Tools for Practice Outils pour la pratique


#172 Drugs for male- and female-pattern baldness: Just a hair bit more effective than doing nothing?


CLINICAL QUESTION
QUESTION CLINIQUE
What is the effect of approved medications for androgenic alopecia in men and women?


BOTTOM LINE
RÉSULTAT FINAL
For men using finasteride or minoxidil, one in 4-8 more than placebo will notice at least slight improvement in hair count over 6-12 months, with no clear evidence one is betterFor every 84 men taking finasteride for hair loss, one extra will experience erectile dysfunction. For women, only minoxidil improves hair countwith one in eight reporting a moderate improvement over placebo.  



CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session



EVIDENCE
DONNÉES PROBANTES
  • Men 
    • Finasteride: Systematic review1 (12 randomized controlled trials (RCTs), 3,927 men) of finasteride 1-5 mg/day versus placebo found: 
      • At least slight improvement in hair count at 3-12 months, 43% versus 26%, Number Needed to Treat (NNT)=6. 
        • At 24-60 months, NNT=4. 
      • Increase in hair counts at balding spots.  
        • 9% at 3-12 months24% at 48 months. 
      • Increase in erectile dysfunction, Number Needed to Harm (NNH)=84.  
        • No difference in other sexual adverse effects. 
      • Limitations: Publication bias, selective reporting (under-reporting sexual adverse effects),3 high loss to follow-up (up to 30%), clinically important differences undefined. 
      • Recent, low quality systematic review found similar.2 
    • Minoxidil: Systematic review4 (11 RCTs, 1,666 men), minoxidil 2% solution BID versus placebo over 6-12 months found: 
      • At least slight improvement in hair count62% versus 40%, NNT=5. 
      • 16% increase in hair counts.  
      • Higher (versus lower) concentrations inconsistently show slight (2-4%) increase hair count.5,6 
      • Adverse effectsApplication-site reactions most common (2-6%), more with higher concentrations.5-7 
  • Only trial comparing finasteride to minoxidil: Poor quality and unreliable.8 
  • Women: Systematic review.9 
    • Finasteride 1 mg (three RCTs, 287 women): No difference in any outcome.  
    • Minoxidil 1-5% versus placebo:  
      • Patient-rated moderate improvement or better (26% versus 14%, NNT=8) 
      • Increase in hair count, +13 hairs/cm2, at 6-12 months. 
Context:   
  • Prevalence of androgenic alopecia increases with age, with approximately ½ of men and  of women balding after age 70.10 
  • Numerous other interventions (like nutritional supplements or Handi-Dome Comb) have low quality evidence with inconsistent results.9,11 
  • Only minoxidil for women or men, and finasteride for men, are supported in guidelines.12,13   
 


Latest Tools for Practice
Derniers outils pour la pratique

#374 Vitamin D and Fracture Prevention: Not what it’s cracked up to be?

Does vitamin D prevent fragility fractures?
Read Lire 0.25 credits available Crédits disponibles

#373 Strategies for initiating insulin in type 2 diabetes

What is the optimal initial insulin for patients with type 2 diabetes?
Read Lire 0.25 credits available Crédits disponibles

#372 Mission Slimpossible Part 2: Oral GLP-1 agonists for weight loss

Are oral GLP-1 agonists effective for weight loss?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session


Author(s)
Auteur(s)
  • G. Michael Allan MD CCFP
  • Ricky D. Turgeon BSc(Pharm) ACPR PharmD

1. Mella JM, Perret MC, Manzotti M, et al. Arch Dermatol. 2010; 146:1141-50.

2. Gupta AK, Charrette A. J Dermatolog Treat. 2014; 25:156-61.

3. Belknap SM, Aslam I, Kiguradze T, et al. JAMA Dermatol. 2015; 151(6):600-6.

4. Gupta AK, Charrette A. SKINmed. 2015; 13:185-9.

5. Olsen EA, Dunlap FE, Funicella T, et al. J Am Acad Dermatol. 2002; 47:377-85.

6. Tsuboi R, Arano O, Nishikawa T, et al. J Dermatol. 2009; 36:437-46.

7. Olsen EA, Whiting D, Bergfeld W, et al. J Am Acad Dermatol. 2007; 57:767-74.

8. Arca E, Acikgoz G, Tastan HB, et al. Dermatology. 2004; 209:117-25.

9. van Zuuren EJ, Fedorowicz KZ, Schoones J. Cochrane Database Syst Rev. 2016; 5:CD007628.

10. Blume-Peytavi U, Blumeyer A, Tosti A, et al. Br J Dermatol. 2011; 164:5-15.

11. Blumeyer A, Tosti A, Messenger A, et al. J Dtsch Dermatol Ges. 2011; 9 Suppl 6:S1-57.

12. Tsuboi R, Itami S, Inui S, et al. J Dermatol. 2012; 39(2):113-20.

13. Blumeyer A, Tosti A, Messenger A, et al. J Dtsch Dermatol Ges. 2011 Oct; 9 Suppl 6:S1-57.

Authors do not have any conflicts to disclose.