Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Treatment of androgenetic alopecia in men

Jeff Donovan, MD, PhD
Beth G Goldstein, MD
Adam O Goldstein, MD, MPH
Section Editor
Maria Hordinsky, MD
Deputy Editor
Abena O Ofori, MD


Male androgenetic alopecia (also known as male pattern hair loss and male balding) is a common, progressive form of hair loss distinguished by the reduction of terminal hairs on the scalp in a characteristic distribution (picture 1A-D). The anterior scalp, mid scalp, temporal scalp, and vertex of the scalp are the typical sites of involvement. Hair loss occurs over the course of years.

Although androgenetic alopecia is a benign and asymptomatic disorder, cosmetic concerns lead some patients to seek treatment. The primary pharmacologic therapies for men with androgenetic alopecia are topical minoxidil and oral finasteride. Hair restoration surgery can also result in cosmetic improvement.

The treatment of androgenetic alopecia in men will be reviewed here. The pathogenesis, clinical features, and diagnosis of male androgenetic alopecia are reviewed in greater detail separately. (See "Androgenetic alopecia in men: Pathogenesis, clinical features, and diagnosis".)


Topical minoxidil and oral finasteride are the therapeutic agents that have been most extensively studied for the treatment of androgenetic alopecia in men. Both drugs have demonstrated efficacy and high tolerability in placebo-controlled randomized trials, supporting their status as first-line agents. The response to treatment with finasteride or minoxidil varies. While some men achieve cosmetically significant regrowth, others benefit most from the slowing of additional hair loss. Continuation of these drugs is required to maintain the results of therapy.

Finasteride — Finasteride is an oral inhibitor of dihydrotestosterone (DHT) production that is efficacious for male androgenetic alopecia.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Feb 07, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Rittmaster RS. Finasteride. N Engl J Med 1994; 330:120.
  2. Price VH. Treatment of hair loss. N Engl J Med 1999; 341:964.
  3. Mella JM, Perret MC, Manzotti M, et al. Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review. Arch Dermatol 2010; 146:1141.
  4. Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol 1998; 39:578.
  5. Leyden J, Dunlap F, Miller B, et al. Finasteride in the treatment of men with frontal male pattern hair loss. J Am Acad Dermatol 1999; 40:930.
  6. Price VH, Menefee E, Sanchez M, et al. Changes in hair weight and hair count in men with androgenetic alopecia after treatment with finasteride, 1 mg, daily. J Am Acad Dermatol 2002; 46:517.
  7. Price VH, Menefee E, Sanchez M, Kaufman KD. Changes in hair weight in men with androgenetic alopecia after treatment with finasteride (1 mg daily): three- and 4-year results. J Am Acad Dermatol 2006; 55:71.
  8. Olsen EA, Whiting DA, Savin R, et al. Global photographic assessment of men aged 18 to 60 years with male pattern hair loss receiving finasteride 1 mg or placebo. J Am Acad Dermatol 2012; 67:379.
  9. Finasteride Male Pattern Hair Loss Study Group. Long-term (5-year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia. Eur J Dermatol 2002; 12:38.
  10. Irwig MS, Kolukula S. Persistent sexual side effects of finasteride for male pattern hair loss. J Sex Med 2011; 8:1747.
  11. Irwig MS. Persistent sexual side effects of finasteride: could they be permanent? J Sex Med 2012; 9:2927.
  12. Amory JK, Wang C, Swerdloff RS, et al. The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men. J Clin Endocrinol Metab 2007; 92:1659.
  13. Samplaski MK, Lo K, Grober E, Jarvi K. Finasteride use in the male infertility population: effects on semen and hormone parameters. Fertil Steril 2013; 100:1542.
  14. Rahimi-Ardabili B, Pourandarjani R, Habibollahi P, Mualeki A. Finasteride induced depression: a prospective study. BMC Clin Pharmacol 2006; 6:7.
  15. D'Amico AV, Roehrborn CG. Effect of 1 mg/day finasteride on concentrations of serum prostate-specific antigen in men with androgenic alopecia: a randomised controlled trial. Lancet Oncol 2007; 8:21.
  16. Shenoy NK, Prabhakar SM. Finasteride and Male Breast Cancer: Does the MHRA Report Show a Link? J Cutan Aesthet Surg 2010; 3:102.
  17. Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol 2002; 47:377.
  18. Olsen EA, Whiting D, Bergfeld W, et al. A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol 2007; 57:767.
  19. Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol 2004; 150:186.
  20. Lachgar S, Charveron M, Gall Y, Bonafe JL. Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells. Br J Dermatol 1998; 138:407.
  21. Li M, Marubayashi A, Nakaya Y, et al. Minoxidil-induced hair growth is mediated by adenosine in cultured dermal papilla cells: possible involvement of sulfonylurea receptor 2B as a target of minoxidil. J Invest Dermatol 2001; 117:1594.
  22. Buhl AE, Conrad SJ, Waldon DJ, Brunden MN. Potassium channel conductance as a control mechanism in hair follicles. J Invest Dermatol 1993; 101:148S.
  23. Price VH, Menefee E, Strauss PC. Changes in hair weight and hair count in men with androgenetic alopecia, after application of 5% and 2% topical minoxidil, placebo, or no treatment. J Am Acad Dermatol 1999; 41:717.
  24. De Villez RL. Topical minoxidil therapy in hereditary androgenetic alopecia. Arch Dermatol 1985; 121:197.
  25. Blumeyer A, Tosti A, Messenger A, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges 2011; 9 Suppl 6:S1.
  26. Olsen EA, Weiner MS. Topical minoxidil in male pattern baldness: effects of discontinuation of treatment. J Am Acad Dermatol 1987; 17:97.
  27. Ebner H, Müller E. Allergic contact dermatitis from minoxidil. Contact Dermatitis 1995; 32:316.
  28. Rogaine extra strength for men (5 percent minoxidil topical solution): for nonprescription use. Summary volume, Pharmacia & Upjohn, Kalamazoo, MI 1997.
  29. Lucky AW, Piacquadio DJ, Ditre CM, et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol 2004; 50:541.
  30. Khandpur S, Suman M, Reddy BS. Comparative efficacy of various treatment regimens for androgenetic alopecia in men. J Dermatol 2002; 29:489.
  31. Arca E, Açikgöz G, Taştan HB, et al. An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology 2004; 209:117.
  32. Saraswat A, Kumar B. Minoxidil vs finasteride in the treatment of men with androgenetic alopecia. Arch Dermatol 2003; 139:1219.
  33. Avram M, Rogers N. Contemporary hair transplantation. Dermatol Surg 2009; 35:1705.
  34. Leavitt M, Perez-Meza D, Rao NA, et al. Effects of finasteride (1 mg) on hair transplant. Dermatol Surg 2005; 31:1268.
  35. Olsen EA, Hordinsky M, Whiting D, et al. The importance of dual 5alpha-reductase inhibition in the treatment of male pattern hair loss: results of a randomized placebo-controlled study of dutasteride versus finasteride. J Am Acad Dermatol 2006; 55:1014.
  36. Eun HC, Kwon OS, Yeon JH, et al. Efficacy, safety, and tolerability of dutasteride 0.5 mg once daily in male patients with male pattern hair loss: a randomized, double-blind, placebo-controlled, phase III study. J Am Acad Dermatol 2010; 63:252.
  37. Leavitt M, Charles G, Heyman E, Michaels D. HairMax LaserComb laser phototherapy device in the treatment of male androgenetic alopecia: A randomized, double-blind, sham device-controlled, multicentre trial. Clin Drug Investig 2009; 29:283.
  38. Jimenez JJ, Wikramanayake TC, Bergfeld W, et al. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study. Am J Clin Dermatol 2014; 15:115.
  39. Lanzafame RJ, Blanche RR, Bodian AB, et al. The growth of human scalp hair mediated by visible red light laser and LED sources in males. Lasers Surg Med 2013; 45:487.
  40. Mapar MA, Shahriari S, Haghighizadeh MH. Efficacy of platelet-rich plasma in the treatment of androgenetic (male-patterned) alopecia: A pilot randomized controlled trial. J Cosmet Laser Ther 2016; 18:452.
  41. Alves R, Grimalt R. Randomized Placebo-Controlled, Double-Blind, Half-Head Study to Assess the Efficacy of Platelet-Rich Plasma on the Treatment of Androgenetic Alopecia. Dermatol Surg 2016; 42:491.
  42. Gupta AK, Carviel JL. Meta-analysis of efficacy of platelet-rich plasma therapy for androgenetic alopecia. J Dermatolog Treat 2017; 28:55.
  43. Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol 2012; 66:794.
  44. Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology 1998; 196:474.