Androgenetic alopecia - Emerging treatments

Oral minoxidil

Oral minoxidil specifically for androgenetic alopecia in men has not been studied extensively, however one study has shown that it may only be marginally more effective than topical minoxidil.[11][51] Low-dose oral minoxidil has also been explored in women with female pattern hair loss and may be of benefit.[52] Adverse effects may include postural hypotension, hypertrichosis, oedema, and/or electrocardiogram abnormalities.[11][52]

Dutasteride

Dutasteride is a more potent 5-alpha reductase inhibitor that binds to type I and type II 5-alpha reductase. While it is only approved for benign prostatic hyperplasia in the US and Europe, it is approved for male pattern hair loss in some other countries. Clinical studies have shown significant increase in hair counts and global hair assessment after 6 months of therapy as compared to placebo and finasteride.[11][53][54] Dutasteride, like finasteride, may also be associated with sexual adverse effects.[39]

Low-level laser treatment

There is growing interest in the use of low-level laser devices to help grow hair. Currently, several units have been granted FDA clearance as hair growth devices. Scepticism as to the validity of low-level laser treatment (LLLT) has decreased among both practitioners and consumers. This is due to additional scientific studies appearing in the literature that demonstrate efficacy and safety, and also due to greater understanding being gained of the putative mechanisms of action.[55][56]

Platelet-rich plasma therapy

Platelet-rich therapy (PRP) is an autologous preparation of plasma with a supraphysiologic concentration of platelets thought to promote wound healing and hair growth through the release of various growth factors from activated platelets.[11] Whole blood is drawn from the patient and after processing, the platelet-rich plasma is injected intradermally into the scalp. A variety of protocols and systems are available to accomplish this process which makes it difficult to establish efficacy. The majority of clinical studies available range from weekly to monthly treatments, with three or more treatments. Improvement in hair counts, density, and patient satisfaction has been reported.[11][57] Adverse effects appear to be limited to transient oedema, erythema, pain, and/or headache.

Microneedling

With microneedling, fine needles are applied to the scalp via a roller or pen and microwounds are induced which activate wound healing and the generation of various growth factors.[13] Few studies exist and are of limited quality, but microneedling is sometimes used in conjunction with other treatments including topical minoxidil and/or platelet-rich therapy. It may improve the penetration of topical treatments.