A definitive guide to Finasteride for Male Androgenetic Alopecia by a Dermatologist
Finasteride is a medication used to tackle the condition of androgenic alopecia, also known as male pattern baldness.
If you are here, then the chances are you’ve heard about Finasteride being used against hair loss. But what does it do, and does it help?
Take a look below to find out more about this medication and the general FAQs with regard to Finasteride.
How Male Pattern Balding Works
Balding in men can occur at any point throughout their lives, with up to 60% experiencing hair loss by the age of 50.
Known as androgenic alopecia, male pattern hair loss is normally a condition that is hereditary and linked to both genetics and hormones.
Hair grows from follicles. But, as balding and hair loss occurs, those follicles get smaller until little – or less – hair than previous grows from that spot. As the follicles shrink, hair gets thinner and shorter. This is known as miniaturization of hair follicles. Hair also falls out a lot faster compared to normal non-balding hair.
The science behind this stems from testosterone, which is then converted into another hormone known as Dihydrotestosterone or DHT. This hormone is the one that shrinks follicles and means the scalp generates less hair.
How Finasteride Works
Finasteride works as a type II 5-alpha reductase inhibitor. This means that it stops testosterone from ultimately becoming dihydrotestosterone (DHT).
DHT has a harmful, damaging effect on hair follicles. By reducing the levels of DHT within the scalp, follicles are left less likely to suffer harm. A daily dose of Finasteride lowers DHT levels in the scalp by around 70% .
Ordering Finasteride
This drug is not approved to be given on the NHS, which means that this has to be gained privately through a medical professional on a private prescription. This can be done face-to-face with a doctor or online. It is important to see a qualified medical professional who can assess your scalp and design a hair care treatment plan. You can find out more about our hair loss consultations here.
Finasteride development
This medicine was approved for use in medicine in 1992 in the treatment of prostate hyperplasia (this is when the prostate enlarges). Known as Proscar, in 1993 the makers of Finasteride were named ‘inventors of the year’ for their work on the drug’s creation.
Finasteride was brought to light in the 70s by researcher Imperato-McGinley who talked of a village in the Dominican Republic where the child males lacked the 5 alpha-reductase.
Because the children did not have this enzyme, they were found to have no hair loss and smaller prostate glands.
Levels of DHT within these individuals were also found to be low.
Finasteride was made to mirror the ability to block the 5 alpha-reductase and thus reduce prostate size and battle hair loss. It took nearly twenty years of development to be approved for medicinal use.
It wasn’t until 1999 that Finasteride was approved in the UK in the battle against hair loss in 1 mg form as Propecia. The FDA approved this medication in the USA slightly before this in 1997.
This means that Dermatologists have over 20 years of experience in treating patients with Finasteride.
Taking Finasteride
Most medical practitioners will suggest that Finasteride is taken as a pill at any point throughout the day. It can be taken with or without food, and it is best to take it at the same time every day.
Topical Finasteride for hair loss
Finasteride can also be applied topically to an area to promote hair growth from the follicle, though this method of taking Finasteride is not licensed in the UK. Topical finasteride solutions are offered from our Clinic. These can be mixed with other ingredients such as minoxidil.
What are the benefits of taking Finasteride?
As with every medication and procedure, there are benefits and risks to taking Finasteride. It is important to understand these before you make the decision to start this treatment, especially as it is a long-term, and possibly even a lifelong, commitment.
Finasteride helps up to 90% with male pattern hair loss
Studies examining photographs of men aged 18 to 41 taking Finasteride for 5 years showed 48% had improved hair appearance, and another 42% were unchanged. This means that about 90% of men may benefit from taking Finasteride when looking at the appearance of the scalp hair. 10% of men may not benefit.
In another study looking at hair counts, men taking Finasteride saw an increase in hair counts by 10% at the end of the first year. Hair counts declined following this, but at a slower pace and at end of 5 years, hair counts were better than they were before starting treatment. This is important as men suffering from pattern hair loss may lose 26% of their terminal (thick) scalp hairs in 5 years without any treatment.
This means that Finasteride boosts hair counts in the first year and then slows down the rate of progression of male pattern hair loss after the first year.
It is important to understand that Finasteride does not permanently stop male pattern hair loss or reverse it. It slows hair loss down – but hair loss will inevitably continue.
How does Finasteride work?
Finasteride seems to thicken hairs and allow them to grow longer as
- Finasteride reverses the miniaturization process – this means fine, small miniaturized hairs become thicker terminal hairs again
- Finasteride increases the anagen numbers of hairs – this means hairs remain in the anagen growth phase longer, so they grow longer. Men with pattern hair loss and not on treatment loose anagen hairs.
Which part of the scalp does Finasteride work best for?
Men under 40 may see an improvement in hair all over their scalp, including the crown (vertex), mid-frontal area (just in front of the crown), frontal hair line and temporal hairline.
Men over 40 mainly see results in the crown and mid-frontal scalp.
When should I start Finasteride?
It is better to start Finasteride earlier as there are more hairs that can be ‘saved’ from becoming miniaturized.
This is also shown in medical studies. When men are given Finasteride one year later, they have less hair than men who started Finasteride one year earlier.
How long should I take Finasteride?
A Japanese study showed that 86% of men taking Finasteride for 10 years continued to see a benefit. 14% experienced further hair loss. Finasteride is generally considered a long-term treatment.
When treatment is stopped, all the improvements seen begin to reverse after 6 months and then there is a return to the original scalp hair in about 12 months.
Those taking Finasteride for balding should be consistent with their schedule of taking the product, as balding can continue to occur one the medicine is stopped.
Who Can’t Take Finasteride?
- Those with allergies or previous reactions to medicine.
- Under 18’s.
Side Effects & Reactions
Like any other medication, Finasteride can come with several side effects depending on the individual. This is why it is important to know just what could happen should Finasteride react with your body.
Any reactions and effects are generally thought to be reversible, but there may be some persistent side effects too. The true rate of long-term side effects is not known.
You should read this information along with the information leaflet that is provided with your medication. If you are concerned by these side effects, then you are advised to discuss this with your practitioner and consider alternative hair loss treatments.
Sexual Dysfunction and Finasteride
Sexual dysfunction can include lowered libido, erectile dysfunction and ejaculatory problems.
1.9% of men may experience low libido and 1.4% erectile dysfunction in the first year of treatment. This compares to 1.3% and 0.6% of men on placebo.
Many men suffering from sexual side effects will see their problems resolve when they stop the medication and even if they continue.
Some men may, however, have persistent difficulties that may last 3 or more months after stopping treatment. The true incidence of persistent problems is unknown.
Breast swelling and Finasteride
Breast swelling is also known as gynaecomastia. Breast tissue change can start with breast tenderness before visible swelling is noticed.
New gynaecomastia from finasteride can occur in 1 to 10 per 1000 men. Finasteride may also worsen pre-existing gynaecomastia, but the risk of this happening is unknown. The problem can start in the first 3 months of treatment. A low dose or topical finasteride may help reduce (but not eliminate) the risk of gynaecomastia.
Gynaecomastia
Some men may choose to continue Finasteride if they develop gynaecomastia, and may have the problem surgically corrected. If gynaecomastia occurs, stopping treatment as soon as possible may help resolve the problem. If there is persistent pain, discharge and ongoing swelling in the breast, then you should have this evaluated by a breast specialist to exclude the remote possibility of breast cancer – see below.
It is important to note that gynaecomastia is quite common in men, and not all gynaecomastia that occurs while on Finasteride is necessarily from Finasteride.
Cancer and Finstaeride
No conclusive link between taking finasteride and male breast cancer exists, but as a precaution, you should check regularly for lumps and bumps in the breast area when taking this medicine.
At doses of 5mg per day, Finasteride may reduce the chance of developing prostate cancer (though cancer may be of slightly higher grade).
Taking Finasteride can affect the results of the blood test used to check for prostate cancer – PSA test, and you should tell your doctor you are on Finasteride if you have a PSA test.
Male fertility and Finasteride
Men could experience a decrease in their sperm count when taking Finasteride due to a change in the composition of sperm upon ejaculation. This is thought to be uncommon. Semen volume is also reduced for many on Finasteride.
Thus far, there have been no reports of increased birth defects in men who have fathered children while taking this medication compared to the background rate of birth defects (generally thought to be 3%). This is because the amount of Finasteride entering sperm is very low. Those who are very cautious might wish to withdraw medication 2 or 3 months before conceiving.
Depression and anxiety and Finasteride
Some men may suffer from low mood and anxiety while they are taking Finasteride. It is not known what the true frequency of this side effect is. If you are experiencing mental health side effects, then you should stop Finasteride and seek help from a medical practitioner.
Hormone changes
Finasteride reduces DHT levels in the blood. There appears to be a trend in elevated Testosterone levels but 2 studies showed this not to be statistically significant after 8 and 26 weeks. 2 studies also showed little variance in oestrogen levels.
A 2020 paper in the Endocrine Journal looking at hormones showed that Testosterone was elevated at 6 months by about 30% but less so (and not significantly so) at 12 months. There was a trend for elevated oestrogen, but the difference was not statistically significant. LH, FSH and Prolactin were unchanged.
Another 2007 paper also showed Finasteride reduced DHT by 70%. Testosterone was elevated by 25% in 8 weeks, but after this period, the elevations were milder and not statistically significant. Very little variation in levels of estradiol, FSH or LH was seen.
Thus far, no clinical studies show if there is any correlation between side effects and hormonal changes, or if side effects can be predicted by changes in hormone levels.
Finasteride & Hair Transplants
When it comes to hair transplants and Finasteride, a few scenarios may affect results.
Firstly, if you are considering getting a hair transplant, you may consider taking Finasteride for a minimum of a year before going under the knife, especially if you are under 30 and the rate of your hair loss progressing is still being evaluated.
This is because Finasteride can take anywhere from 6 months to 1 year to start showing results.
Waiting for this time allows a surgeon to work on thinner areas of the scalp that may not have been covered or dense before starting the drug.
In 2005 it was found that taking 1mg of Finasteride daily improves hair transplant scalp areas and increases hair density.
Finasteride and Pregnancy
Finasteride can cause harm to an unborn baby. So much so, it is advised that those who are pregnant do not touch broken or crushed Finasteride pills.
Alternatives to Finasteride
When finding a treatment for hair loss, there are certain avenues that may be more suitable to an individual than others. Take a look at alternatives to the medicine Finasteride below.
Oral minoxidil
This is a promising alternative which avoids hormonal side effects. More information on oral minoxidil can be found here.
Hair Transplants
This is an established way of dealing with hair loss, especially if you have strong donor hair and it is not too widespread. Don’t forget that hair transplant may need to be repeated as the condition progresses; hence it may still be useful to consider Finasteride to slow the process.
Scalp micropigmentation
This is not a way to tackle or promote new hair growth. But, it is a great way to cover up any balding areas. Essentially semi-permanent tattoos are placed to either mimic a ‘buzz cut’ or to cover the scalp showing through for those with longer hair styles.
Microfibres
Microfibres are also used to camouflage hair loss. These fibres are colour matched and are ‘shaken’ on thinning areas. They form static electrical bonds with hair fibres and with each other giving the illusion of stronger hair. Microfibres come off with water.
Wigs or Hairpieces
This is not a way to tackle or promote new hair growth. But, it is a great way to cover up any hair loss or balding. Wigs and hair pieces are also significantly cheaper than treatment options such as a hair transplant.
While wearing a wig means that hair loss will continue, it does help support an individual’s self-esteem, which can be affected negatively through the hair loss/thinning process.
Taking Finasteride with Minoxidil
Minoxidil is the only other hair loss product on the market recommended by the British Association of Dermatologists.
Minoxidil is applied to the scalp and areas suffering hair loss. However, it has been shown that topical Minoxidil is less effective than Finasteride for male pattern hair loss.
Taking both together is likely to have a synergistic effect as the medications work in different yet complementary ways. There is now evidence to suggest this is the case.
Finasteride can be combined with minoxidil in a topical solution for those not wishing to take either medication orally.
Minoxidil can be taken orally with Finasteride for those wishing to take oral medications only.
Frequently Asked Questions
Will Finasteride Affect Body Hair?
Whilst Finasteride can help the scalp grow new hair, there is no evidence to suggest that body hair is affected. It is a common misconception that taking the drug will make body hair grow thicker and faster.
Mixed with Other Drugs
A few drugs can interact with Finasteride – 21 of them to be exact.
What If I Miss a Dose?
Should you miss a dose, don’t panic – it happens. In a perfect world, try to be consistent with your medication schedule. However, should you find that you miss a dose, simply wait for your next dosage time and continue as normal. Do not double dose.
My doctor has asked me to take Finasteride less than daily?
You should follow your physicians advice which is likely to be bespoke to you, as it is for patients at our Clinic. Finasteride binds the type II 5 alpha reductase enzyme permanently, so the effects of Finasteride may last longer than one day. Alternate day and twice a week regimes in some instances may still have a desired effect.
I am not seeing any results as my hair appears to look the same even though I have been taking Finasteride for 3 years?
You are seeing results as the condition of male pattern hair loss is progressive. This means that it continues to progress with time. Studies show that 26% of terminal hairs are lost on average after 5 years. If you are seeing no change, then the medication is reducing progression, which is a positive result.
I’m thinking of stopping Finasteride now as I’ve had really good results with one year’s treatment
You will lose any benefits of treatment within 6 to 12 months, and if you start again, you will be at a lower baseline than when you started a year ago. Finasteride only works when you take it, and stopping and starting are unlikely to bring as good results as taking it continuously.
Hair loss consultation
If you are unsure whether you may have the type of hair loss that could benefit from finasteride, then we offer a specialist hair loss consultation service in Birmingham with dermatology doctors specialising in hair loss.
A hair loss consultation in Birmingham is ideal for men who are experiencing early hair loss and would like to establish a diagnosis. A hair loss consultation is also ideal for those with more established hair loss.
A discussion about the possible individual benefits and risks of finasteride can be discussed at a hair loss consultation.
Prescriptions for Finasteride are provided only at a hair loss consultation.
Summary
Finasteride is the second most commonly used medication for male pattern hair loss after Minoxidil. The majority of men who take Finasteride will see a slowing down in their rate of hair loss without any long-term side effects. Benefits are greater if treatment is started earlier rather than later. Some men may experience side effects – the majority of which are thought to be reversed when the medication are stopped. Some men may experience long-term side effects, including sexual dysfunction, even after they come off medication though the exact incidence is unknown. You should only take this medication if you understand and accept the risk of the possible side effects.
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Author information
Author: Dr Sajjad Rajpar
Date last reviewed: 15 Aug 2021
