Men searching for hair loss treatment will often be faced with a plethora of options. Prescription medications, herbal remedies, laser combs, and special shampoos and conditioners are just of the various methods available to men looking to slow down male pattern baldness, or even boost hair regrowth.
But how proficient are these methods at slowing hair loss in reality?
In this post, we’ll assess some of the better known options for treating male pattern baldness and look at the evidence:
Marketed by MSD, Propecia is a hair loss medicine which is only available on prescription. It contains an ingredient called finasteride, and this slows down hair loss by stopping a specific androgen conversion in the body.
In short, the presence of raised levels of dihydrotestosterone (DHT) in the hair follicles leads to hair loss in men. DHT is catalysed from the hormone testosterone by an enzyme called 5 alpha-reductase. Finasteride works by inhibiting the function of this enzyme, thereby slowing down the conversion of testosterone to DHT (and the rate of hair loss).
As it is a prescription medicine, an extensive clinical study has been undertaken in order to determine the efficacy of Propecia.
Its performance was measured by:
- conducting a hair count of a representative 1-inch circular region of scalp in users of Propecia and users of placebo
- visual analysis by investigators on users of Propecia and placebo
- and photographic assessment of users of Propecia and placebo by an independent panel of dermatologists
Measuring actual hair count, the study found higher hair counts in the treatment group compared to placebo which were ‘significant’; there was a 107-hair difference within a 1-inch diameter circle between the treatment and placebo groups at 12 months, and a 138-hair difference at 2 years. After 5 years, there was a 277-hair difference.
The assessments by both investigators and by the independent panel yielded positive results for Propecia too.
The investigators deemed that:
- at 12 months, 65% of men using Propecia had increased hair growth (compared to 37% using placebo)
- at 2 years, 80% of men in the Propecia group had presented increased growth (compared to 47% using placebo)
- and at 5 years, 77% of men in the treatment group had presented increased growth (compared to 15% in the placebo group)
The independent panel who evaluated photographs deemed that:
- at 12 months, of the men using Propecia, 48% had presented an increase in scalp hair (compared to 7% using placebo)
- at 2 years, an increase in growth was present in 66% of the treatment group (compared to 7% using placebo)
- at 5 years, 48% of the treatment group had shown growth, 42% had shown no change, and 10% had demonstrated hair loss (of those in the placebo group, 6% were rated as having increased growth, 19% rated as having no change and 75% as having lost hair).
A total of 1,879 men were involved in the above clinical studies, and all were aged between 18 and 41.
Available as a foam or a scalp solution, Regaine is an over-the-counter treatment for hair loss, and is also available for women.
For men there are two strengths; 2% and 5% (or ‘Extra Strength’) and the latter of which cannot be bought straight off the shelf; a pharmacist will need to check that it is suitable for someone before they can issue it.
It is not fully understood how minoxidil works in treating hair loss. However, it is thought that it helps to increase the circulation of blood to the scalp, by helping to dilate blood vessels. This is then thought to boost growth.
Once more, as a licensed treatment minoxidil has undergone extensive clinical testing.
According to the Regaine product characteristics on the Electronic Medicines Compendium, photographic data was used to compare patients using minoxidil 5% with another group using the 2% version, and another group who used the ‘vehicle alone’ (a version of the product with no active ingredient).
Evaluations deemed that:
- at 48 weeks, 60% of patients in the minoxidil 5% group showed ‘increased scalp coverage’ (compared to 23% in the vehicle alone group)
- 35% showed dense or moderate regrowth (compared to 7% in the vehicle alone group)
- 30% of those in the minoxidil 5% group were found to have ‘no change’ (compared to 60% in the vehicle alone group)
The summary of product characteristics states that 4 in 5 patients using minoxidil 5% could expect a ‘stabilisation’ of hair loss (both re-growth and no further loss would be considered in this), compared to 3 in 4 using the vehicle alone.
On the face of it, these figures (75% against 80%) do not seem to indicate a dramatic difference; however, the authors of the clinical trial did conclude that when compared to the 2% formula and the vehicle alone formula, minoxidil 5% did demonstrate an ‘enhanced efficacy’.
In short, where minoxidil 5% was applied, the results it produced in many of those cases where hair loss did stabilise were significantly more pronounced.
The trial involved 393 men aged 18-49.
Caffeine shampoo is relatively new to the market. The shampoo is said to stimulate hair growth by protecting the hair follicle against the effects of DHT, as well as providing an energy boost to prolong the hair’s growth phase.
Largely perhaps because it is a new phenomenon, research into the efficacy of caffeine in treating hair loss is somewhat sparse.
Initial laboratory studies into the effects of caffeine on hair growth seemed to show encouraging results; when applied to hair cultures contained in a laboratory vessel, caffeine significantly stimulated growth.
However, critics have stated that the in vitro nature of such studies does not replicate realistic use on a human head.
Another argument put forward by hair treatment specialists the Belgravia Centre is that the levels and concentrations of caffeine used in such laboratory studies would not be reflective of those absorbed into the scalp during hair washing.
Propecia vs Caffeine Shampoo vs Regaine
Unlike finasteride and minoxidil, caffeine shampoo is not a prescription drug. Therefore, little in the way of clinical testing has been undertaken to determine how effective it is in treating male pattern baldness.
It is not yet feasible then to realistically compare the clinical efficacy of caffeine shampoo products against Propecia or Regaine, simply because evidence for the former is in short supply; more testing needs to be done in order to carry out any kind of comparison.
Comparing the end results of clinical analyses for minoxidil and finasteride is complex, as the study for the former took place over 48 weeks; whereas the study for the latter over 5 years. Though the results show that both treatments were successful overall after similar time frames (minoxidil after 48 weeks and finasteride after 12 months), it is not possible for us to determine which one was more successful as the parameters of the two analyses were different.
Assessing the performance of the two treatments in test scenarios with identical settings would then be needed then to provide a fair comparison.
One study by Turkish scientists in 2004 did set out to do this; it assigned minoxidil and finasteride randomly to a pool of 65 patients (25 received minoxidil, 40 received finasteride), and compared results after one year of treatment. Finasteride was shown in this study to ‘increase intensity of hair’ in a higher percentage of cases than minoxidil (80% to 52%).
However, it could be argued that the test pool in this study was a relatively small one; and that more in-depth more analyses carried out over a longer period of time with more respondents would be needed to come to a definitive conclusion.
If you are concerned about hair loss and thinking about seeking treatment, it’s always better to speak to your doctor first to discuss which is going to be most beneficial and suitable for you.
To find out more about treatments for male pattern baldness and how they work, head over to our hair loss page.