Response: Finasteride's Effect on Frontal and Vertex Hair Loss

In a letter to the editor, Walter Unger raised concerns about Marc Avram's statement that finasteride and minoxidil work well on the frontal scalp as well as the vertex, citing a study by Leyden et al. as evidence. Unger pointed out that the "frontal area" in Leyden's study was defined differently from what hair restoration surgeons typically consider the frontal area, which is from the hairline to a line drawn vertically from the tragus of the ears. Unger argued that Leyden's study did not provide definitive information on finasteride's effect on the surgical frontal area and that the response to finasteride in this area has not been scientifically studied. In response, Avram defended the practical positive effect of finasteride on the vertex and frontal scalp, suggesting that the clinical effects should not be confused with FDA labeling requirements and that further studies on the frontal scalp are not necessary once a medication is FDA-approved.