AGA and FAGA medications: How effective are they? Expectations based on research and remaining limitations

Finasteride, an oral medication for AGA, increased hair count at one year in a large trial of 1553 people, providing a solid research foundation[1]. In contrast, combination drug therapies and treatment for female hair loss are primarily based on small trials, with some showing mixed results[2][3][4]. The range of expected results varies by sex and the medication used.

How well-established is the research on oral medications for male AGA?

In men, the effects of 1 mg finasteride are most well-established. In a randomized trial of 1553 people, hair count at the crown after one year increased significantly more than with placebo[1].

Dutasteride, which has a stronger mechanism of action, showed greater efficacy than finasteride in some trials[5]. However, a review combining multiple studies took the position that there is still no clear evidence supporting its use in men[6]. This is a medication where research assessments vary.

How much difference does combining topical medication make?

The effects of combination therapy show mixed results across studies. A review combining 7 trials with 396 people found that a topical mixture of minoxidil and finasteride improved hair density and thickness compared to minoxidil alone[2].

On the other hand, in a trial comparing 40 people over 12 weeks, hair increased in both groups, but there was no difference between them[3]. The authors of the combined review also noted the need for confirmation in larger, longer-term trials[2].

There is a report that 5% topical minoxidil was more effective than 2%, resulting in 45% more hair growth at 48 weeks[7].

What are the expectations and risks of oral minoxidil?

While oral minoxidil improves the condition in many people, attention must also be paid to side effects. In a review combining 27 studies with 2933 people, 35% showed clear improvement and 47% showed improvement[8]. However, side effects were observed in 27%[8].

This review combined data without a comparison group, and the authors noted that further research is needed to confirm efficacy and safety[8]. Textbooks also note that large studies examining the dosage and safety of oral minoxidil have not yet been conducted[7].

What is known about FAGA in women?

In female hair loss, the same medications used in men cannot necessarily be applied directly. A review stated that there is not yet clear evidence for the use of finasteride or dutasteride in women[6].

In a trial of 48 premenopausal women, adding the oral medication spironolactone to topical minoxidil resulted in moderate or greater improvement in 38%, exceeding the 9% without the addition[4]. However, menstrual irregularities were observed in 37.5%[4].

A report reviewing spironolactone studies found that 56.60% of people improved[9]. On the other hand, 37.80% showed no change or only slight improvement[9]. For female hair loss, screening for other causes of hair loss and checking for elevated androgens is also recommended[1].

In a trial of 40 women, adding weekly treatment with a fine-needle microneedling technique to 2% minoxidil resulted in efficacy in 85%, higher than 45% with minoxidil alone[10]. However, this is a small trial and the results have not been repeatedly confirmed[10].

What are the research limitations? When can results be judged?

Most trials assess efficacy at 24 weeks (approximately 6 months) to one year[1][4][10]. It is important not to conclude that medication is ineffective even if there is no change in a few weeks.

On the other hand, studies on female treatment and drug combinations are often small, and long-term results are still insufficient[2][9]. Research figures are averages, and you may not experience the same effects.

Organizing the following points before your consultation will help the discussion progress more smoothly.

Where hair loss is occurring and when it began to increase[1]

For women: menstrual patterns, changes in acne or hair growth, and plans for pregnancy[1][4]

Concerns about side effects: whether you prefer to start with oral or topical medication[8]

Whether your hair loss is AGA or FAGA and which medication to start with cannot be decided from an article alone. During your consultation, have your scalp and hair condition examined, confirm there are no other causes, and discuss the balance of efficacy and side effects with your doctor.