Several clinical treatments have already been proposed to try to solve or delay AGA. However, only two treatments are currently accepted by the FDA: the topical use of Minoxidil and the oral ingestion of Finasteride.

The main objective of the pharmacological therapy is to reverse and/or stabilize the miniaturization process of the pilose follicles. In hormonal terms, it consists in reducing androgenic activity on capillary follicles.

The clinical treatment of the donating region before the surgical procedure is done is specially advantageous, for it reverses the evolution of the follicles form the telogenous phase to anagenous, making it easier to visualize the hair, that gain density, and increasing the number of available follicular units in the donating area.

MINOXIDIL

Minoxidil is a biological modifier that acts by reversing the miniaturization process of the hair in the AGA normalizing the follicle’s cycle, extending the anagenous phase. Its active agent, the substance responsible for the stimulation of the pilose follicle, is minoxidil sulfate (MS).

This medication does not stimulate normal follicles; it acts only on follicles in miniaturization process, but not completely miniaturized, that is, small diameter, short (between 0.5 and 2cm) and hypo pigmented follicles.

Minoxidil solution is usually found at a 2% concentration, however, a short time ago, appeared a 5% solution minoxidil. A recent placebo-controlled study compared the therapeutic responses of 352 men 36 years old in average, bearers of AGA degrees III-V, to these two concentrations of minoxidil solution. The growth of hair in the 5%-concentration group was faster and stronger.

In another research, also placebo-controlled, hair cut in the frontoparietal region of men with AGA was evaluated. During the two-year study, the responses of the placebo and of minoxidil 2% and 5% were compared. After 42 weeks the average variation in the weight of the hair was of 5%, 24% and 29%, respectively. After 96 weeks, 14%, 15% and 19%. The difference between the treated group and the one that received the placebo remained constant in 34% for minoxidil at 5% and 29% for minoxidil at 2%. The greatest increase in hair was observed during the first 20 weeks of treatment.

After these studies, the use of 5% minoxidil twice a day was standardized for all patients. The recommendation is to use 1 ml of the product each time it´s applied and always when the hair is dried. It´s important to the product is spread on the scalp and not in the hair. The product must be absorbed to order to reach the roots of hairs. Minoxidil takes no action in the steem. To get the desired result, it´s best to leave the medication in action for at least 4 hours. For this reason, we recommend that this procedure is done at night and in the morning. After 4 hours, hairs can be washed.

Women with female pattern AGA can also be treated with minoxidil, but they respond better to minoxidil 5% than to 2%.
In 7%  of these women,facial hipertricose can happen, that means, the growth of thicker hairs in this region. It´s more common to happen in women who already had a certain amount of of fácil hairs, be over 50 years old or in some cases, the ones who present any kind of hormone  disfunction. This problem can be perfectly treated and solved. At first, and attempt to reduce the concentration to 2%, and if after a couple of months  there´s no reduction in the amount of hairs, the medication should be interrupted. The use of the drug during either pregnancy or breastfeeding is not recommended.

The first results of minoxidil treatment can be observed after approximately four months. Its side effects are “irritations” (drying, itching and rashes) and tend to disappear with the interruption of drug intake or after a year of use.

It´s first observed the reduction of capillary fall, after the process of miniturazation settles down. At last, there´s an increase in the amount of hairs.

Some patients can suffer from a temporaly capillary hair fall in the first weeks of the tretment. It occurs because the medication stimulates that in order to make them grow then.

The earlier the diagnosis is done, the earlier the treatment can begin, and consequentely better results will be obtained. Because live follicules will act in any kind of non-surgical treatment for hair loss. That follicule which is already “dead” will never recover back again. There´s no medication that makes hair grow back again in na área where is totally without them. The only solution is the hair transplant which is the only thing that is able to fill out the empty space buy removing the follicules from the donating area and placing them back in area which is bald. It´s very important that the patient knows that it´s an ongoing treatment. Once the medication is interrupted, baldness will get back to the the same state before the treatment, in about 4 to 6 months.

FINASTERIDE

Finasteride is a hormonal modifier that acts as androgenic blocker. It is the first selective inhibitor of the 5-alpha-redutase enzyme which does periphery conversion of T into DHT. It´s responsible for the process of miniaturation.

Its employment in males began in 1986, when it was developed to treat individuals with benign prostatic hyperplasia (BPH). Its use in the treatment of AGA was approved by the FDA in 1997.

An initial study tested the use of finasteride on patients, bearers of AGA, who present a great activity of 5-alpha-reductase enzyme and elevated levels of DHT. After the treatment via oral ingestion, over 65% of the patients showed a significant reduction of DHT in their scalps.

In 1998, three multi-centric studies, each one of them placebo-controlled, analyzed 1,879 men with light-to-moderate AGA who took 1mg of finasteride orally or placebo. 48% of the men treated with finasteride presented hair growth after one year of treatment, in opposition to the 7% in the control group.

The incidence of side effects was similar in the study groups that took both placebo and finasteride. 3.8% of the patients treated with finasteride presented sexual malfunction, with diminished libido, ejaculation malfunctions and erectile malfunction, against 2.1% in the control group.

It is important to emphasize that finasteride does not cause impotence. And once the medication is interrupted, the possible side effects disappear.

Finasteride is used to preserve the hairs that have not fallen yet. It does not cause new hair to appear in bald spots. It is effective only during the use of the medication. Once it is interrupted, the baldness process restarts. It does not accelerate the falling of hairs once the treatment is interrupted.

Finasteride is used in order to preserve the hairs that haven´t fall yet. It doesn´t make new hair grow in the hair that is already bald. Its effect is only to kept up during the medication. Once interrupted, the process of baldness is back again. It doesn´t speed up the process of hair loss when interrupted.

It´s recommended the use of Finateride after the age of 18, under medical supervision. Once the treatment hás started, it´s indicated that the patient has medical followups each 6 months in the first 2 years. After that, once a year in case of the intake medication.

The deadline to stop taking the medication is 2 years. In case the patient still longs for more amounts of hair, it´s indicated the association of the capillary transplant surgery.

The association of Finasteride and minoxidil lotion brings more efficient results than only Finasteride by itself. The use of cetoconazol shampoo 2 to 3 times a well also helps.