Finasteride for Hair Loss - Deep Dive

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. What are the active ingredients in this medication?

Do you have any allergies?

Do not use this medication if you sensitivity to finasteride or any active/inactive ingredients

How do I use this oral medication?

Finasteride comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take finasteride at around the same time every day.

What if I miss my daily dose? (same for finasteride and minoxidil)

Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What should I expect during treatment with this medication?

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. 

Who should not use this medication?

Women, men with known allergy to finasteride or any of its active/inactive ingredients. Men with chronic liver disease.

What are the common side effects of this medication?

Common side effects are rash, breast tenderness or enlargement (< 1% of patients) 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: A literature review shows there may be evidence of increased depressive symptoms in users younger than age 45 while using finasteride for hair loss. Patients with new or worsening depression should stop finasteride use and follow up with their health care provider or a mental health therapist.[https://www.medpagetoday.org/dermatology/generaldermatology/89913?xid=nl_mpt_DHE_2020-11-28&eun=g989986d0r&utm_term=NL_Daily_DHE_dual-gmail-definition&vpass=1]

Prostate cancer and prostate enlargement (BPH): There have been reports of a slight increased risk (1.8% with 5mg Finasteride dosage versus 1.0% Placebo) of High Grade Prostate Cancer for men over age 55 years old. Again, this is at a much higher dosage (5mg versus 1mg ) than we prescribe for hair loss.  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.  

What are 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 new growth 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.

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.

How should I use the minoxidil?

It is best to apply minoxidil to completely dry hair. If that is not possible, towel drying is recommended before applying the minoxidil. Wash your hands after application of minoxidil.

Can I still use regular hair products with minoxidil?

Yes, but you must apply the minoxidil first and let it dry completely before using other hair styling products.

Do I need to use a special shampoo or conditioner with minoxidil?

You can use your normal hair products, but should not wash your hair for 4 hours after applying minoxidil. If your scalp is dry and flaky, use a gentle shampoo. If it does not improve, consult with your healthcare provider.

Can I blow dry my hair?

Yes, you can use the blow dryer, but you should use the low setting. Heat makes the minoxidil less effective.

Can I use minoxidil on my entire scalp?

Yes, but you should apply the prescribed amount to the center of the area being treated and follow the instruction given by your healthcare provider.