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Drug Treatments

In this part medicines clinically tested and effective  in the treatment of hair loss  will be presented.   These medicines  must be used with a doctor's prescription.


Its effect   is based on  preventing  the  conversion of testosterone to  its more potent form – dihydrotestosterone. This transformation is  done by 5 alpha reductase enzyme. Finasteride blocks the activity of this enzyme. Preventing  these irreversible transformations reduces the  debilitating effects of androgens on  scalp and protects from   hair loss.  While in some neurological diseases   5 mg daily usage is prescribed  in   hair loss   1 mg is sufficient. Effectiveness of Finasteride  is proven in male type hair loss but  it  can be used also by  women patients.  Finasteride is contraindicated in pregnancy. Even  mostly used as  tablets in recent years it has  been developed in  topical form.  Finasteride has   synergistic effect with Minoxidil,  when used in combination   they increase   their  mutual effect. Male pattern hair loss or androgenetic alopecia (male pattern hair loss is genetic)  is due to the effects of  dihydrotestosterone  (DHT) on   hair follicles  located in  front  and top of the head. DHT  slows  down  hair growth and hair cycle and  causes   miniaturization of   hair follicles.

These hairs begin slowly  to shorten and thin, in the end they completely fall. DHT is formed  from  testosterone by the  the enzyme of  5-alpha reductase. Finasteride prevents  the formation of 5-alpha reductase enzyme.

Finasteride  reduces  the level of DHT in the scalp,   its effect is apparently felt. Finasteride, reduces  the level of DHT with %70. Serum increases testosterone with %9 and it is a normal rate. Finasteride is used to treat prostate at first, but it was fortunately   found as  effective in hair loss too. This truth was  searched on boys in Salinas-Dominican Republic  in 1974. These children have   small amount of 5-alpha reductase. Also their DHT levels were very low and they had  never been  with  prostate problems during their lifetime,     they also had  not experienced hair loss problems. Researchers were forced to find a  medicine that  prevents the formation of 5-alpha reductase enzyme. Later  they used  this medication to prevent  the progression of the prostate  and  to prevent hair loss. This  medicine  stops  progression of   prostate in men over the age of 50. It is Finasteride 5-mg with  label  -  name Proscar and is approved by FDA. Five years later Finasteride 1-mg was approved for hair loss treatment  by FDA . Studies conducted  that Finasteride stops  hair loss and protect the existing  hair among    90% of persons .  Increase in  amount of hairs  was  observed  in   48% of men treated with Finasteride in a period of 5 years.  In %42 of men hair loss increased and in %10 there was no difference according to their previous conditions.  By comparison %6 of patients received Placebo treatment had prolonged hairs,  no difference in %19 and hair loss was observed  in %75 .

Effect of Finasteride on   front side of   head

Finasteride is used in treatment of hair loss in front and top parts of   head. There are proves that Finasteride treats the hair loss in front side.


Finasteride  Uses

Finasteride must be taken one time per a day before or after meals.

 Finasteride  must be used during   one year and in the end of this period hair loss stops and new hairs start grow.     The effect  of  Finasteride  is visible after one year. During first six months you can observe that existing hairs thin.  The reason is that  untill Finasteride shows its  effect hairs continue to fall.  It is very important to be patient in this period.  To see the effect of this medicine you  have to use it in a  period of  at least one year.

Side Effects  of Finasteride  

There is no side effect  of  Finasteride- 1 mg.  After  regular usage   during 1 year in %3,8 of parients decrease in sexual desire was observed.  The decrease in sexual desire was observed in  %2,1  of the patients treated by  Placebo treatment. After 5 year studies side effects observed were such: decrease in sexual desire (%0,3), impotence (0.3%), decrease in sperm count (0.0%).

Once you start using  this medicine   during time a decrease in sexual desire  was determined. This condition finished in all patients who stop  the therapy, and in  %58 of patient who continue  treatment.   After stopping    usage of this medicine side effects disappear in  the period of couple of weeks.  After stopping  usage of Finasteride only hairs that grow as a result of this medicine will fall.



For many years, Minoxidil was used as  antihypertensive (blood pressure lowering).  Its side effects of  strengthening hairs  were determined  and  it started to be produced also  as    2% and 5% lotion formula. The formula of %5 is  is more effective with %50 according to the formula of %2.  This medicine   gives expansionary effect on   blood vessels and lowers  blood pressure, probably it causes the same effect when used topically and  this increase  feeding of  follicles. There are not  known significant side effects except  itching, burning, forming  of acne and contact dermatitis. After stopping   using it     these side effects disappear. One side effect, very rarely observed,  is that it also causes   hypotension (low blood pressure). To be more effective  usage of %5 formula is recommended for men and usage of  %2  formula is recommended for  women. It must be used as cures for 6-9 months in the mornings and in the evenings. When used in excess, flowing  to    front side may cause thickening in hairs on the forehead area. Patients should be warned about it.  

Minoxidil is the first medicine which   treats  hair loss and is approved by FDA.  Minoxidil is a lotion  and is applied directly to  head. Nowadays it can be purchased from pharmacies without prescription.  Minoxidil is a developed version of  the antihypertensive  medicine -  Minoxidil.  Minoxidil is  taken orally but because it  has side effects on heart and blood circulation   it is being  prescribed to be used when the effects of the other  medicines    pass. Virilisation on bodies of the patients who used Minoxidil was observed and it was thought that  its directly applying on head will increase hair growing.  Minoxidil  was applied directly  to   tops of   heads and  it was wrongly thought that it was effective only to this area.  Minoxidil  is effective as on   top of   head as on   other areas too.  But   Minoxidil is  not effective to totally bald areas.   The best results are visible  since 5 months till  2 years period of time.  Patients who use Minoxidil continue to lose their hairs  even in a very small amount.   The  principle of working of Minoxidil  is not clear yet but it is known that this medicine increases  the period of   follicle growing circle. This condition effects  as  enlarging the diameter and length of  miniature hairs.


Minoxidil Uses

Minoxidil is used two times per a day.  The treatment is directly applying to  head and   its effect is visible only there.  That’s why if there is hair loss Minoxidil   must be applied  to the front part of the head. The formula  of %5 is  double effective in comparison with  the formula  of %2 solution, but because of the content of    propylene glycol   it  may  cause stiffness and dificulty in combing. This problem can be solved as using the solution of %5 in the nights before sleeping and  %2 solution during days.  When you start to use Minoxidil you will see its effect   in the period  of  6-12 months. Also, Minoxidil  provides thickenning of your hairs. It can not make   new hairs to grow  on the areas where are not existing hair roots.  In these situation the single solution is hair transplantation.


Usage  by  Women

Women must use only the solution of  %2.  Because women are more sensitive to side effects and it can cause hypotension. Also   Minoxidil  can cause allergy to women more often than to men.  The side effect will be increased with the products  of %5,  and that’s why  FDA don’t approve this doze for women. Besides, Minoxidil  can cause virilisation on women faces. Eventough some bristles spills  after treatment,  some women  may need laser hair removal.  Care must be taken   not to   use Minoxidil  on temples and forehead. Side effects are more common in using of  %5  formula  solution.


There are some important medicines that are being still experimented and not approved by FDA and WHO.  Inosetero acetate, flupamid, spirinolacton, hyaluronic acid, topical applications of estrogen, aromatase cytochrome P-450 enzymes,   ketoconazole  can be  mentioned  among them.

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