ANDROGENETIC ALOPECIA QUESTIONS

DHT is important in the pathogenesis of androgenetic alopecia. But no, it’s not the only mechanism. In fact, in women, it has even less of a role for some women. It’s a mistake to assume that AGA is strictly a DHT driven process. It sure is important - but no, it’s not the only process. Laser is listed as a second line agent because a limited number of reasonably well conducted studies have shown benefit. Evidence for PRP is even weaker. Much of what we do as hair loss practitioners is treat downstream events rather than the precise cause because we don’t fully understand the cause for most things (even AGA we don’t fully understand). But at the end of the day, what matters is that the treatments we offer to patients help them. PRP and laser can help human beings with hair loss.

Thanks for the question.

There are a few options in a situation like this.

a) Reduce the dose and accept the fact that there could be a reversal of the nice effects

b) Continue the dose and bring onboard strategies to fight the swelling.

Reducing the dose will likely cause some hair loss. It could be a lot, or it could be a little. It’s hard to say. That’s just the reality.

The second option is to try to reduce the effects of the oral minoxidil on swelling.

a) A dramatic reduction in salt intake helps a lot. So if patients normally salt their food, it’s worth advising them not to salt quite so much. Sometimes, this helps a lot.

b) The second option is to add an oral diuretic. I’m not a great fan of this plan in males as, generally speaking, I don’t like addressing side effects with more and more drugs. However, for women, spironolactone is a treatment for AGA anyway, and sometimes 25-50 mg helps the swelling and perhaps helps the AGA a bit. If well tolerated, then patients can increase to 50-100 mg. The maximum dose is 200 mg (taken as 100 mg twice daily).

c) Some patients can use diuretic teas as well. I don’t think they do all that much for most people but I have been surprised in some. Examples include Milk Thistle Tea, Green Tea, Peppermint, Nettle and Dandelion Root. They are not without possible side effects, but fortunately, the side effects are low. Practitioners should review side effects before recommending anything.

d) Switching to topical minoxidil. We are in a bit of an oral minoxidil frenzy right now. 1 mg is fairly equivalent to 5 % minoxidil in women. So yes, the patient could improve with a switch to topical. Oral minoxidil is not necessarily better than topical minoxidil. At very low doses of oral minoxidil, it’s fairly equivalent.