has shown that the effectiveness of topical finasteride and oral finasteride are similar, but both the oral and topical forms have shown to decrease DHT in the blood, so it is not clear if the topical formulation is truly safer. Another issue is standardization of the topical formulation, since it is not FDA approved. Until the formulation (i.e., the way it is compounded) and application method have been standardized, it is very difficult to draw broad conclusions.
he medical term for it is androgenetic alopecia (AGA), also referred to as “male pattern baldness.” It is due to the hormone dihydrotestosterone (DHT) which acts on genetically sensitive hair follicles causing them to miniaturize over each growth cycle. This results in shorter, smaller, finer hairs. Over time, this “miniaturization” process leads to the appearance of thinning or balding. This type of hair loss can be treated with medication and/or surgery depending upon the age of the patient and the extent of the hair loss. The most effective medication for AGA is oral Finasteride which blocks the formation of DHT and prevents the cycle of miniaturization. Surgical hair restoration can be performed by one of two methods – either Follicular Unit Transplantation (FUT) using a strip or Follicular Unit Excision (FUE) where follicles are removed one-by-one from the back of the scalp.
et="_blank">published article, Dr. Shaver talked about why female hair loss can often be harder to treat than male hair loss. In men, the hormone DHT is the main culprit behind genetic hair loss. The main way to treat male hair loss is by blocking the formation of DHT with a medication called finasteride. However, treating female hair loss with the same medications that block that hormone for men can prove to be tricky. There are safety concerns for women, particularly if they have a history of breast cancer, are pregnant or nursing; or wish to become pregnant. Hair transplants may be more challenging in women, as thinning hair on women is typically diffuse, making it harder to find a sufficient donor area. The good news is that there are a number of effective ways to treat both female and male hair loss. Here, Dr. Shaver explains the best methods we currently have for hair restoration and what to look for in the future.
t as with the oral version. It is not clear that using it topically can increase the efficacy/side effect ratio (i.e., depression of serum DHT levels may be important for its effect).
ed on a variety of hormonal therapies to support gender transitioning; it is important to also address residual testosterone and dihydrotestosterone (DHT) in the body that can be a source for continued hair loss. For example, spironolactone, minoxidil, and/or finasteride can address hair loss.
receptor targeted drug called KX-826. The medicine is applied in topical form to the scalp and works by reducing the ability of dihydrotestosterone (DHT) to attach to its androgen receptor in the follicle. DHT is the hormone largely responsible for androgenetic alopecia or genetic thinning. By weakening this interaction, KX-826 may be a suitable topical option to slow hair loss. While oral finasteride is currently the most popular drug used to block the formation of DHT and thus slow hair loss, KX-826 does not interfere with the amount of DHT produced. This makes KX-826 potentially safe for use in women, since DHT production is left unaltered and other body hormone levels will be not be disrupted. Currently, KX-826 has finished Phase 1 clinical trials in the US and China and is set to begin phase 2 clinical trials soon. The hair loss community is waiting with anticipation for the results of Kintor’s clinical trials to be completed since there has not been an FDA-approved drug indicated for hair loss since approval of finasteride in 1997.
Dr. Bernstein was recently a guest on "The Beauty Doc" podcast with a master of oculoplastic & facial plastic surgery, Dr. Joel E. Kopelman. Here, they discussed causes of hair loss in both men and women, the difference between hair falling out and balding, both the mental and physical effects of hair loss, when to come in for a consult and medical and surgical treatments for hair loss.
t can happen. I understand there is no definitive explanation for this but I would like Dr Bernstein's opinion on why this happens. My theory is that DHT is more prominent on the top of the head and is changing the structure of the transplanted hair. The hair is so dry and unmanageable it looks like I am wearing a wig. I await his response. -- P.O., Greenwich, CT
ride and we do not routinely perform them. If a patient requests test then Total and Free Testosterone, DHT, and Prolactin are reasonable to obtain, but there is no consensus on what the appropriate tests might be. If a patient requests tests because he has symptoms (i.e. such as lack of energy associated with low T), he should see his internist, urologist, or GP. That said, patients 50 and over (40 and over in patients with a high risk of developing prostate cancer) should have a PSA before starting finasteride.