Male androgenetic alopecia (Part II)

Androgenetic alopecia only becomes a medical problem when the hair loss is excessive, premature and distressing to the patient. A number of medical treatments aimed at arresting the progression of the hair loss have become available in recent years, and surgical treatments are constantly being refined. The three distinct aims of therapy for male androgenetic alopecia are: to arrest further progression, to stimulate regrowth and to conceal the hair loss. Topical minoxidil stimulates regrowth but may or may not arrest further progression. Oral 5 alpha reductase inhibitors arrest further progression but may or may not stimulate regrowth. Hair transplantation, coloured hair sprays, wigs and toupees conceal the hair loss but do not stimulate regrowth or arrest further hair loss. Hair transplantation redistributes hair more evenly over the scalp. Substantial efforts have been undertaken to refine the methods used to evaluate therapeutic response and define acceptable primary and secondary endpoints for clinical trials. Currently the US Federal Drug Association (FDA) accepts numerical hair count data and patient subjective response as primary endpoints and standardized scalp photography as a secondary endpoint. This difficulty in evaluation of outcome is magnified in clinical practice where hair counts are not feasible and the clinician relies overly on patient subjective assessment. Serial scalp photography is especially valuable in this setting.