# Androgenetic alopecia (pattern hair loss)

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: BAD Guidelines for Male and Female Pattern Hair Loss · Egyptian National Drug Formulary - Endocrine System 2024 (finasteride monograph) · Regaine 5% Cutaneous Solution SmPC section 4.2 (eMC product 5765)
- Verified date: 2026-08

## Verified against

- Regaine 5% Cutaneous Solution SmPC section 4.2 (eMC product 5765)
- Egyptian National Drug Formulary - Endocrine System 2024 (finasteride monograph)

## Treatment metadata

- Minoxidil — topical
- Finasteride — 1 mg — oral.solid

## Complete treatment card

```text
ANDROGENETIC ALOPECIA (PATTERN HAIR LOSS)
Sources: BAD Guidelines for Male and Female Pattern Hair Loss · Egyptian National Drug Formulary -
         Endocrine System 2024 (finasteride monograph) · Regaine 5% Cutaneous Solution SmPC section
         4.2 (eMC product 5765)
Review status: REVIEWED against 2 sources listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (4)
    - Hair loss develops gradually and predictably after puberty  [hair loss]
    - In men it usually starts with thinning at both temples of the front scalp, later involving the
      crown
    - In women the thinning is more spread out, often centered on the crown while the front hairline
      is preserved
    - Early-onset disease in men is defined as starting before age 30
  SIGNS - what you find (1)
    - The Norwood-Hamilton scale grades severity in men, and the Ludwig scale grades it in women
  TESTS (6)
    - Dermoscopy can show miniaturized hairs and brown perihilar casts, helping separate this from
      alopecia areata
    - Alopecia areata instead shows exclamation-point hairs with a tapered fracture pattern on
      dermoscopy
    - A biopsy is usually not needed unless the diagnosis is unclear
    - Thyroid tests, a complete blood count, and iron studies such as serum iron, TIBC, and ferritin
      may be added to check for other causes
    - Syphilis screening can be considered if there is clinical suspicion
    - A brief mental-health screen for depression or other psychiatric conditions is suggested for
      hair-loss patients
  IF NOT THIS - what else fits (5)
    - Alopecia areata is a mimic to distinguish from pattern hair loss
    - Anagen effluvium, hair loss during the growth phase, is on the differential
    - Syphilis can cause hair loss and belongs on the differential
    - Various systemic illnesses are considered as alternative causes
    - Telogen effluvium is a differential, and can also unmask underlying pattern hair loss
  Source  StatPearls "Androgenetic Alopecia" - disease-level clinical article
  Status  traced to the source above

1. MINOXIDIL                                              [1st line]
   Adult    A dose of 1 ml Regaine for Men Extra Strength Scalp Solution 5% w/v Cutaneous Solution
            should be applied to the total affected areas of the scalp twice daily (total dosage
            should not exceed 2 ml). - long-term (continuous)
   Peds     Not indicated in children under 18 years
   Choice   Alternatives. Topical minoxidil is the first-line agent that carries no systemic sexual
            side effects, which matters when the treatment is cosmetic and indefinite.
   Source   Regaine 5% Cutaneous Solution SmPC section 4.2 (eMC product 5765)
   Why      Topical vasodilator that prolongs the growth phase of hair follicles and increases
            follicle size in pattern hair loss; the exact mechanism is not fully understood, and any
            benefit is only maintained with continued use.
   Caution  Initial transient shedding of hair during first 2-6 weeks of treatment is expected.
            Must be continued indefinitely; hair loss recurs within 3-4 months of stopping.
            Scalp irritation, contact dermatitis, and facial hypertrichosis (especially in women)
            may occur.
            Avoid in patients with scalp inflammation or breakdown.
            In women, the 5% strength is licensed as a once-daily foam; the twice-daily 5% solution
            is the men's regimen. Twice-daily 5% solution in a woman raises the risk of facial
            hypertrichosis.
            Contraindicated during pregnancy or lactation.
   Egypt    MINOXIDIL FORTE 5% TOPICAL GEL 60 GM EGPI > PHARMACARE                        127.00 EGP

2. FINASTERIDE                                            [1st line]
   Adult    1 mg once daily (men only) - Continue for 3-6 months to assess full effect; continuous
            use is recommended to sustain benefit
   Peds     CONTRAINDICATED in children and women
   Source   Egyptian National Drug Formulary - Endocrine System 2024 (finasteride monograph)
   Why      Selective 5-alpha reductase inhibitor for male pattern androgenetic alopecia
   Caution  STRICTLY CONTRAINDICATED IN WOMEN OF CHILDBEARING POTENTIAL: pregnant women must not
            touch crushed/broken tablets (teratogenic risk to male fetus).
            There are rare reports of persistent sexual side effects and depression post-
            discontinuation.
            Impotence occurs in >10% of patients; decreased libido and ejaculatory disorders occur
            in 1-10%.
   Egypt    PROHAIR 1 MG 30 TAB.             SIGMA               24.00 EGP (0.80/unit)
            NOPECIA 1 MG 30 CAPS.            ADWIA               36.00 EGP (1.20/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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