What can I do to keep from losing my hair?

washingtonpost.com

I get this question all the time at the student health center, which tells me that it’s time to drop some scalp science on you.  (DISCLAIMER – We are talking about hair loss in men.  Hair loss in women is a little trickier to diagnose and manage, and should be evaluated by a health care provider.)

You’ve basically got two options when it comes to preventing or treating male-pattern baldness:

Minoxidil (Rogaine) is a topical medication that is available without a prescription.  It comes in a 2% solution and a 5% solution or foam.  (I’ve seen a 15% strength advertised online but this is not FDA approved and is probably made in an off-shore pharmacy so best to stay away from it).  The 5% strength works a little better but has a higher incidence of skin irritation and itching.  The foam may be a little less irritating than the solution.

  • Not covered by insurance – costs around $30 per month
  • Must be used twice a day for at least 4 months before you can say whether or not it’s working
  • The maximum benefit plateaus at 12-18 months
  • It’s successful in about 30-40% of men who use it
  • Once you stop using it, all hair that has been maintained or re-grown will be lost

Finasteride (Propecia) is a prescription only oral medication that comes in a 1mg pill.  It works by blocking an enzyme that converts testosterone to dihydrotestosterone in the scalp.  A 5mg version is used to treat benign prostate enlargement – side effects at that dose include decreased sex drive and erectile dysfunction, but they aren’t seen too often with the 1mg dose.  Although it doesn’t affect testosterone in the body, finasteride has such a high risk of causing birth defects in male fetuses that pregnant women are advised to not even touch the medication.    

  • Also not covered by insurance – costs a little over $60 per month.
  • It’s successful in about two-thirds of men who use it
  • Positive effect continues to increase after 2 years of use
  • Improves not only hair count, but also length and thickness and color
  • Once you stop using it, all hair that has been maintained or re-grown will be lost

So they both work, but not always and only for as long as you are using them.  Finasteride works better than minoxidil and is easier to use, but it’s more expensive and has potentially worse side effects.  They’re both pretty expensive – we’re talking $360 to $720 a year – and you pick up the tab completely.

Like all medicines, you have to weigh the benefits and risks of taking it.  And you don’t need to take anything for your hair.  I mean, sure I’d love to have the flowing mane of Troy Polamalu, but paying 60 bucks a month for a pill that pregnant women can’t even touch!?  I’ll buy a hat, thanks.

But if you feel otherwise, you’re always welcome to come in to the Student Health Center and talk it over with us.

John A. Vaughn, MD
Student Health Services
The Ohio State University

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