Two drugs have been approved by the FDA to treat male pattern hair loss: Minoxidil (Rogaine), and Finasteride (Propecia).

Minoxidil is a topical medication applied to the scalp daily to maintain or reduce the rate of hair loss. This slowing of hair loss occurs for the majority of Minoxidil patients; a smaller minority re-grows some hair as well. Its most common side effect is scalp irritation, which occurs in a small number of patients. The earlier Minoxidil is used to treat hair loss, the more effective it is, but it must be used once daily, indefinitely, to maintain its benefits. Patients lose the hair regained or maintained about four to six months after they stop using Minoxidil; it will not, however, promote further hair loss itself if stopped.
Recently a 5% Minoxidil foam was introduced. Many of our patients have switched from the liquid form to the foam. They find it less irritating and “greasy” and studies have demonstrated a better penetration through the skin than the liquid form of minoxidil.

Finasteride ( Propecia ), approved in 1997 , is an oral medication that also maintains and delays hair loss.  Unlike Minoxidil, only male patients should use Finasteride, since it can cause birth defects in women who become pregnant while on the medication. It is safe for a man to get a women pregnant while on the medication.  It has been studied for over fifteen years, and, like all oral medications, has a few side effects that patients should note, such as infrequent cases of decreased libido or sexual function ( 1-2 % of patients ) and rarely breast tenderness or enlargement. If the sexual side effect occurs it is completely reversible if the medication is discontinued.  No harmful interactions with other drugs, allergic reactions, or blood monitoring have been reported with Finasteride. Like Minoxidil, it is more effective at the early stages of hair loss, and must be used indefinitely to continue delaying hair loss: and as with Minoxidil, patients lose the hair regained or maintained about four to six months after they stop using Finasteride; it will not, however, promote further hair loss itself.
 
Finasteride and the prostate
Finasteride, in a dose 5 times higher  than propecia, has been  used since the 1980 s to treat enlarged prostates.  One of the positive side effects of the medication was the regrowth of hair. This observation lead to studies and FDA   approval of Finasteride in a 1 mg daily dose.   Studies have been done to determine if  Finasteride  helps  protect or promote prostate cancer. The broad consensus of comprehensive studies is Finasteride should not be used to prevent prostate cancer and it does not promote prostate cancer. A PSA level is a routine screening test done to detect prostate cancer. Patients on Finasteride need to have a simple adjustment in their blood test reading to reflect their  true level.

Medications and hair transplantation
Using either minoxidil and/or finasteride with or without a transplant is the most effective treatment for maintaining existing hair. If a patient is a candidate for a transplant and has existing hair, using a medication in conjunction with surgery will result in the maximum perceived density. Some of our patients decide to use only medications, some use both medication and surgery and others chose only to pursue surgery.  While medications can be an excellent adjunct to surgery they are elective and the short term (1-3 years) and long term (10-30) cosmetic results should be natural with or without medications.

Through the internet and other media outlets, a  myriad of products claim to stop or counteract hair loss, but Minoxidil and Finasteride are the only ones that have withstood scientific scrutiny. Over the next several years, the FDA will likely approve other medications currently in clinical trials.

In 2007, the FDA approved a lasercomb for use. It is a low level light therapy ( LLLT ) of  continuous red light. Treatments are painless and safe.  In a  study done patients and physicians found there was a clinical  benefit from the lasercomb compared to placebo. There have not been any longterm studies .  There are few side effects and the device is sold directly to patients from the manufacturer.