana seed extract, theobroma cacao seed extract
- Reduces hair shedding, reduces perifollicular inflammation
- Increases hair thickness
- Improves healthy hair
- Promotes new healthy hair
All these treatments are meant to support healthy hair growth, especially if oral finasteride is not suitable. And the treatments can be used on their own or in combination with one another. Speak to your hair physician to understand your options and see which treatment suits your hair condition the best. Consistency is key and treatments need time to work. The best way is to monitor your hair growth objectively with proper before and after hair photographs and hair scope analysis.
Medically reviewed by Dr. Harold Ma, Medical Director at Freia Medical
Think Hair, Think Dr Harold
