On what parts of the scalp do Finasteride and Minoxidil actually work?
There is no permanent cure for male pattern baldness at this time. Medical treatments work best by retarding or preventing future hair loss. There are no known medications that can significantly regrow hair once it has been lost.
Although their mechanisms of action are different and although Finasteride is far more effective than Minoxidil they both work on similar “targets.” Both drugs work only on miniaturized hair by increasing their diameter. Neither medication will work on areas that are totally bald. Both work in any areas on the scalp that are subject to androgenetic changes i.e. the front, top and crown. The medications work best in the crown where the miniaturization period is more prolonged. However, if there is miniaturization in the front of the scalp the medications can regrow hair in this part of the scalp as well.
As far as preventing hair loss, they work in all parts of the scalp subject to androgenetic changes. Both medications are far more effective in preventing future hair loss than in regrowing hair.
Remember that Finasteride is far more effective than Minoxidil for both regrowing hair and preventing hair loss. Their actions do appear to be synergistic and their use together may be advantageous, particularly in young people.
Does Finasteride work only in the back of the head?
It can work all over, as long as the balding is not complete. It has the potential to work wherever there are miniaturized (fine) hairs. It is just that the crown has a longer phase where the hairs are in their transitional state. That is why it is important to treat the front early on.
Once I start Finasteride won’t I have to use it for life?
Not necessarily. You use it only as long as you want it to work to hold onto your hair. And there will be even better treatments in the future. However, regardless of future medical advances, it will always be much easier to hold onto your hair than to try and grow it back.
Dutasteride was FDA approved in 2002 for the treatment of BPH benign prostatic hyperplasia symptoms. Phase II FDA trials showed that dutasteride was superior to finasteride in increasing hair growth. Phase III FDA trials are currently on hold, believed due to the concerns about the long half life of dutasteride (5 weeks in contrast to finasteride’s 8 hours). The FDA’s lack of approval makes us reluctant to prescribe this drug at the present time, except in exceptional circumstances.