Finasteride for Hair Loss - Deep Dive

Finasteride for Hair Loss

At hims, we are committed to providing the latest clinical information to our customers regarding all prescription medications we offer.  We want you to be able to make the most informed choice about your wellness. This article focuses on the medication called Finasteride that is used for hair loss.  

What causes hair loss?

Male pattern baldness, or androgenic alopecia, is the most common form of hair loss and it is typically an inherited condition. As the condition progresses the natural hair growth cycle begins to weaken and your hair follicles begin to shrink causing your hair to become shorter and finer. The exact cause for this type of hair loss is unknown but it is related to the production of the hormone dihydrotestosterone (DHT). Treatments that inhibit the production of DHT are sometimes effective in slowing, stopping or reversing hair loss due to androgenic alopecia.

What is Finasteride and how does it work?

Finasteride is an FDA-approved medication for the treatment of hair loss. Also known as the brand name Propecia, Finasteride belongs to a class of drugs known as 5-alpha-reductase inhibitors.  It works by preventing testosterone from breaking down into DHT, the hormone that causes baldness. 

Does Finasteride work?

Finasteride (1mg dose prescribed for hair loss) has been shown to be 85% effective with hair regrowth occurring in 3-4 months. The medication needs to be taken on a continuous basis or else new hair will be lost after one year of stopping the medication. (In comparison, topical Minoxidil 5% is about 50% effective in stimulating new hair growth.)

Is Finasteride Safe?

A 1mg dose of Finasteride is a very safe drug with minimal side effects (see below).  However, people who are pregnant or have chronic liver disease should not use Finasteride.   It is also recommended that you stop taking NSAIDS (Motrin, Advil, Aleve type medication) for the period of time you are taking Finasteride due to some increased risk of side effects (see below). 

Does Finasteride Cause Side Effects?

Finasteride can cause the following side effects in a limited number of patients:

  • Rash or Breast Tenderness: Less than 1% of patients will develop a rash or breast tenderness which is reversible after the medication is stopped.
  • Sexual Dysfunction: 1.2%-1.4% (vs 1% placebo) of patients experience drug-related sexual dysfunction side effects including decreased libido, erectile dysfunction or a decrease in the volume of ejaulation.  
    • Decreased libido 1.8%
    • Erectile dysfunction 1.3% 
    • Decreased volume of ejaculate 1.2%

Several studies have documented the great majority of these side effects are reversible.   However, 1.4% of the patients who experience side effects will continue to have symptoms following discontinuation of Finasteride. Of particular note there was an association of the sexual dysfunction symptoms and the use of NSAIDS (Motrin, Advil, Aleve type medications.)  For this reason Finasteride should be stopped for the period of time when you take NSAIDS.

Does Finasteride Cause Depression or Prostate Cancer?

 

  • Depression: There is no direct link between Finasteride and depression.

 

  • Prostate cancer and prostate enlargement (BPH): 
    • There is no increase in the incidence of prostate cancer. There have been conflicting studies on the increased risk in the number of high grade prostate cancers however several recent studies have shown no increase in the number of deaths (with a recent study showing fewer deaths) in patients who  use Finasteride at the 1mg dosage.
    • Finasteride can be useful in the treatment of BPH and urinary retention because it can have an antiandrogenic effect (testosterone blocking) at a 5mg dosage.  For hair loss, patients are given a 1mg dosage which should not produce any antiandrogenic effect.  

Alternate Treatment Options for Hair Loss

Below are a list of other treatment options for hair loss other than Finasteride.  

  • Minoxidil: Minoxidil is a topical medication that promotes hair growth. It works by stimulating your hair follicles to enter the growth phase, increasing blood flow to your hair and helping to transport essential nutrients to your hair follicles. 

Unlike finasteride, minoxidil doesn’t affect DHT and has no effects on your production of hormones. Like finasteride, it’s backed up by a huge amount of scientific evidence, with studies showing a significant increase in hair growth after several months of use. Studies show that minoxidil and finasteride are safe to take together. In fact, many studies have been conducted using finasteride and minoxidil together to prevent hair loss while fueling newgrowth of healthy hair.

Supplements and non-pharmaceutical products: While supplements aren’t as effective as FDA-approved medications like finasteride and minoxidil, they can be a helpful part of your baldness prevention routine.

  • Saw palmetto: While it’s not as effective as finasteride, studies show that saw palmetto can help to reduce DHT levels by a modest amount, helping to slow down male pattern baldness in men sensitive to DHT.  
  • Biotin: While biotin doesn’t directly prevent hair loss, it’s linked to improvements in hair growth in scientific studies. Biotin is available as an oral supplement, or as an ingredient in hair loss prevention shampoos.
  • Hair loss prevention shampoo: There are countless hair loss prevention shampoos on the market. Look for shampoos that contain proven ingredients like biotin, ketoconazole and saw palmetto, all of which have real benefits for your hair.

Other treatments

  • Hair transplant surgery: Hair transplant surgery involves transplanting hairs from the back and sides of your head (areas that aren’t affected by male pattern baldness) onto your crown, hairline or other areas with hair loss. Performed by a skilled surgeon, a hair transplant can restore your hairline and almost completely eliminate any visible signs of hair loss. Like other cosmetic surgeries, hair transplant surgery is highly effective but very costly and rarely covered by insurance.
  • Scalp micropigmentation: Scalp micropigmentation is a cosmetic procedure that can change the pigment of your scalp, creating the appearance of small, short hairs and a fuller head of hair. Although scalp micropigmentation can make it look like you have a thicker head of hair, it’s not a treatment for male pattern baldness and does not restore any real hair follicles.   
  • Hairpieces: While they won’t help you grow back any real hair, hairpieces and weaves can produce surprisingly good results if you need to fill in thin spots and cover up your hair loss for an important event.
  • Acceptance: If your hair loss is severe and you’re not interested in treating it, you can simply accept it. Whether you choose to shave your head or keep your remaining hair cut short, rocking the bald look can be a great option if you’ve got the confidence.

For more information on the above please see these medical references:

-Merck Package insert Propecia

 

-Adverse Effects and Safety of 5-alpha Reductase Inhibitors: A Systemic Review

Clinical Aesthetic Dermatology 7/2016 Volume 9 Number 7

 

-Sexual dysfunction in men taking systemic dermatologic medications medication:A systematic review.Zakhem et al Journal of Academic Dermatology Volume 81, Number 1

 

-New Data: Finasteride Safely Prevents Prostate Cancer  Dr Ian Thompson American Urologic Association 2018 Annual meeting  Medscape article

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