Finasteride : FAQs

At present Finasteride 1 mg is considered 1st line therapy and is the only FDA approved oral medicine for androgenic alopecia, the common male pattern baldness. As a hair transplant surgeon I prescribe it to some of my patients who have sufficient amount of hair in balding zone and who do not want another session in near future.

In some of these patients, I have seen strong resistance and bias against Finasteride. This bias, mostly generated through internet 'research', is sometimes so strong that it persists even after thorough counselling. Since it is impossible to give details to every individual in person, I am writing this post.

What is Finasteride?
Finasteride is an enzyme blocker used for Benign Prostatic Hypertrophy in high doses(5mg) and for male pattern baldness in low dosage form (1mg).

How does it work?
Finasteride inhibits type II 5-alpha-reductase, the enzyme that converts testosterone into dihydrotestosterone (DHT), which is responsible for the progressive miniaturization of hair follicles seen in male pattern hair loss.

What is the evidence that it works?
Multiple clinical studies have shown that finasteride 1 mg/day slowed hair loss and
increased hair growth in men with mild to moderate pattern hair loss. Results can be seen in 4 to 6 months.
Long-term studies also revealed that the continuous use of finasteride decreases the likelihood of developing further visible hair loss. Discontinuation of the drug leads to return to pretreatment condition.

For readers who are interested in actual studies, they can be found in medical journals mentioned here.
1. Kaufman KD, Olsen EA, Whiting D, et al (1998) Finasteride in the treatment of men with
androgenetic alopecia. J Am Acad Dermatol 39:578–589
2. Leyden J, Dunlap F, Miller B, et al (1999) Finasteride in the treatment of men with frontal
male pattern hair loss. J Am Acad Dermatol 40:930–937
3. Kaufman KD, Rotonda J, Shah AK, et al (2008) Long term treatment with Finasteride 1 mg
decreases the likelihood of developing further visible hair loss in men with androgenetic
alopecia. Eur J Dermatol 18:400–406
4. Price VH, Menefee E, Sanchez M, et al (2006) Changes in hair weight in men with androgenetic
alopecia after treatment with fi nasteride (1 mg daily): 3- and 4-year results. J Am
Acad Dermatol 55:71–74

Does it work in Asians and Indians?
Among Indians, Finasteride was found to be superior on all measures of efficacy at study conducted in All India Institute of Medical sciences, New Delhi. At the end of 12 month study there was an improvement in hair count and hair growth while reducing the hair fall.
Among Asians a study done on Japanese men with pattern hair loss showed that 1 mg of finasteride taken once daily slowed hair loss and improved hair growth in Japanese men with male pattern hair loss .Similar results were seen among Taiwanese men with male pattern hair loss .

1. Prasad H, Khanna R, Pandhi (2005)   A randomized double blind study of the effect of finasteride on hair growth in male patients of androgenetic alopecia. Indian J Dermatol 2005;50:139-45 
2.Kawashima M, Hayashi N, Igarashi A, et al (2004) Finasteride in the treatment of Japanese
men with male pattern hair loss. Eur J Dermatol 14:247–254
3. Lin JH, Chen WC (2002) Finasteride in the treatment of Taiwanese men with androgenetic
alopecia: a 12-month open-label study. Kaohsiung J Med Sci 18:379–385

What are the side effects?
The only notable side effects in various studies were decreased libido, erectile dysfunction, and breast tenderness. In a long-term efficacy and safety study, 1524 patients treated with Finasteride tablets USP and 1516 patients treated with placebo were evaluated for safety over a period of 4 years. The most frequently reported adverse reactions were related to sexual function. 3.7% (57 patients) treated with Finasteride tablets USP and 2.1% (32 patients) treated with placebo  discontinued therapy as a result of adverse reactions related to sexual function, which are the most frequently reported adverse reactions.
Note: Placebo refers to a sham tablet with no medicine that looks exactly like real medicine. It is used for comparative studies to negate the psychological effects of 'taking a medicine'.

Are these side effects permanent?
 These adverse events were seen only in a very small percentage of patients and were noted to
disappear soon after finasteride was stopped .
It was also noted that side effects also disappeared on continuation of the medicine, so that at 2,3 & 4 years the side effect profile was same in Finasteride and placebo group.

1. Finasteride: Official FDA information

Whatever I have written in this post, is based on published scientific studies. I have tried to be non judgmental and just report the facts. This is in no way an authoritative monograph and, I would be grateful for further words and comments on this topic.


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