Androgenetic alopecia
Progressive thinning and loss of scalp hair driven by dihydrotestosterone action on the hair follicle in genetically predisposed individuals. In men, typically presents as hairline recession and vertex thinning (Norwood-Hamilton scale); in women, as diffuse mid-scalp thinning with preserved frontal hairline (Ludwig scale). Evidence-based treatments include minoxidil (topical and low-dose oral), finasteride, dutasteride, and spironolactone in women.
ICD-10 L646 drugs
Also known as: Male pattern hair loss, Female pattern hair loss, Pattern baldness
Drugs used for this condition
- AFinasterideFirst line · Testosterone 5α-reductase type 2 inhibitorsFinasteride 1 mg/day is first-line therapy for male androgenetic alopecia. Kaufman 1998 RCT (n=1879, 2 years) showed 86 hairs/cm² increase in vertex hair count, with sustained results during continued use. Effect plateaus by 12 months and persists only with continuous use – discontinuation leads to renewed hair loss. The drug is not approved in premenopausal women. Post-finasteride syndrome (PFS) – persistent sexual, cognitive, and emotional symptoms after discontinuation – has been reported in a small subgroup; incidence and causality remain debated. AAD and BAD guidelines list finasteride as first-line for male androgenetic alopecia.
- AMinoxidilFirst line · Other dermatologicals (topical); peripheral vasodilators (systemic)Topical minoxidil is first-line therapy for male and female androgenetic alopecia. Cochrane meta-analysis (van Zuuren 2016, 12 RCTs, n=3927) confirms significant hair count and patient satisfaction increases at 6–12 months. In men, 5% solution/foam outperforms 2%. Low-dose oral minoxidil (0.25–5 mg/day) has been studied since 2017: Vañó-Galván 2021 RCT (n=104) and multiple retrospective series show hair density gains comparable to topical, in patients intolerant or unresponsive to topical. The main side effect of oral minoxidil is facial hypertrichosis (60–90%). AAD and BAD guidelines list topical minoxidil as first-line; low-dose oral minoxidil as second-line off-label.
- BDutasterideSecond line · Testosterone 5α-reductase types 1 and 2 inhibitorsFor androgenetic alopecia, dutasteride is considered an option in patients unresponsive to finasteride. The Olsen 2006 RCT (n=416, head-to-head) showed that dutasteride 2.5 mg/day increased hair count by 17 hairs/cm² more than finasteride 5 mg/day (note: high dose). The Tsunemi 2016 RCT in Japan at 0.5 mg/day showed superiority over placebo. Side effect profile is similar to finasteride; sexual dysfunction and post-finasteride syndrome risks are comparable. AAD and BAD guidelines list dutasteride as second-line for male androgenetic alopecia.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DPumpkin seed oil (Cucurbita pepo, Cucurbita maxima)Not recommended · Plant product, supplement. In EU – traditional herbal medicinal product per EMA HMPC monograph; AEMPS does not register as monomedicineCho 2014 RCT (n=76, Korea) showed a 40 % hair count increase with pumpkin seed oil 400 mg/day × 24 weeks in men with M-pattern androgenetic alopecia; control group showed no significant changes. Small sample, not reproduced in independent groups. AAD 2024 and SEDEF list oral finasteride 1 mg/day and topical minoxidil 5 % twice daily first-line for male androgenetic alopecia; for women – minoxidil 2–5 %, in postmenopause – spironolactone. Pumpkin seed oil is not in guidelines. If pumpkin seed oil was recommended for marked hair loss instead of finasteride and minoxidil, consider seeking a second opinion from a trichologist or dermatologist.
- DSaw palmetto (Serenoa repens)Not recommended · Dietary supplements and phytotherapeutics, sabal palm fruit extracts (local classification)Over the past 10 years saw palmetto has been marketed as a «natural finasteride» for androgenetic alopecia. Five to seven small RCTs (Prager 2002, Rossi 2012) totaling about 350 participants show modest hair density gains of 20–40 hairs/cm² at 6–12 months. Head-to-head comparisons with finasteride (Rossi 2012, n=100) show finasteride is substantially more effective. AAD and BAD guidelines for androgenetic alopecia do not include saw palmetto.
- DStinging nettle root (Urtica dioica, radix)Not recommended · Plant extract, supplement. In EU – traditional herbal medicinal product per EMA HMPC monograph 2010 for BPH symptoms; AEMPS does not register as monomedicineStinging nettle root appears in supplements and hair products that promise to slow hair loss in androgenetic alopecia. It has not shown convincing benefit for this use, and there are no good quality clinical trials of nettle root in male or female pattern hair loss. For androgenetic alopecia, other options with documented effect help, such as topical minoxidil and oral finasteride in men, both chosen together with a doctor. Do not use nettle root in place of such treatment, since this can mean losing the window when a proven therapy works best.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit