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Finasteride against hair loss (2021)

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Medically reviewed by Dr. Sternberg Written by David Stelzer on 1 Feb 2021

One of the most effective treatments to combat male pattern baldness is finasteride. Originally used as a remedy for prostate enlargement, today it helps many individuals who suffer from hair loss. One of the most famous users is the former American president Donald Trump.

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Cost 38 - 52 USD per month svg
Side Effect 2 - 5% of users svg
Chances of success 66% of users svg

What is finasteride?

Finasteride is a medication for male pattern baldness (androgenetic alopecia) and for benign prostate enlargement. When used for hair loss, 1mg of finasteride is taken daily with a glass of fluid.

The active ingredient has been approved in the USA since 1992. In 2017, finasteride was prescribed to more than 9 million patients in the US. Finasteride is available only by prescription and is prescribed by your family doctor, dermatologist or urologist.

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How does finasteride work against hair loss?

The drug finasteride inhibits the enzyme reductase of 5α- DHT. This means that the conversion of testosterone to dihydrotestosterone (DHT) is blocked. The hormone DHT reduces the growth phase of the hair follicles and the result is hair loss. The following table is an overview of several clinical finasteride studies and their results:

Study Result
Drake et al (1999) It was shown that DHT levels in the scalp were reduced by 64% for 1mg and 69% for 5mg after 42 days of treatment compared to a 13% decrease in the placebo group.
Roberts et al (1999) This study showed that treatment with finasteride leads to both an increase in hair count and a cosmetic improvement in hair growth. The efficacy of finasteride 1 mg was similar to the efficacy observed with the 5 mg dose, but was significantly greater than the efficacy observed with lower doses (0.2 mg and 0.01 mg) of finasteride.
Kaufman et al (1998) The expert panel's evaluation of standardized clinical photographs showed that 48% of men treated with finasteride showed improvement in hair growth after one year, compared to 7% of men in the placebo group. The benefits of finasteride continued to increase after two years: 66% of the men experienced an improvement in hair growth based on the evaluation of standardized clinical photographs, compared to 7% of the men who received placebo.

In all studies an improvement of the hair loss condition could be observed. Therefore, the conclusion that finasteride helps to stop hair loss can be drawn.

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Who is finasteride suitable for?

Men who suffer from male pattern baldness can take finasteride. The medication should not be taken by women. Women who suffer from hair loss should utilize the drug minoxidil or pursue a hair transplantation.

If the hair loss is already advanced (Norwood scale 5 to 7), taking finasteride is not really helpful, as the drug primarily stops hair loss.

Various studies show that finasteride can stop hair loss, particularly on the crown of the head. In many cases, however, the spread of a receding hairline can also be prevented.

According to the medihair hair transplant study, only 15.6% of the patients who are interested in a hair transplant are treating their hair loss with medical proven hair loss medication such as minoxidil or finasteride. However, a hair transplant should always be the last resort and in most cases the hair transplant needs to be complimented with hair loss medication to achieve a lasting result.

Hair loss treated with Finasteride or Minoxidil

Finasteride Before and After

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Finasteride for women

Finasteride is not a recommended medicine for women suffering from hair loss. Women who are seeking treatment to stop hair loss should use the topical medicine minoxidil, it can be applied as a gel or foam to the scalp. If they are seeking to regain hair in balding areas, they should look into hair transplantation.

Finasteride can be harmful to an unborn child if a pregnant woman comes into contact with it. When having intercourse with a partner taking finasteride a condom should be worn if you are pregnant or suspect you could be. In addition, pregnant women should not handle finasteride tablets because if the tablet is broken it can reach the bloodstream through the skin and harm the unborn child.

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How much does finasteride cost?

Finasteride is sold under the trade names Propecia or Proscar. The monthly package of the branded product Propecia costs about 52 USD. Generic drugs start at about 38 USD for 28 tablets.

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Finasteride medications for hair loss are roughly ten times more expensive than finasteride medications for benign prostate enlargement (when the active ingredient content is compared). However, the active ingredient composition of finasteride drugs for hair loss and for benign prostate hyperplasia (brand name Proscar) is identical. Finasteride for benign prostate enlargement can therefore also be used for hair loss. Since the dosage per tablet is higher (5mg) than the recommended dosage for hair loss (1mg), the tablet should be divided several times. (Please only do this in consultation with the appropriate specialist. We do not provide medical advices.)

How to use finasteride?

The drug is to be taken orally in 1mg tablets once a day. The hair loss is stopped only during the period of use. Therefore, the treatment period can last for years.

Although officially finasteride against genetic hair loss is only approved with a dosage of 1mg per day, a reduction of the dosage may continue to stop hair loss while reducing the negative side effects. The following diagram shows the percentage of DHT inhibition per dosage:

The graph shows the strongly degressive effect of finasteride on the DHT levels in the scalp. At 0.2mg finasteride daily, 61.7% of DHT is already inhibited, at 1mg 68.7% and at 5mg 69.2%. Since the frequency of side effects increases the higher the dosage, a reduction of the dosage is a recommended method to mitigate the side effects.

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What are the side effects of Finasteride?

The possible side effects of finasteride should not be underestimated and have already prompted the Federal Institute for Drugs and Medical Devices to issue a Red Hand Letter warning of the risk of sexual dysfunction and psychological disorders.

The following side effects can be caused by finasteride:

  • Erectile dysfunction
  • Infertility
  • Depressions
  • Decreased libido

According to the manufacturer, the side effects are common. This means that side effects occur in 1 to 10 percent of those treated. The following table shows an overview of several studies on the sexual side effects of finasteride:

Study Result
Drake et al (1999) 5mg: Decreased libido (2.6%) 1mg: Decreased libido (0%) Placebo group: Decreased libido (4.5%).
Roberts et al (1999) 1mg: Sexual function side effects (4.2%) Erectile dysfunction (1.4%) Decreased ejaculation volume (1.0%) Decreased libido (1.9%) Placebo group: Sexual function side effects (2.2%) Erectile dysfunction (0.9%) Decreased ejaculation volume (0.4%) Decreased libido (1.3%).
Kaufman et al (1998) 1mg: Decreased libido (2.9%) 0.2mg: Decreased libido (1.5%) Placebo group: Decreased libido (2.2%).

The lower the finasteride dose, the less likely these sexual side effects will occur. As the graph “DHT Inhibition Per Dosage” (see above) shows, the DHT level can be effectively reduced even with lower dosages than 1mg.

However, the results of the placebo groups also show that sexual side effects can occur independently of finasteride. Studies show that the number of young people generally suffering from erectile dysfunction is 7% and increases by up to 25-30% with age.

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How to obtain finasteride?

Finasteride is available only with prescription. Usually the family doctor, dermatologist or urologist prescribes the medication and the patient can then buy finasteride at the pharmacy upon presentation of the prescription.

Recently, finasteride has been also conveniently prescribed and purchased online. This saves you the trip to the doctor and preserves your anonymity.

What happens when you stop taking finasteride?

The effect of finasteride is reversible. This means that the hair loss will start again as soon as the medication is stopped. In addition, some patients report their side effects persisting even after the product is discontinued (the so-called post-finasteride syndrome). However, there has been no scientific evidence from research studies to support these claims of long-term side effects after discontinuing the use finasteride.

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Alternatives to finasteride

According to the evidence-based S3 guideline for the treatment of androgenetic alopecia, there are only three treatment options that have a proven efficacy in preventing male pattern baldness:

Unlike finasteride, minoxidil is applied locally to the affected areas by gel or foam. Minoxidil can also have considerable side effects. It is controversial which remedy works better against hair loss. However, finasteride and minoxidil can also be taken in combination. According to a study from 2015, even the efficiency can be increased compared to the single therapies.

Dutasteride is another 5-alpha-reductase inhibitor. The drug leads to a much stronger decrease in DHT levels (by about 93% compared to about 60% for finasteride), but dutasteride also has more side effects. Dutasteride is currently not approved for androgenetic alopecia.

Hair transplantation is the only way to regain hair in balding areas. Finasteride and minoxidil can stop hair loss and help maintain hair, but they cannot regrow hair. For this reason, hair transplantation is often accompanied by drug therapy. Although a hair transplant can be quite expensive, the results are promising in combination with effective hair loss medication.

Frequently Asked Questions

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How long does it take for finasteride to take effect?

Are finasteride results permanent?

Sources

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