ALOPECIA

Treatments for male-pattern baldness:

Finasteride 1mg po QD

• Inhibits 5-alpha-reductase which converts testosterone to dihydrotestosterone
• Better than placebo in nonpublished premarketing trials over as long as 2y of f/u for hair loss at top of head or frontal area in 18-41yo men
• Adverse effects in excess of placebo included decreased libido and erectile dysfunction
• Theoretical concerns exist for long-term fertility
• Can be teratogenic so not for use in women

Minoxidil 2% solution (OTC) or 5% solution ("Rogaine Extra Strength")

• Acts directly on hair follicles through an unclear mechanism
• Adverse effects include dizziness, tachycardia, local irritation, dryness, and erythema, as well as small but stat. sig. increase in LV mass
• No diff. between 2 strengths in women
• 5% may be slightly more effective than 2% in men over 48wk f/u
• Oral minoxidil has been associated with congenital anomalies

(Med. Lett 40:26, 1998)