Finasteride in the treatment of men with androgenetic alopecia

  • Keith D. Kaufman
    Affiliations
    Department of Clinical Research, Merck Research Laboratories, Rahway, New Jersey
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  • Elise A. Olsen
    Affiliations
    Duke University Dermatopharmacology Study Center, Durham, North Carolina
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  • David Whiting
    Affiliations
    Baylor Hair Research and Treatment Center, Dallas, Texas
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  • Ronald Savin
    Affiliations
    Savin Dermatology Center, New Haven, Connecticut
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  • Richard DeVillez
    Affiliations
    Division of Dermatology, University of Texas Health Science Center, San Antonio, Texas
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  • Wilma Bergfeld
    Affiliations
    Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
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  • Vera H. Price
    Affiliations
    Department of Dermatology, University of California, San Francisco, California
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  • Dominique Van Neste
    Affiliations
    Skin Study Center, Tournai, Belgium
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  • Janet L. Roberts
    Affiliations
    Northwest Cutaneous Research Specialists, Portland, Orgeon
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  • Maria Hordinsky
    Affiliations
    Department of Dermatology, University of Minnesota Twin Cities, Minneapolis. Minnesota
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  • Jerry Shapiro
    Affiliations
    Department of Dermatology, University of British Columbia, Vancouver, Canada
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  • Bruce Binkowitz
    Affiliations
    Department of Clinical Biostatistics, Merck Research Laboratories, Rahway, New Jersey
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  • Glenn J. Gormley
    Affiliations
    Clinical Development, US Medical and Scientific Affairs, Merck & Co, Inc, Horsham, Pennsylvania
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  • the Finasteride Male Pattern Hair Loss Study Group
    Author Footnotes
    * The Finasteride Male Pattern Hair Loss Study Group includes (in alphabetical order) R. Asarch, N. Birchall, I. H. Boersma, S. Brenner, K. Bruno, D. Buntin, G. Burg, J. Cilliers, P. Cotterill, W. J. Cunliffe, D. Ferguson, V. Fiedler, D. Fivenson, T. Funicella, C. Gencheff, D. Gratton, W. He, S. Horwitz, J. Imperato-McGinley, F. Jurado Santa-Cruz, I. Katz, A. P. Kelly, D. Kopera, P. Kotey, J.-M. Lachapelle, M. Ling, E. Lopez-Bran, N. Lowe, A. Lucky, S. MacDonald Hull, A. McDonagh, C. Mork, G. Peck, E. Prens, P. Reygagne, R. Rietschel, R. Rittmaster, E. Round, T. Rufli, N. Sadick, P. Saiag, P. Sanchez-Pedreno, J. B. Schmidt, M. Sher, J. Shupack, D. Steiner, D. Stewart, M. Stiller, D. Stough, J. Swinehart, L. Swinyer, G. Todd, W. Unger, J. Waldstreicher, G. Weinstein, D. Weiss, J. Weiss, S. E. Whitmore, and H. Wolff.
  • Author Footnotes
    * The Finasteride Male Pattern Hair Loss Study Group includes (in alphabetical order) R. Asarch, N. Birchall, I. H. Boersma, S. Brenner, K. Bruno, D. Buntin, G. Burg, J. Cilliers, P. Cotterill, W. J. Cunliffe, D. Ferguson, V. Fiedler, D. Fivenson, T. Funicella, C. Gencheff, D. Gratton, W. He, S. Horwitz, J. Imperato-McGinley, F. Jurado Santa-Cruz, I. Katz, A. P. Kelly, D. Kopera, P. Kotey, J.-M. Lachapelle, M. Ling, E. Lopez-Bran, N. Lowe, A. Lucky, S. MacDonald Hull, A. McDonagh, C. Mork, G. Peck, E. Prens, P. Reygagne, R. Rietschel, R. Rittmaster, E. Round, T. Rufli, N. Sadick, P. Saiag, P. Sanchez-Pedreno, J. B. Schmidt, M. Sher, J. Shupack, D. Steiner, D. Stewart, M. Stiller, D. Stough, J. Swinehart, L. Swinyer, G. Todd, W. Unger, J. Waldstreicher, G. Weinstein, D. Weiss, J. Weiss, S. E. Whitmore, and H. Wolff.

      Abstract

      Background: Androgenetic alopecia (male pattern hair loss) is caused by androgen-dependent miniaturization of scalp hair follicles, with scalp dihydrotestosterone (DHT) implicated as a contributing cause. Finasteride, an inhibitor of type II 5α-reductase, decreases serum and scalp DHT by inhibiting conversion of testosterone to DHT. Objective: Our purpose was to determine whether finasteride treatment leads to clinical improvement in men with male pattern hair loss. Methods: In two 1-year trials, 1553 men (18 to 41 years of age) with male pattern hair loss received oral finasteride 1 mg/d or placebo, and 1215 men continued in blinded extension studies for a second year. Efficacy was evaluated by scalp hair counts, patient and investigator assessments, and review of photographs by an expert panel. Results: Finasteride treatment improved scalp hair by all evaluation techniques at 1 and 2 years ( P < .001 vs placebo, all comparisons). Clinically significant increases in hair count (baseline = 876 hairs), measured in a 1-inch diameter circular area (5.1 cm 2 ) of balding vertex scalp, were observed with finasteride treatment (107 and 138 hairs vs placebo at 1 and 2 years, respectively; P < .001). Treatment with placebo resulted in progressive hair loss. Patients’ self-assessment demonstrated that finasteride treatment slowed hair loss, increased hair growth, and improved appearance of hair. These improvements were corroborated by investigator assessments and assessments of photographs. Adverse effects were minimal. Conclusion: In men with male pattern hair loss, finasteride 1 mg/d slowed the progression of hair loss and increased hair growth in clinical trials over 2 years. (J Am Acad Dermatol 1998;39:578-89.)
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