Finasteride for Hair Loss
Book a free Zoom consultation with Dr Bonaros to find out how this medication can be used to treat hair loss for your unique case.
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Male pattern baldness is related to your sex hormones and genes. Hormonal changes, genetics or ageing can cause a receding hairline as well as a pattern of hair thinning on the crown.
Finasteride is a prescription drug used to treat male hair loss, particularly male pattern baldness, and promote scalp hair growth.
As a hair loss treatment, finasteride is perhaps the most extensively studied medication for male pattern baldness. Finasteride is also used as a treatment for benign prostatic hyperplasia, referred to sometimes as an enlarged prostate, although the dosage is typically higher. It has also been studied for its prevention of low-grade prostate cancer.
In this article, we discuss the use, dosage, mechanism of action and side effects of finasteride so you have a better understanding of its uses as a male pattern baldness treatment.
FDA-approved and approved in the UK (prescription only), finasteride prevents the androgen-dependent miniaturisation of hair follicles by binding to and blocking the type II 5 alpha reductase enzyme and preventing the conversion of testosterone to DHT. DHT, or dihydrotestosterone, is an androgen produced from testosterone and is the hormone responsible for male pattern hair loss.
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%.
The first questions many of our patients want to know are, “Does finasteride stop hair loss?” or “How effective is finasteride for hair loss?”
Many clinical trials and results of 10-year follow-up studies examining finasteride and its long-term efficacy suggest significant lasting increases in hair growth after long-term finasteride use. A finasteride treatment 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, a finasteride treatment can lead to increased hair thickness as well.
Baldness results from your hair follicles slowly shrinking over time, creating finer, wispier hair. Eventually, hair follicles will not grow new hair. That being said, as long as the follicle remains intact, patients can grow new, thicker hair when using finasteride for hair growth.
Finasteride is able to stop further hair loss in this way in over 95% of men that take it. 66% of patients will achieve moderate finasteride hair regrowth and 5% will achieve marked finasteride regrowth.
Hair regrowth from finasteride may be possible in some patients. As finasteride is most effective on the vertex scalp, finasteride crown regrowth is more commonly seen than that of the temporal regions or frontal scalp.
Many male patients exploring solutions for their hair loss ask Dr Bonaros the question “How long does finasteride take to work?”
Finasteride hair loss treatments should be continued for at least 12 months to assess its full effect. Long-term studies have found that the patient’s finasteride results after 1 year may predict its effectiveness going forward. Patients who fail to respond in the first year are likely to be non-responders in the long term too.
Finasteride needs to be continued indefinitely to maintain efficiency as it only works for as long as it is used.
The typical dosage prescribed for the hair loss treatment of male pattern hair loss is 1 mg/day.
A finasteride tablet 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 can include sexual dysfunction, such as low libido, erectile dysfunction, reduced ejaculatory volume and temporary reduction in sperm count. These sexual side effects typically resolve with finasteride discontinuation.
Men taking finasteride may also experience testicular pain, gynecomastia or mood disturbances, such as an unusually low mood or depression. In rare cases, finasteride side effects can also include breast cancer.
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.
When starting treatment, shedding while using finasteride is sometimes reported. This can present similarly to hair loss, which may seem as though it is caused by finasteride.
But while taking finasteride may cause hair shedding a few weeks after beginning treatment, this is caused by the reactivation of the dormant hair follicles and is actually a positive sign that finasteride works.
The finasteride shedding and regrowth cycle is a normal part of the treatment process that your doctor will walk you through.
Typically, oral or topical finasteride 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 in hair growth at 10 years and can be considered to be non-responsive to long-term therapy.
Finasteride tablets are available under the brand name Propecia or as a generic. The generic version of Propecia contains the same active ingredient (finasteride). One film-coated tablet of Propecia contains 1 mg of finasteride.
Over and above finasteride, there are also other medicines and alternative hair loss treatments that patients can consider to combat hair loss. A finasteride alternative is minoxidil (also sold as Regaine).
Both oral finasteride and topical minoxidil are effective and safe in the treatment of mild to severe male androgenetic alopecia. However, finasteride appears to be the most effective of these two types of hair loss treatments.
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.
Clinical studies have suggested that a combined treatment with finasteride 1 mg and 5% minoxidil topical solution may lead to better improvement than monotherapies when prescribed under a qualified doctor’s supervision. In most cases, the two drugs are safe to use simultaneously.
Topical administration of finasteride offers the potential to reduce systemic effects related to the finasteride mechanism of action by preferentially inhibiting 5 alpha reductase in the scalp.
Only a limited number of randomised 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 (finasteride tablets).
Men who are uncomfortable with oral finasteride in a 1 mg tablet form may find topical finasteride to be a good alternative.
Dr Bonaros is often asked, “Does topical finasteride work?” along with, “Is topical finasteride safe?”
Topical finasteride results in significantly improved hair count compared to a 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. Several topical finasteride studies found an overall decrease in the rate of male hair loss. Finasteride as a topical treatment may work to increase your total and terminal hair counts.
The conversation of topical vs oral finasteride is best had on a case-by-case basis because the right hair loss treatment will differ for each patient.
Generally speaking, when compared to a finasteride tablet prescription, topical finasteride only decreases scalp DHT levels in a localised area rather than affecting serum DHT levels in the body. Due to its localised treatment, studies have indicated a potential decrease in the systemic side effects of topical finasteride. Side effects reported by patients are still the same as that of finasteride tablets, but may be less likely.
Currently, topical finasteride with minoxidil is a treatment commonly used for hair loss. Some versions of topical finasteride and minoxidil can be applied as one solution from a dropper bottle.
Various formulations exist that combine topical minoxidil and finasteride as well.
Typically, applying up to 1 ml of the solution onto the scalp in balding areas in the morning and at night is recommended.
If this is the right treatment for you and a topical finasteride prescription is warranted, Dr Bonaros will advise you on how to apply topical finasteride for your specific treatment areas, including the frequency and method of use.
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. Even though the transplanted new hair grows permanently, there is always the chance that you will continue losing your native hair.
Taking finasteride after a hair transplant surgery is a good way to prevent future hair loss and regrow any thinning hairs.
For this reason, as a long-term hair loss treatment, the results of finasteride may be promising for many men.
Book a free Zoom consultation with Dr Bonaros to find out more about our male hair loss treatment options and to take the first step in regaining your hair and your confidence.
At our clinic in Glasgow, we offer a full spectrum of male hair loss treatment solutions to suit your needs, preferences and budget, including hair transplants and medical treatment with finasteride.
In your first hair loss consultation, Dr Bonaros will discuss the benefits and possible side effects of finasteride for hair loss with you and advise whether it is a suitable option for you.