Finasteride

Finasteride, also sold as Propecia, is one of two FDA-approved medications to treat hair loss and is only available by prescription from your doctor. It works by blocking the enzyme that converts testosterone to DHT. However, it is only approved for hair loss treatment for men due to potential unfavorable effects in women of childbearing age. Finasteride was initially developed to treat prostate enlargement, but a secondary effect of delaying the progression of male pattern hair loss and improved hair density led to it being repackaged and rebranded for use in male pattern hair loss.

The decreased levels of DHT caused by taking the drug help to protect the follicles susceptible to this hormone and allows them to reverse the miniaturization process. The starting dose is typically 1mg daily, and this medication must be taken daily to be effective. Side effects can include weakness, dizziness, decreased libido, erectile dysfunction, changes in ejaculation, and gynecomastia (the enlargement of male breast tissue). Depression and suicide have been noted in some men taking this medication, but it is unclear if the drug itself actually causes these symptoms. These side effects typically resolve after the affected individual discontinues the medication. A small subset of men claims to continue to have the sexual dysfunction side effects even though they have stopped the medication. However, it is unclear if this is due to an actual physiological effect of the drug or if it is more of a psychological issue. Inform your healthcare provider immediately if you experience any of these side effects.

Studies have shown that 83% of men taking finasteride did not experience further hair loss after taking it for two years, and 66% of men reported some increase in hair regrowth. This medication works best for men who are just beginning to experience hair loss. To date, there are no large-scale, long-term studies on the effectiveness of the long-term use of finasteride.

Finasteride can cause a birth defect in a male fetus by interfering with the development of normal male genitalia. This is why it is not indicated for use in women if pregnant or planning to get pregnant. Intact pills are coated; however, women of childbearing years should not touch/handle broken tablets because the medication can be absorbed through the skin resulting in the feminization of a male fetus.

Topical finasteride is not well studied, and it has yet to be proven to be effective. Some clinics offer topical finasteride made by compounding pharmacies, and the amount of the active substance varies greatly. The scalp is very thick, so it is difficult for topical medication to penetrate the layers of the scalp to reach its target area. Furthermore, it needs to be clarified if there is a decrease in side effects using this method of administration.

Although oral finasteride has been clinically proven to improve hair counts and density in male patients taking this medication for hair loss, it only delays the inevitable hair loss because what is written in the DNA will eventually win over the temporizing effects of this medical treatment.