When it comes to hair loss medication there are three different products that are continually spoken about. ‘The big 3’ in hair loss usually refers to the main products that are used to reduce hair loss. These products are Minoxidil (Rogaine/Regaine), Finasteride (Propecia) and Ketoconazole (Nizoral) and today we’re looking at all three medications.
Finasteride, also known as propecia is an antiandrogen which acts by inhibiting type II 5-alpha reductase. This is the enzyme that converts testosterone to dihydrotestosterone (DHT). Although not its only use, finasteride is registered as a treatment for male pattern baldness in many countries.
Finasteride works by blocking the enzyme, type II 5 alpha-reductase, by doing this it reduces the level of the hormone in the scalp. Type II 5 alpha-reductase shortens the hair growth cycle and by blocking this you can expect to see hair return to its normal growth cycle. By allowing hair to resume a normal growth cycle it can stop hair loss and increase new hair growth in those with male pattern baldness.
For finasteride to work, continuous daily use for 3-6 months is required and the effects are reversed 6-13 months after treatment is discontinued, due to this, continuous use is recommended to ensure the benefit is sustained.
Minoxidil is a vasodilator which was exclusively used as an oral drug to treat those with high blood pressure. However, it was discovered to have interesting side effects of hair growth and reversing baldness. Due to this, in the 1980s a topical solution was produced that contained 2% minoxidil to be used a hair loss treatment.
Minoxidil is usually found in a 5% concentration solution which is designed for men and a 2% solution which is used for women. It is unknow exactly how the drug stimulates hair growth but it is thought that it dilates the blood vessels around the hair follicles, increasing the nutrient supply and encouraging increased hair growth.
When it comes to using Minoxidil, the key is to try to use it early on in your hair loss. Those with the most success tend to have thinning hair and are not yet bald. If the medication is stopped after prolonged use, hair loss can increase.
Ketoconazole, which is sold under the brand name Nizoral, is an antifungal medication that is used to treat a number of fungal infections. It is applied to the skin if used for fungal skin infections such as tinea, dandruff and dermatitis. It can also be taken orally, however, this is less preferred and only recommended for severe infections when other agents cannot be used.
An ‘off label’ use of Ketoconazole shampoo is to be used in conjunction with an oral 5a-reductase inhibitor such as Finasteride. It is speculated that the antifungal properties of ketoconazole reduce scalp microflora which can reduce follicular inflammation that contributes to alopecia.
There have been limited clinical studies that suggest ketoconazole shampoo used either alone or in combination with other treatments are useful in reducing hair loss.
It is important to remember that as with most drugs, there will be a number of side effects and warnings and it is very important to discuss with a GP and fully research medication you are considering taking.