Male pattern hair loss (MPHL) is the most common hair loss disorder in men, also known as androgenetic alopecia (AGA) due to the unclear link with androgens. It is characterized by progressive thinning in the central, frontal, and parietal scalp regions. It’s a non-scarring condition resulting from hair follicle miniaturization (Fabbrocini et al., 2018). Baldness affects both men and women, though it is more commonly seen in men. MPHL accounts for 58% of diffuse hair loss aged 30–50 years among Indian men (Mysore et al., 2019).

Etiology and Pathogenesis

MPHL is a multifactorial condition primarily influenced by genetic predisposition and hormonal factors. Its pathogenesis involves the action of androgens, particularly dihydrotestosterone (DHT), which induces hair follicle miniaturization and alters the hair growth cycle. A comprehensive understanding of MPHL requires exploring genetic determinants, hormonal impacts, and cellular mechanisms. 

Genetic Factors 

MPHL is highly heritable, with recent studies identifying 389 genomic regions associated with the condition. Key genes implicated in MPHL are those involved in androgen signaling and hair follicle development, underscoring the genetic basis of the disorder (Henne et al., 2023). 

Hormonal Influence 

Androgens play a pivotal role in MPHL, particularly in the miniaturization of hair follicles within the frontal and vertex regions of the scalp (P et al., 2024; Goodarzi et al., 2009). The condition typically manifests during puberty, with as many as 80% of men experiencing some degree of hair loss over their lifetime (Henne et al., 2023). 

Cellular Mechanisms 

At the cellular level, MPHL involves a dysregulation of the hair growth cycle, marked by a shortened anagen phase and a prolonged kenogen phase, leading to progressively thinner hair (Redmond et al., 2023). Emerging evidence also points to the role of microRNAs in hair follicle biology, highlighting their potential involvement in the condition’s pathophysiology (Goodarzi et al., 2010). 

While genetic and hormonal factors remain central to MPHL, growing evidence suggests that environmental and lifestyle factors, including smoking and stress, may contribute to its progression (P et al., 2024). Understanding these multifactorial influences is essential for developing targeted therapeutic approaches. 

Cipla Ltd has developed a medication Tugain F+ for controlling Androgenetic alopecia. The product consists of Minoxidil 5% + Finasteride 0.1% Solution Fortified with 0.0033% Melatonin. Currently, there are only two US Food and Drug Administration (FDA)-approved drugs for AGA: topical minoxidil and oral finasteride.

The combination of minoxidil and finasteride is well-supported by clinical evidence, the role of melatonin remains less established (Chandrashekar et al., 2015; Husanain et al., 2021; Fischer et al 2004). This study seeks to provide insights into effectiveness of combination minoxidil, finasteride with melatonin, outcome of the treatment and also documenting the safety profile of this combination.