AGA and FAGA treatment: what is the difference between oral and topical medications? How drug selection differs between men and women

Treatment drugs for AGA and FAGA fall into two categories: oral medications that reduce the male hormone that causes hair loss, and minoxidil, which widens blood vessels[1]. Both options are available for men, but women with the possibility of pregnancy face strong restrictions on oral medications that reduce hormones[2][3]. Which to choose depends on sex, how the drug works, and how side effects appear.

Oral versus topical medications: how does their mechanism of action differ?

Finasteride and dutasteride are oral medications that reduce DHT, the male hormone that causes hair loss[1]. Minoxidil is a medication that widens blood vessels, and it prevents hair loss through a different mechanism[1].

The only hair loss treatment drugs approved in the United States are finasteride 1 mg oral medication and minoxidil topical medication (5% and 2%)[1].

In men, do medications differ in how well they work?

Differences have been reported. In an analysis comparing male hair loss treatments, the most effective among the treatments compared was dutasteride 0.5 mg daily[1].

When limited to approved drugs, the results showed that finasteride 1 mg was most effective among oral medications, and minoxidil 5% was most effective among topical medications[1]. There is also expert consensus that finasteride should be the first choice based on approval status and other factors[3].

Topical minoxidil is said to work clearly in about 3–4 out of every 10 people[4]. Hair does not grow in everyone who uses it; only about 3–4 out of 10 people experience results.

How does the selection process change for female FAGA?

In women, minoxidil is the mainstay of treatment. A summary of research showed good response in women with minoxidil (5% and 2%) and low-level laser therapy[5].

Oral medications that reduce hormones are handled carefully in women. Finasteride is not recommended for women of childbearing age with the possibility of pregnancy[3], and there is concern about effects on the developing fetus[6].

When using dutasteride, contraception must be continued for at least 6 months after stopping the medication[2].

In women, spironolactone, a medication originally used for high blood pressure, is sometimes used[2]. In an analysis examining oral spironolactone, improvement was seen in 56.6% overall[7].

When combined with other treatments, it was 65.8%; as monotherapy, it was 43.2%, showing a difference[7]. On the other hand, 37.8% of people showed no improvement or only minimal improvement[7].

How do side effects differ among medications?

Finasteride has been associated with decreased libido and erectile dysfunction. In clinical trials, these side effects occurred in 3.8%, compared to 2.1% with placebo[6].

Some side effects may persist even after stopping the medication, and this should be explained in advance[1]. In clinical trials of dutasteride in men, the frequency of side effects showed no major difference from placebo[6].

Topical minoxidil can cause scalp itching, dandruff, and redness[4]. In women, it is recommended to receive an explanation about the possibility of increased hair density on the face and other areas[8].

Can PRP injections and similar treatments replace medications?

Not replace, but rather supplement medications. Expert consensus positions PRP (platelet-rich plasma derived from your own blood) as an addition to minoxidil or finasteride, not for use alone[8].

An analysis found that adding PRP to minoxidil improved hair density[9]. However, 3 of the 5 underlying trials had a high risk of bias, and the results should be interpreted with caution[9].

What is decided during a consultation to find a treatment suited to you?

Which medication is appropriate depends on sex, pregnancy plans, progression of hair loss, and existing conditions and medications you are taking. This cannot be decided from an article alone.

During your consultation, confirm whether hair loss is truly caused by AGA or FAGA, whether you plan to become pregnant, and what to do if side effects occur.