Finasteride is a prescription drug used to treat hair loss and promote scalp hair growth. It is perhaps the most extensively studied medication for male pattern baldness. In this article, we discuss the use, dosage, mechanism of action and side effects of finasteride.
Finasteride prevents the androgen-dependent miniaturization of hair follicles by preventing the conversion of testosterone to DHT, the hormone responsible for male-pattern hair loss. DHT, or dihydrotestosterone, is an androgen produced from testosterone. In men susceptible to hair loss, DHT can bind to receptors in the hair follicles and cause them to shrink and eventually die.
1mg of finasteride can lower serum and scalp DHT levels by 60%.
Many clinical trials and results of 10-year follow-up studies confirm significant durable increases in hair growth after finasteride treatment. Finasteride is able to stop hair loss in over 95% of men that take it. 66% of patients will achieve moderate hair regrowth and 5% marked hair regrowth. Finasteride is most effective on the vertex scalp, less on the frontal scalp and it is least effective on the temporal regions.
In addition to improved hair counts, finasteride treatment leads to increased hair thickness as well.
Finasteride should be continued for at least 12 months to assess its full effect. Long term studies have found that the result after one year may predict its effectiveness going forward. Patients who fail to respond in the first year are likely to be non-responders’ long term. Finasteride needs to be continued indefinitely to maintain efficiency. It only works for as long as it is used.
The optimum dosage suggested for the treatment of male pattern hair loss is 1 mg/day. Finasteride may be orally administered with or without meals, as the absorption is not affected by food.
Finasteride is generally well-tolerated. Side effects associated with finasteride include low libido, erectile dysfunction, reduced ejaculatory volume, temporary reduction in sperm count, testicular pain, depression and gynecomastia. Post-finasteride syndrome (PFS) has been a recently reported issue. This term refers to the continuation of adverse effects despite the discontinuation of therapy. Further investigational studies to better understand post-finasteride syndrome are currently underway.
Finasteride may cause hair shedding a few weeks after beginning treatment. This is caused by the reactivation of the dormant hair follicles and it is actually a positive sign that finasteride works. Shedding will subside within a few months as hair regrowth becomes more evident.
Studies suggest that the patients who showed improvement after the first year of finasteride treatment are more likely to improve or maintain their hair growth after 10 years. Patients who do not see improvement or continue to lose hair after the first year are less likely to experience improvement of hair growth at 10 years and can be considered to be non-responsive to long-term therapy.
Both oral finasteride and topical minoxidil are effective and safe in the treatment of mild to severe androgenetic alopecia. However, finasteride appears to be the most effective of the two.
The mechanisms of action of minoxidil and finasteride treatments are different. Finasteride blocks DHT, while Minoxidil seems to work partly by increasing blood flow on the scalp. Thus, a combination of topical minoxidil and oral finasteride is possible and can be considered for greater efficacy in carefully selected patients. Combined treatment with finasteride 1 mg and 5% minoxidil topical solution actually leads to better improvement than monotherapies. The two drugs are perfectly safe to use simultaneously.
Men who are uncomfortable with oral finasteride may find topical finasteride to be a good alternative.
Topical administration of finasteride offers the potential to reduce systemic effects related to its mechanism of action by preferentially inhibiting 5-α reductase in the scalp,
Only a limited number of randomized controlled trials look at finasteride as a topical treatment for androgenetic alopecia. However, the data from those studies show promising results and non-inferiority compared to systemic delivery.
Topical finasteride significantly improves hair count compared to placebo and is well tolerated. Its effect is similar to oral finasteride but with markedly lower systemic exposure and less impact on serum DHT concentrations.
Currently, various formulations exist, combining topical minoxidil and finasteride.
If you are a man who has decided on hair transplant surgery, it is important to think about the long-term maintenance of the procedure.
And even though the transplanted hair will grow permanently, there is always the chance that you will continue losing your native hair.
Taking finasteride is a good way to prevent future hair loss and regrow any thinning hairs.
If you are looking into a solution to your thinning problem, contact our clinic in Glasgow. We offer a full spectrum of treatment options to suit your needs, preferences and budget, including medical treatment with finasteride. Dr Bonaros will discuss the benefits and possible side effects and advise whether it is a suitable option for you.
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