One male hair loss treatment works better than others, study finds

Male-pattern baldness affects most men at one point in their lives.

(CNN)A receding hairline. A bald spot spreading on the top of head. Painfully thin hair that is especially noticeable where the hair parts. Some 90% of men will suffer some form of hair loss during their lifetime, often leading to symptoms of low self-esteem, anxiety and depression.

Studies on which nonsurgical treatments work best for male-pattern baldness have been limited, leaving men at a loss as to the most effective solution.
    Now a new meta-analysis of 23 studies sheds light on that issue. The study, published Wednesday in the journal JAMA Dermatology, analyzed research on the impact on thinning male hair of using various dosages of the three oral and topical medications -- minoxidil, dutasteride and finasteride -- for two to four months.
      "This meta-analysis is important. We don't have randomized clinical trials that compare these medications for male pattern baldness against one another, which would be ideal," said dermatologist Dr. Anthony Rossi of Memorial Sloan Kettering Cancer Center in New York City, who was not involved in the study.
      Top performer: The analysis found taking 0.5 milligrams a day of oral dutasteride had the highest probability of reducing male hair loss.
      Dutasteride is a prescription drug approved by the US Food and Drug Administration for the treatment of enlarged prostate glands in men. It's also used to treat male-pattern baldness, but that use is considered "off-label" since dutasteride does not have FDA approval as a hair loss treatment.
        Off-label use is quite common in medicine, Rossi said. "Many medications are used off label, but there's usually enough evidence out there to explain why we believe those drugs will work," he added.
        Male pattern baldness is one of the most common types of hair loss.
        Dutasteride does have more severe side effects than several of the treatments, however, including a loss of sexual drive and the ability to get and keep an erection.
        Second place: Taking 5 milligrams a day of oral finasteride was second in effectiveness, the study found. Finasteride, another prescription drug in the same chemical family as dutasteride, is also used to treat enlarged prostate. It has received FDA approval as a treatment for hair loss.
        Finasteride also produced the greatest increase in total hair count at 48 weeks. A total hair count is just what it sounds like -- a count of all the different types of hair on a head, including finer baby hairs or "peach fuzz."
        Third place: The third most successful treatment for male pattern baldness was a pill containing 5 milligrams of oral minoxidil. That pill produced the greatest increase in terminal hair count at the end of two months, much stronger than the lower dose.
        "Terminal" hairs are the more mature hairs on the head (as compared to new, fine baby hairs) and are more likely to create that 'full head of hair" effect that many strive for, Rossi said.
        Fourth place: Taking a reduced dosage of finasteride, only a 1 milligram pill each day, came in fourth in the ability to reduce male hair loss, the study found. However, it did show the greatest increase in mature hair count at 48 weeks.
        Fifth place and lower: Using a 5% topical solution of minoxidil on the scalp was fifth in effectiveness, followed by the 2% solution of topical minoxidil. Last place in effectiveness, according to the study, was a much smaller dosage of oral minoxidil -- only 0.25 milligrams a day.
        One caveat: While the study did ultimately rank the treatments in descending order, each had different benefits at different times during the 24- and 48-week cycle, and each comes with its own unique set of problematic side effects.