Physiological Difference Between Crown and Hairline Balding?

Dear Dr. Rassman,

My question is regarding the non-approved use of minoxidil for frontal balding. In your response here your thoughts were that it might work to some degree. My question is whether there is a physiological difference between balding at the hairline and on the crown? If not, is there some other reason why minoxidil might be less effective at the hairline, or is it simply the case that Pfizer didn’t test it there, and if not, why not as it would surely increase sales.

The drug PI in fact specifically says not to use it for receding hairline, do you believe that it’s possible that it may have negative effects? Further, is there a likelihood that minoxidil use by a man who in fact wasn’t balding but only having a maturing hairline would have negative effects (other that normal drug side effects)?

Many thanks

You raise an interesting question, but no one really knows why minoxidil or finasteride work better on the crown area. There may be a physiologic difference of hair follicles in the frontal area versus the hair follicles in the crown area, or it could be that hair loss in the frontal area is more rapid and medication works better when the hair loss is earlier with more miniaturized hairs. I do not think there is a danger or negative consequence of using the medication for the frontal area, though. In fact, many of my patients do use these drugs for the frontal area with some success.

I really do not know why the drug companies did not study the effect of the medication on the frontal area of the scalp. My cynicism would tell me that their initial results were very weak and they’d rather not publish poor results, but I actually believe that it was too complex for a good science study to show the type of results seen in the crown.