What is the best treatment for androgenetic alopecia?

The best treatment for androgenetic alopecia (AGA) involves a combination of pharmacological and non-pharmacological approaches, tailored to the patient's gender and specific needs. For male patients, the most effective treatments with the highest level of evidence are oral finasteride and topical minoxidil. Finasteride, a 5-alpha reductase inhibitor, is FDA-approved for male AGA and has been shown to be effective in improving hair density and slowing hair loss.[1][2][3] Minoxidil, available in 2% and 5% topical formulations, is also FDA-approved and effective for both men and women, promoting hair growth and increasing hair density.[2][3][4]

For female patients, topical minoxidil remains the primary treatment option with strong evidence supporting its efficacy and safety.[3] While finasteride is not typically used in women due to potential teratogenic effects, some studies suggest its use in postmenopausal women under careful supervision.[5]

Low-level laser therapy (LLLT) is another FDA-cleared option for both men and women, with evidence supporting its efficacy in promoting hair growth.[2][4][6] Platelet-rich plasma (PRP) therapy has also shown promise in some studies, although the evidence is less robust and more variable.[4]

Emerging treatments, such as dutasteride, have shown potential, particularly in men, but are not yet FDA-approved for AGA. Dutasteride may offer superior efficacy compared to finasteride, especially in the frontal scalp area, but concerns about side effects remain.[1][4]

Overall, the choice of treatment should be individualized, considering the patient's gender, the severity of hair loss, and potential side effects. Regular follow-up is essential to assess treatment efficacy and adjust the therapeutic approach as needed.

References
[1] Saceda-Corralo D, Domínguez-Santas M, Vañó-Galván S, Grimalt R. What's New in Therapy for Male Androgenetic Alopecia?. American Journal of Clinical Dermatology. 2023;24(1):15-24. doi:10.1007/s40257-022-00730-y.
[2] Adil A, Godwin M. The Effectiveness of Treatments for Androgenetic Alopecia: A Systematic Review and Meta-Analysis. Journal of the American Academy of Dermatology. 2017;77(1):136-141.e5. doi:10.1016/j.jaad.2017.02.054.
[3] Varothai S, Bergfeld WF. Androgenetic Alopecia: An Evidence-Based Treatment Update. American Journal of Clinical Dermatology. 2014;15(3):217-30. doi:10.1007/s40257-014-0077-5.
[4] Gupta AK, Mays RR, Dotzert MS, et al. Efficacy of Non-Surgical Treatments for Androgenetic Alopecia: A Systematic Review and Network Meta-Analysis. Journal of the European Academy of Dermatology and Venereology : JEADV. 2018;32(12):2112-2125. doi:10.1111/jdv.15081.
[5] Kelly Y, Blanco A, Tosti A. Androgenetic Alopecia: An Update of Treatment Options. Drugs. 2016;76(14):1349-64. doi:10.1007/s40265-016-0629-5.
[6] Lama SBC, Pérez-González LA, Kosoglu MA, Dennis R, Ortega-Quijano D. Physical Treatments and Therapies for Androgenetic Alopecia. Journal of Clinical Medicine. 2024;13(15):4534. doi:10.3390/jcm13154534.


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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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