Half of all men are balding by the age of 50 years ,called androgenic alopecia , the change in hair growth over the vertex and front of the scalp that occurs . It is a complicated inherited tendency combined with the effect of circulating androgen hormones that leads to progressive shrinkage of the scalp follicles. Once commenced, hair is lost from the margins at a rate of 5-10% per year. Not all hair follicles are affected equally, as body and pubic hairs are under different influences. Hair at the back of the head is relatively spared. The number of follicles does not reduce. The pattern for men is well recognised and investigations are not usually necessary.

There are two TGA approved medications available in Australia.

1. Minoxidil

Initially developed orally to treat high blood pressure as a vasodilator, and hair growth on the backs of hands and faces was noticed. It is available over the counter at pharmacies as a lotion and 5% foam preparation to apply to the scalp. It may be effective early in hair loss, but results are variable. Up to 50% of men will have stabilisation of loss and 10% achieve regrowth. It can take up to 4 months to see any improvements and treatment needs to continue long term, as stopping results in the loss of new hair. The miniaturisation process continues and the overall density will continue to fall after the initial regrowth of about 18 months. The cost varies, but the foam can be approximately $180- $480 for 1 years use.

Minoxidil can make hair difficult to style and cause irritant dermatitis. overuse can lead to falling blood pressure.

2. Finasteride

The only oral agent approved for treatment in Australia. It has been available for approximately 15 years and requires a prescription from your GP. The medication blocks the conversion of testosterone to dihydrotestosterone. It is also used in the treatment of prostate conditions. Studies demonstrate increased hair counts for more than 90% of men, most of the increase occurs in the first 2 years. Ceasing treatment results in return to the normal rate of hair loss expected for the person. it works best at stopping the progression of genetically programmed hair loss and partial regrowth.

Side effects are minimal, but can include reduce libido, erectile dysfunction and retrograde ejaculation. The side-effects resolve during prolonged treatment and disappear a few weeks after ceasing the drug.

The Prostate Cancer Prevention Study demonstrated reduced incidence of prostate cancer for men over 55yrs taking the medication for 7 years during the trial, but the incidence of high-grade prostate cancer was increased. The significance of this to young man at the dose of 1mg daily is unknown.

The cost depends on whether the medication is bought as the 5mg tablet ( and 1/4 taken daily)approx $150 per year or bought as a 1mg tablet ( approx$1080 per year).

3. Testosterone, Hihydrotestosterone, Spironolactone and Cyproterone

These share a common androgen receptor, and are unsuitable due to the side-effects and complications such as gynaecomastia, impotence and feminisation, increased risk of heart disease death and prostate cancer.

4. Camouflage

May be used early, with various sprays or solutions and powders which are applied to the scalp and hair. They need to be replaced daily and an rub off onto clothing.

Wigs are useful and can be synthetic or natural hair, complete or partial. Human hair wigs are most expensive, but look better, last longer and can be styled more easily.

5. Hair Transplantation

Now a well established treatment, hair restoration surgery evolved from the 1960s. Initial involved the plug transplantation process. Occipetal scalp hair continues to grow according to the original programming when transplanted. Redistributing the follicles can cover the balding areas.

A strip of skin is dissected into follicular units and transplanted to the frontal and side areas, inserting the small numbers of hair follicles into small slits attempting to create a natural appearance. The limiting factor is whether there is enough remaining donor hair to transplant. Chest and body hair has been used and artificial hair implants are possible. The cost depends on the number of units and can be $5000 - $10000.

Skin flap surgery is also performed, but is controversial in terms of the final appearance. The final appearance is also complicated by the progression of hair loss process and whether the result remains acceptable.

6. New Treatments

Further research using medications related to finasteride is occurring and a prostaglandin analogue used for glaucoma ( latanoprost) is being trialled on the scalp.

7. Alternative Treatments

Considerable money can be spent on dietary supplements, vitamins, lasers, stem cell therapy and platelet rich plasma treatments. There has been no evidence of any benefit either in spending the money or from the various treatments on offer.


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