Pills or Sprays: Which Hair Loss Treatment is Better?
When it comes to androgenetic alopecia (also known as male pattern hair loss), there are two main delivery methods for your medication: oral tablets and topical liquids. I often get asked what the difference between these two is, and which one is ‘better’. The simple answer is that in terms of effectiveness they are both largely comparable. Choosing the best option for you will end up being the medication that you are able to consistently maintain.
In the past few decades, treatments of male pattern hair loss have stuck to the ‘gold standard’ options of topical minoxidil and oral finasteride. Minoxidil is a vasodilator, which means it widens blood vessels to allow more oxygen and nutrients to get to the hair follicles. When applied to the scalp, it prolongs the growth phase of hair follicles. Topical minoxidil is effective in about 70% of people. Some people don’t respond to minoxidil because they don’t have enough of the enzyme sulfotransferase in the scalp, which converts minoxidil to its active form (minoxidil sulfate).
Finasteride is a type II 5-alpha reductase inhibitor, meaning it blocks the enzyme type II alpha reductase from converting testosterone to dihydrotestosterone (DHT). DHT is the main hormone responsible for the miniaturization of hair follicles that results in male pattern baldness. By blocking the production of this hormone, finasteride stops hair loss at the root (pun intended).
New approaches
In the last few years, a lot of research has gone into expanding the kind of treatments that we have available for male pattern hair loss. Finasteride now comes not only in the oral form but also as a topical solution and has been shown to be just as effective as the oral tablet in terms of hair count. Minoxidil, similarly, can now also be taken as an oral tablet.
To make life as easy as possible, these two medications are also now commonly put together into one single tablet or topical solution, forming a two-pronged approach that is more effective than using either one or the other. Another medication, dutasteride (which works similarly to finasteride but is more potent), can now also be combined with minoxidil.
Oral tablets
The benefit of taking a once-a-day tablet is that it is easy. Adding a small tablet into your daily routine is negligible shift in lifestyle. For those that use styling products or those with longer hair, it also means it is less trouble than a spray or oil which may leave some topical residue after application.
Oral tablets are swallowed and then absorbed into your bloodstream to work from the inside out. Because they circulate systemically throughout the body, they go to all organs and not just the scalp. This means that they have a slightly higher risk of side effects, as the effect of the medication isn’t just limited to the scalp.
The side effects that you might experience are most commonly due to the finasteride in the tablet. Because it blocks the creation of testosterone, it can cause sexual side effects like decreased libido, sexual dysfunction, testicular pain and mood changes. However, we give finasteride in a very low dose for male pattern hair loss, and so the risk of side effects is likewise very low. Less than 5% of people will experience these side effects. Minoxidil in tablets is also given in such a low dose that it very rarely causes side effects.
Topical medications
Topical medications have a lower risk of side effects as the medication goes straight onto the hair follicles, thus minimizing the amount of drug that enters the general circulation. For men who are concerned about the systemic side effects associated with the oral medications, the topical medication is a good choice. If you enjoy the ritual of grooming, the topical application can even feel proactive and satisfying.
Topical medications can however cause some scalp irritation. This is often due to the alcohol solution that is used to make up the medication. Most of the time, the irritation is short lived, however if it persists a less irritating solvent can be used.
The topical solution will also need to stay on the head for some time for it to be completely absorbed, with around 90% absorption at the 4-hour mark. For some people this can be difficult, for example if you like to style your hair with gel or sweat a lot. However, as most combination topical treatments these days only require once daily application, many of my patients overcome this by simply leaving the solution in overnight and washing it out in the morning.
Summary: pills or sprays?
Overall, the effectiveness of a pill vs spray is similar. It is important to remember that it takes roughly four to six months to see the first signs of visible change in the hair regrowth journey. Fo this reason, the ‘better’ treatment will be the one that you will never skip. If you travel frequently or have an unpredictable schedule, a bottle of tablets in your bag may be easier to manage. If you are concerned about the side effects associated the medication, the topical spray may be the better choice.
Regardless of what you choose, the most important step is professional oversight. Attempting to self-diagnose or use over-the-counter products without guidance can lead to wasted time and money. Hair loss is a progressive condition: the follicles you lose today are significantly harder to "wake up" two years from now.
If you'd like to speak to a hair loss doctor about your hair situation, book a free online consultation with one of our team. We'll be able to chat to you about which treatments are available, and what will be the most safe and appropriate one for you. If you can't see a time that suits you, get in touch with our team and we'll find a way to assist you.
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