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Male Androgenetic Alopecia — SCE Dermatology MCQ

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ModerateHair DisordersMale Androgenetic AlopeciaSCE Dermatology

A 23-year-old man presents with progressive hair loss. He has a receding frontal hairline with thinning at the vertex (Hamilton-Norwood grade IV). There is no scarring, scale, or inflammation. Family history is positive for baldness. What is the first-line pharmacological treatment?

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Correct answer: A — Both topical Minoxidil 5% and oral Finasteride

Male androgenetic alopecia (AGA) is optimally treated with combination therapy. Topical Minoxidil 5% (a potassium channel opener/vasodilator that prolongs anagen) and oral Finasteride 1 mg daily (a 5-alpha reductase type II inhibitor that reduces DHT) together provide synergistic benefit. BAD guidelines recommend both as first-line options. Minoxidil works predominantly on vertex thinning; Finasteride addresses both vertex and frontal recession. Finasteride side effects include decreased libido and erectile dysfunction (1-2%). Dutasteride is more potent but is used off-label for AGA.

Reference: BAD 2022 Male Pattern Hair Loss Guidelines