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Hair Care

What Hair Loss Drugs Can Fix Your Receding Hairline?

Hair loss and recession of the hairline are common events as the person grows older. Most of us look to hair loss drugs like finasteride and minoxidil to fix it. But does it work?

Hormonal imbalances, nutrient deficiencies, stressors, and genetic factors contribute to the onset of hair loss.

One of the most common forms of hair loss is androgenic alopecia characterized by an exaggerated response to androgens resulting in excess hair loss. This can be treated by using oral finasteride, a 5-alpha reductase inhibitor.

So, in this article, we’ll find out if finasteride works for receding hairlines, and why?

If you’re wondering why we’re not talking about minoxidil, we’ve covered them in another article here.

Important: If you’re a female, finasteride won’t work for you – due to its working mechanism. Therefore, you should look for other remedies for female pattern baldness and receding hairline such as minoxidil.

female receding hairline

What is a receding hairline?

Receding hairline, also known as hair recession occurs as the hairline moves back across the scalp. Not only does the hairline recedes, but the hair may also grow thinner. Hairline recession is commonly seen in male and female pattern baldness.

In some hair loss conditions, hair loss occurs at both the temples more rapidly than at the frontal region of the scalp, giving the hairline the characteristic V shape also called widow’s peak. On the contrary, the hairline recession may involve both the temples and frontal region of the scalp, giving a more uniform appearance to the hairline.

What are the common causes of hair loss?

Following are the common causes of hair loss that may lead to recession of the hairline:

Genetics

Some people have a greater genetic predisposition to hair loss than others. Receding hairline is the first sign of hereditary hair loss among men along with the appearance of a bald spot. On the contrary, females suffer from diffuse thinning of hair in this condition. Androgenetic alopecia is a form of hereditary hair loss characterized by the exaggerated response of hair follicles to androgens in the body.

Age

The metabolism and energy levels decline as the person grows older. Likewise, hair follicle cells divide less rapidly as the metabolism declines, therefore, hair grows at a slower rate. This leads to hair thinning and hairline recession.

Alopecia Areata

This is an autoimmune condition characterized by immune-mediated damage to the hair follicles. Alopecia areata not only affects scalp hair but also leads to hair loss in different parts of the body.

Cancer Therapy

This includes chemotherapy and radiotherapy for cancer treatment. The radiation and/or chemicals target the rapidly dividing body cells including hair follicle cells. However, hair growth is restored upon withdrawal from the therapy.

Telogen Effluvium

This is characterized by hair loss in the presence of internal and environmental stressors. Pregnancy, surgery, and emotional stress may cause the hair follicles to enter the telogen phase of the hair growth cycle prematurely resulting in excessive hair loss. Hair loss ceases some time after the removal of these stressors.

Traction Alopecia

This is used to describe hair loss that occurs due to excess pull on the hair roots during hair styling.

Endocrine Abnormalities

Hair loss may also be a manifestation of hormonal imbalances in the body that disrupt the human hair growth cycle. Women who consume oral contraceptive pills or suffer from polycystic ovarian syndrome (PCOS) may experience a permanent loss of hair.

Scalp Infections

Fungal and bacterial infections of the scalp may also lead to hair loss. Infections lead to inflammatory and scarring alopecia giving rise to stubs of hair in mild or bald spots on the scalp in more severe cases.

Thyroid Disorders

Thyroid abnormalities may also manifest as hair loss which is reversible upon treatment of these pathologies.

What happens in a hair growth cycle?

man looking at mirror receding hairline worried

The normal human hair growth cycle comprises the following stages.

Anagen or Growth Phase

Approximately 85% of the total scalp is in the anagen phase of the hair growth cycle at a given time. During this phase, melanin synthesis occurs in the hair follicles and the cells undergo rapid proliferation. This is also accompanied by an increased extracellular matrix and thickness of the dermal papilla.

Catagen or Transitional Phase

This phase of the hair cycle lasts for about 2-3 weeks. This phase is characterized by the cessation of the proliferation of hair follicle cells and melanin synthesis. The root bulb regresses towards the scalp surface and forms a club-like structure.

Telogen or Resting Phase

This is the last phase of the hair growth cycle after which the hair strands are shed. The telogen phase may last for several months. During this phase, the hair remains attached to the follicles and may be shed either due to the growth of anagen hair or during brushing and washing hair. At a given time, approximately 10-15% of the total scalp hair is present in this phase of the hair growth cycle.

What is finasteride?

Finasteride is a 5-alpha reductase inhibitor that is approved by the US Food and Drug Administration (FDA). This pharmacologic agent is widely used for the hair restoration treatment of benign prostatic hyperplasia (BPH), androgenic alopecia or male pattern baldness, and signs and symptoms of hyperandrogenism. Finasteride dosage for BPH is approved at 5 mg while for hair loss conditions, the approved finasteride oral dosage is 1 mg.

Finasteride has a mean bioavailability of 65% in an oral dosage of 1 mg. This indicates the greater efficacy of finasteride even at relatively lower doses. Finasteride undergoes extensive metabolism in the liver and may excrete in both faeces and urine. The terminal half-life of finasteride is 5-6 hours in most individuals. Food intake does not hinder the bioavailability of finasteride.

How does finasteride work?

Higher levels of dihydrotestosterone (DHT) disrupt the hair growth cycle leading to excessive hair loss and hairline recession. Finasteride, a 5-alpha reductase inhibitor, reduces the concentration of DHT both locally and in the serum. Finasteride works by competitive inhibition of types II and III 5-alpha reductase. These enzymes are commonly found in the outer root sheath of the hair follicles as well as in the dermal papilla.

Finasteride suppresses the catalytic activity of types II and III 5-alpha reductase, thus halting the production and release of DHT. Reduced levels of DHT are important for normal progression of the hair growth cycle and reduction in hair loss. Finasteride also prevents DHT from shrinking the hair follicles, ensuring that the follicle cells proliferate rapidly and normally.

Inhibition of these two 5-alpha reductase isozymes leads to a reduction of DHT levels up to 90% in the prostate gland and 70% in the serum. Finasteride has minimum inhibitory effects on type I 5-alpha reductase which is present in the liver and sebaceous glands of the scalp, however, type II 5-alpha reductase has far greater importance concerning androgenic alopecia.

Finasteride is contraindicated in individuals who are suffering from hepatic impairment. The safety and efficacy of finasteride use are also not established in pediatric, geriatric, pregnant, and breastfeeding patients. Finasteride may elicit hypersensitivity reactions in susceptible individuals and individuals who are consuming this medication shall abstain from donating blood.

Does finasteride regrow your receding hairline?

man applying finasteride on scalp

The treatment regimen is initiated with a 0.5 mg dose of finasteride per day. This is followed by a 1 mg oral dose of finasteride per day once the patient is comfortable. Noticeable results and hair loss improvement appear about 3-6 months after initiating finasteride treatment. However, one shall not discontinue using finasteride as this may lead to the remission of hair loss and BPH symptoms.

Oral finasteride is relatively safe in the given dosage of 1 mg per day. In case of any adverse reactions to the drug, one must consult his or her doctor for the management of these adverse effects. One must also refer to his or her doctor before discontinuing the drug. During the treatment, prostate-specific antigen (PSA) levels must be monitored as finasteride is associated with the onset of high-grade prostate cancer.

How fast will you see results from finasteride for your hairline?

There is no guarantee of exactly when you will see hair regrowth. Although finasteride starts working the moment you apply it, your hair takes time to grow safely and healthily.

In one study of Korean male patients suffering from male pattern hair loss, finasteride has been shown to provide results anywhere from 3 to 6 months.

For others, it might take up to one year.

In another study in J Am Acad Dermatol, research showed that finasteride efficacy stabilized in the second year of continuous usage.

It’s important to note that you might not see any visible improvements within the first few months of usage, and it doesn’t necessarily mean it’s not working.

If you’re experiencing hair loss, finasteride might just be able to stop your receding hairline.

Can you combine minoxidil and finasteride for your receding hairline?

After hearing that, you might want to combine your finasteride tablets with topical minoxidil. After all, if both of them have different mechanisms and both of them target your hair loss, it would make sense to use them together as your hair loss treatment.

The good news is yes, you can combine these two hair loss prevention options. Various studies (like this one) have highlighted the improved effectiveness when combined together.

Are there side effects to finasteride?

Common adverse effects experienced during finasteride male hair loss treatment include sexual dysfunction, loss of libido, gynecomastia, and orthostatic hypotension which may be exaggerated with the concomitant use of alpha-blocker medications. Post-finasteride syndrome (PFS) is characterized by the persistence of adverse effects even after withdrawal of the finasteride treatment option.

The characteristic features of PFS are classified under three domains – sexual, psychological, and physical adverse effects.

Sexual adverse effects

These include sexual dysfunction, loss of libido, enlarged prostate, ejaculatory abnormalities, erectile dysfunction, atrophy of the testicles, impaired orgasm, and hypogonadism. Ejaculatory abnormalities may include reduced ejaculatory volume and force. Sexual adverse effects also contribute to psychological disturbances in patients suffering from PFS.

Psychological adverse effects

Individuals who are suffering from PFS may experience psychological derangements as well. These include slow cognitive potential, increased risk of self-harm, emotional and sleep disturbances, and other psychological pathologies. People may also suffer from brain fog or mental cloudiness and anxiety disorders.

Physical adverse effects

These include the onset of skin rash, metabolic abnormalities, and gynecomastia in individuals who consume oral finasteride. People may also experience muscle spasms, fasciculations, tremors, ataxia, myalgia, arthralgia, headache, migraine, chronic fatigue, and dizziness.

Finasteride & Receding hairline: The Verdict

Yes, finasteride will work to regrow your receding hairline.

Finasteride is an FDA-approved oral hair loss medication used for the treatment of hair loss in individuals suffering from androgenetic alopecia.

Finasteride works by inhibiting 5-alpha reductase and reducing the production of DHT.

Oral finasteride is relatively safe, however, this may be associated with PFS in some individuals including psychological, sexual, and physical adverse effects of finasteride even after withdrawal.

If you are wary of its side effects, take a look at hair transplant surgery.

Read more:

References

  1. https://www.nhs.uk/conditions/hair-loss/
  2. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8583126/
  3. https://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138795
  4. https://www.sciencedirect.com/topics/medicine-and-dentistry/hair-growth
  5. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3481923/
  6. https://www.ncbi.nlm.nih.gov/books/NBK513329/
  7. https://www.nhs.uk/medicines/finasteride/
  8. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7231981/
Dr. Ahmad Chaudhry M.D.
Dr. Ahmad Fayyaz Chaudhry earned his MBBS degree from Punjab Medical College, Faisalabad, in 2020. During graduation, he enrolled himself in the Dermatology Ward DHQ Hospital Faisalabad for all the necessary training required to pass the bachelor's exam and encounter dermatological diseases daily. Currently, he is posted as a House Physician in the Medical Unit 3 Allied Hospital Faisalabad, where he encounters all kinds of hepatic, cardiac, neurological, and dermatological diseases daily.

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