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- Finasteride: is part of a family of medications called 5-alpha reductase inhibitors. Finasteride works by blocking the conversion of Testosterone to dihydrotestosterone (DHT). It is well studied that it is DHT and not testosterone that causes male pattern baldness. DHT causes hair follicles to shrink and lose the ability to create new hairs. By blocking the conversion of testosterone to DHT there is improvement in hair loss.
You should only take finasteride tablets by mouth.
The absorption of finasteride is not affected by food, so you can take it with or without food.
You should take finasteride once a day at the same time every day.
Store finasteride at room temperature, away from heat, direct light, and moisture. Do not allow it to freeze.
- If you miss a dose, skip the missed dose and continue on your regimen the next day. It is important to take your medication without days of interruption, so be sure to pack enough when traveling.
- Finasteride dosage will be different for different patients. The daily amount depends on your medical conditions and risk factors.
- The average dose of finasteride is 5 mg once a day to treat BPH symptoms and 1 mg once a day to treat male pattern hair loss symptoms.
- Be sure to follow the instructions on the prescription label carefully and take it exactly as directed. If you have any doubts about dosage, you should consult your pharmacist or physician for medical advice.
- Finasteride takes ~3 months to start showing its benefit and will continue to show continued improvement for up to a year. Interestingly, when you start taking finasteride, it may even cause expected shedding of fine hairs. Do not be concerned. Some men do not respond to finasteride – the exact number is not known but can be as high as 1 out of every 10 men. It is recommended to continue finasteride for at least one year to maximize finasteride’s benefit.
- Finasteride reduces the size of the prostate by over 20%.
- Hair counts in 48% of finasteride users show improvement after one year, hair counts in 66% of finasteride users show improvement after two years, and 83% have no further hair loss. Only 17% had a reduced number of hairs while taking finasteride.
- If you are taking finasteride to treat BPH symptoms, you should know that the drug works to alleviate BPH symptoms, but it does not cure it.
- Finasteride only slows hair loss and encourages hair growth while you are taking the medication.
- If you are taking finasteride for male pattern hair loss and do not see any improvement in 12 months, an extended treatment time will probably not help.
- Even after you see improvement in your BPH symptoms, you should continue to take finasteride as long as your doctor prescribes it.
- If you have further hair loss and do not see any results after 12 months of taking finasteride for male pattern hair loss, you should talk to your doctor to ask if you should continue treatment.
- You should continue to take finasteride even after you notice an improvement in male pattern hair loss. Finasteride only prevents hair loss while you take it. If you stop taking it, you will probably begin to lose the hair you gained while taking finasteride.
- For men who take finasteride there a few very important things to know.
- Blood donation: Men who are taking finasteride should not donate blood for the entire time taking the medication and for one month afterwards due to its ability to be transferred to a fetus in a pregnant woman. This could in turn affect the normal genital development of the fetus.
- Prostate specific antigen: Prostate specific antigen is a marker in the blood that is used to identify and screen for prostate cancer. Finasteride artificially decreases the PSA and cuts it roughly in half. For men who are taking finasteride the need to tell their physician so that a more accurate PSA reading can be taken. For men on finasteride simply double the PSA to obtain the real PSA number. The point here is that men on finasteride need to tell their physician so that together a more accurate risk assessment for prostate cancer may be undertaken.
- Increased risk of high-grade prostate cancer: Two studies looked at 5 alpha reductase inhibitors at higher doses to see their effects on prostate cancer. These were the Prostate Cancer Prevention Trial (PCPT –https://www.nejm.org/doi/full/10.1056/NEJMoa1215932) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) https://www.nejm.org/doi/full/10.1056/NEJMoa0908127. Both studies demonstrated an overall reduction of prostate cancer but showed a trend towards high-grade cancers. After 18 years this did not demonstrate any clinically significant differences in survival and some cancer experts believe that finasteride increases the ability to detect these cancers. It should be noted that the dosage for hair loss is 1/5 of the dosage studied in the studies.
- Hair loss is potentiated by dihydrotestosterone (DHT), a very potent derivative hormone of testosterone. DHT causes the hair follicle to shrink and miniaturized over many years which at some point becomes irreversible
- Luckily medical science has developed an understanding of how DHT undermines hair growth and therapies exist to interrupt or slow the process.
- Androgenetic alopecia otherwise known as Male Pattern Baldness (MPB), affects both men and women. This can be receding hairline along the temples where hair loss at the very front of the hairline. More men than women are affected hence the name male pattern baldness. 98.6% of men and 64.4% of women have hair loss along the temples. 60% of women over the age of 80 and 75% men over the age of 80 are bald in both areas.
- Starting with adolescence people who are genetically inclined to go bald will start losing hair. The hairline in the crown of the head are both affected and will ultimately blend to a completely bald top of the head
- Normal hair growth consists of three phases: Anagen, Catagen and Telogen.
- Anagen: The root divides rapidly, as rapidly as any cells in the body, and a hair will stay in this phase of growth for 2 to 6 years depending on the individual. If one person’s growth phase lasts 6 years, they might be able to grow long hair; another person with hair that stays in the growth phase for a mere 2 years will have a shorter maximum length. Most hairs (approximately 85%) are in this phase at any one time.
- Catagen: This phase is very short (14 to 21 days) and it here that hair stops growing. The outer sheath of hair attaches to the root of the hair and begins to weaken at its base. About 5% of hairs are in this intermediate phase.
- Telogen: This phase lasts for about 3 months and the hair cells are completely at rest. Approximately 10% of hairs are in this phase. Hairs called “club hairs” are now ready to be shed at a rate of about 25–100/day. This is normal.
- Disruptions in either the anagen phase or telogen phase can cause hair loss. Drugs like chemotherapy, infections like fungal infections, radiation or autoimmune diseases can disrupt these phases and cause hair loss.
- Androgenic Alopecia or male pattern baldness can cause hair loss. But many other diseases or nutritional deficiencies can cause it too.
- Nutrient imbalances such as deficiencies in iron, certain B vitamins, protein, and zinc. Excess vitamin A can also cause hair loss.
- Chronic illness such as thyroid disorders, uncontrolled diabetes, anorexia nervosa, cancer, and cancer treatment, and many others.
- Autoimmune diseases such as lupus and alopecia areata.
- Scarring and burns to the scalp from from injuries or inflammation.
- Chronic infections of the scalp such as chronic fungal infections such as tinea capitis and kerion.
- Hormones imbalances such as women with polycystic ovarian syndrome (PCOS) and men who take anabolic steroids.
- Medications such as blood thinners, gout medications, beta blockers, NSAIDs, ACE inhibitors, some acne medications, some antidepressants, and some seizure medications.
- Stress is a factor for hair loss and can often be found as an exacerbating factor combined with another cause.
- Trichotillomania is an inability to control the urge to pull repeatedly on hair and often leads to hair loss.
- Finasteride has minimal interactions with other medications. In addition no interactions of clinical importance with other medications have been described.
- Studies have shown that finasteride has not showed clinically significant adverse interactions with multiple medications such as antipyrine, digoxin, propranolol, theophylline, warfarin, acetaminophen, acetylsalicylic acid, α-blockers, analgesics, angiotensin-converting enzyme (ACE) inhibitors, anticonvulsants, benzodiazepines, beta blockers, calcium-channel blockers, cardiac nitrates, diuretics, H2 antagonists, HMG-CoA reductase inhibitors, prostaglandin synthetase inhibitors (also referred to as NSAIDs), and quinolones. No i
- If any interactions are encountered please report them to the FDA at 1–800–FDA–1088 or https://www.fda.gov/Safety/MedWatch/default.htm.
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