Sara Wasserbauer, M.D.

Two hair restoration medications have been approved by the U.S. Food and Drug Administration after appropriate double-blind, placebo-controlled clinical trials. It is important to note that only two hair restoration medications have won such approval. Many products are advertised and marketed with a claim for hair restoration, but few have ever been subjected to the clinical trials necessary to prove efficacy and safety.

• Minoxidil (Rogaine®)—a topical solution available over-the-counter in 2% and 5% strengths. Minoxidil is effective in some people, moderately effective in some, and ineffective in others. When effective, minoxidil can retard hair loss and stimulate new hair growth. Its mechanism of action is not well understood. Best results with minoxidil are often achieved by combining the topical solution with hair restoration surgery.

• Finasteride (Propecia®)—an oral medication that treats the root cause of male-pattern hair loss by inhibiting the activity of the hormone responsible for hair loss. Finasteride is available only by prescription. Finasteride is usually not prescribed for women; women who may become pregnant are at risk for a certain type of birth defect in the unborn child. Finasteride works best for early to moderate degrees of hair loss. Men with extensive hair loss are unlikely to have much regrowth. Regrowth associated with finasteride is better over the crown of the scalp than at the frontal receding hairline. When used in conjunction with hair transplantation, finasteride may prevent further hair loss while transplantation fills in areas such as the frontal hairline.

Hair Additions and Replacements

A small number of people with hair loss are not candidates for surgical or medical hair restoration. For these persons, hair additions or total hair replacement may be considered:

• A person with temporary total hair loss due to radiation or chemotherapy may be a candidate for temporary total hair replacement (a wig).
• A person who is congenitally unable to grow hair may be a candidate for permanent total hair replacement (a wig, or several wigs for different occasions)
• Hair additions may be a temporary measure for the person who wants hair loss corrected but is not yet ready to undergo hair transplantation.
• Hair additions or replacements may be considered by the person who has too little donor dominant hair for use in hair transplantation.

The physician hair restoration specialist can recommend hair additions and replacements for those persons who are not candidates for surgical or medical hair restoration.