Treatments for Androgenetic Alopecia

Although hair loss is devastating, with proper treatment, androgenetic alopecia is possibly reversible. The goals of treating this condition are to grow more hair and or reduce the amount of hair loss while improving the quality and health of existing hair. The types of treatments for androgenetic alopecia fall into several categories; proven treatments, anti-androgens, 5 Alpha-Reductase inhibitors, topical treatments/non-drug commercial solutions and dietary supplements.

Anti-Androgens:

Anti-androgens are a classification of drugs that prevent the activity of androgens in one of three different ways; it restrains the production of androgens, it inhibits the body from handling androgens in the normal way (inhibiting androgen metabolism) or it barricades androgenic activity at the cellular level, by blocking androgens to binding at receptor sites, most commonly at the hair follicle.

Spironolactone/Aldactone:
Dermatologists prescribe a high blood pressure medication called spironolactone (brand name Aldactone) to treat androgenetic alopecia. Spironolactone is actually a drug used to treat high blood pressure and is a diuretic that retains potassium while excreting sodium and water. This medication counteracts a hormone called aldosterone, which is responsible for regulating the body's salt and potassium. As an anti-androgen, it blocks DHT from binding to it's receptor in the hair follicle. It will also slow down production of androgens within the adrenal gland.

In prescriptions given to women, Spironolactone is usually taken orally (whereas in men, spironolactone is prescribed as a topical solution). The birth control pill Yasmin contains a progestin called drospirenone, which has anti-androgenic properties. Drospirenone’s chemical structure is very similar to spironolactone and it is an equivalent to about 25 mg of spironolactone.

Some possible side effects are menstrual irregularities, cramps, fatigue and breakthrough bleeding. Do not use spironolactone if you have kidney or liver disease, are pregnant or are planning on becoming pregnant, nursing, have high potassium levels, low blood pressure or are taking potassium supplements. Spironolactone may cause birth defects.

Cimetidine/Tagamet: You may be surprised to know that the Tagamet pills that you can buy in the supermarket have been studied as a possible benefit or treatment for pattern baldness. If cimetidine (sold as Tagamet) is taken multiple times throughout the day, it works like an anti-androgen by preventing the androgens from linking to their receptors.

In one study done in 1987, ten women with moderate to severe female pattern baldness took 300 milligrams of cimetidine 5 times daily (just above the average dosage prescribed for ulcer patients) for 5 months. Seven of the ten patients showed regrowth, with no side effects reported. Even though the results of the study are interesting, cimetidine/Tagamet is not an approved drug for treating baldness, therefore it is not advised that you take cimetidine unless you have been evaluated or are under medical supervision.

Cyproterone Acetate/Androcur:
Cyproterone Acetate, or CPA, is sold under the name Androcur, and is only available in Europe and Canada. CPA is a steroidal anti-androgen, one of the first prescribed for the treatment of hair loss. It is a synthetic steroid that, like other anti-androgens, blocks androgen activity from binding to the receptors in the skin and hair follicles. CPA also lowers the amount of androgens being produced by decreasing the activity of the ovaries.

The low dose birth control pill Diane-35 contains about 2 milligrams of CPA, and many women are prescribed Androcur with Diane-35 (also available only in Europe and Canada). One study has shown that CPA and Diane-35 have improved hair loss in almost half of the women who were using both pills.

Side effects that women may experience include fatigue, weight gain, breast tenderness, headaches and irregular bleeding. It also drains the body of vitamin B12, which can become a deficiency. This can cause irreversible nerve damage. Therefore a daily supplement of vitamin B12 can help prevent this deficiency.

Flutamide/Eulexin:
Flutamide in conjunction with a drug called Lupron is used to treat prostate cancer, but it has also been studied as a potential treatment for pattern baldness. It is a very powerful anti-androgen that blocks and weakens androgens. One study showed modest hair regrowth and reduction of facial hair in women. The side effects can include anemia, high blood pressure, diarrhea, anxiety, breast swelling and very serious liver problems which may be fatal.

A newer offshoot of flutamide is bicalutamide, or Casodex. It is also a powerful anti-androgen, but with much less side effects. It has not yet been tested or studied as a baldness treatment for women.