the world's No. 1 Proven Hair Growth Agent: Finasteride

1. What is Finasteride?

Finasteride is 1 of 2 FDA-approved products for the treatment of hair loss, the other being minoxidil.

Interestingly, both finasteride and minoxidil were found to have hair growth effect as side effects.

Minoxidil was found to grow more hair in those people who took it as an antihypertensive vasodilator drug; while Finasteride stopped hair loss and even reversed hair loss when used to treat benign prostatic hyperplasia.

2. How does finasteride work?

Finasteride inhibits the expression of the enzyme 5-alpha-reductase, which regulates the production of dihydrotestosterone (DHT).

By lowering the DHT levels in the scalp, it reduces the harmful effect of DHT on the hair follicles.

Finasteride reduces DHT concentrations in the serum and scalp by 70 and 60%, respectively.

Male hair loss, or androgenetic alopecia, is an androgen-dependent condition.

In genetically susceptible men, dihydrotestosterone (DHT), a potent metabolite of the male androgen testosterone, contributes to male hair loss.

The conversion of testosterone to DHT is regulated by the enzyme 5-alpha reductase.

3. How does finasteride affect the body's hormonal/endocrine system?

Finasteride inhibits the enzyme responsible for regulating the conversion of testosterone to dihydrotestosterone (DHT).

By lowering the level of DHT in the scalp, the drug reduces the effects of DHT on the hair follicles, thereby reversing the process of hair loss.

4. Is topical finasteride as effective as finasteride?

Finasteride was initially approved as an oral pill to be taken once a day. The usual dose is 1 mg per day, taken with or without food, at any time of the day. A topical formulation of finasteride has been approved in India and has been shown to be as effective as oral finasteride.

5. Why shouldn't women use finasteride?

Finasteride is not indicated for use in women with hair loss (female hair loss).

Finasteride is contraindicated in women who are pregnant or may be pregnant because it may cause abnormalities of the external genitalia of a male fetus (pregnancy category should not be used during pregnancy or if there is a risk of pregnancy.)

6. How effective is finasteride?

The data comes from three large, multicenter, placebo-controlled studies involving 1.879 men with mild to moderate, but not complete, male pattern hair loss.

The men received oral finasteride once a day or placebo for one year.

The endpoints for the studies were objective hair counts taken from a circular area 1 inch in diameter and subjective ratings of improvement by patients, researchers and an independent panel of dermatological experts who evaluated pre- and post-treatment photographs.

The studies showed that finasteride can prevent hair loss in men with mild to moderate male hair loss.

In two of the clinical trials of men with mild to moderate male pattern hair loss, 86% of men treated with finasteride maintained an increase in the amount of hair on a hair count basis over the course of the studies. Only 14% of finasteride-treated men had further hair loss after 12 months of treatment, compared to 58% of placebo patients.

Ongoing studies have shown that finasteride stops hair loss or regrows hair in 9 out of 10 men who use it long-term every day.

7. Are some patients more likely to respond to finasteride than others?

It is difficult to predict which patients will respond and to what extent.

Patients studied in clinical trials had mild to moderate, but not complete, hair loss and ranged in age from 18 to 41 years.

8. How long should I take finasteride to see any results?

Daily use for three months or more may be necessary before a patient notices further hair loss or increased hair growth is prevented.

9. Can I stop using finasteride once I have grown enough hair?

Daily use of finasteride for three months or more may be necessary before a patient notices that further hair loss or increased hair growth has been prevented.

There are no controlled clinical data on treatment beyond 12 months.

It will likely be necessary to continue treatment indefinitely to maintain benefits.

10. What happens if you stop taking finasteride?

If a patient stops taking finasteride, DHT levels in the scalp will rise again and hair loss is likely to resume.

11. Will I grow more hair on another part of my body?

Finasteride is a specific inhibitor of type II 5-alpha-reductase, which is mainly found in hair follicles on the scalp.

In clinical trials, there was no reported effect on hair on the other parts of the body.

12. What are the side effects of finasteride?

In clinical trials, finasteride was very well tolerated in men, with most patients reporting no serious side effects.

The main side effects of finasteride were decreased libido (1,8% of finasteride patients versus 1,3% of placebo) and erectile dysfunction (1,3% of finasteride versus 0,7% of placebo).

In addition, reduced ejaculate volume was reported in 0,8% of men treated with finasteride and in 0,4% of men given placebo.

Gynecomastia (enlargement of the breasts) has also been reported.

All of these side effects resolved upon discontinuation of therapy and resolved in many men who preferred to continue therapy.

Post-marketing reports include some patients complaining of depression, but the risk of this is probably very small.

13. What is the long-term effect of using finasteride?

Finasteride was evaluated in 3200 men and was found to be very well tolerated, including patients treated for up to two years.

Long-term suppression of DHT does not appear to be harmful.

This is based on extensive research dating back to 1974 among men born with a deficiency of 5-alpha reductase.

Finasteride results in an average reduction of 50% for the prostate specific antigen score (PSA test).

The score must be doubled to determine the risk of prostate cancer.

The risk of prostate cancer related to the use of finasteride has been assessed very carefully.

Current evidence is reassuring and does not appear to increase the risk of cancer or result in more severe disease than in those who do not take the drug.

Although some cases of breast cancer have been reported in patients taking finasteride, there is no evidence that the drug was the cause.

14. Are there contraindications to finasteride?

Finasteride is not indicated for use in women or children.

However, it is sometimes prescribed off-label to postmenopausal women without any problems.

Finasteride is contraindicated in women who are or may be pregnant.

Finasteride is contraindicated in patients who are hypersensitive to any component of the product.

It is not recommended in men who are not fertile.

In men planning to have children, some doctors check sperm counts before starting finasteride, and repeat this after 6 months of treatment.

If sperm count has decreased, finasteride should be stopped.

15. Can you combine finasteride with minoxidil?

The combination has been shown to produce better results than minoxidil or finasteride alone. If switching from one treatment to another, it is best to overlap by six months to reduce the chance of hair loss due to withdrawal from the first agent while waiting for a response to the new product.