Everyone loses hair over time, maybe up to 100 strands a day. They fall out, then grow back in, and the cycle starts over again. But what happens if you will start to notice that you’re losing hair that is not growing back?…
Up to 95% of guys with thinning hair can blame the hair loss on a condition called androgenetic (or pattern) alopecia. This is caused by genes you get from your parents.
The symptoms of male pattern baldness generally include a receding hairline at the temples and thinning of hair at the top of the head.
What is male pattern hair loss?
Male pattern hair loss is a common condition in which men experience thinning of the hair on the scalp. The condition is characterised by a gradual onset. Thinning of the hair typically starts in men in their 20s.
The prognosis of androgenetic alopecia is not known. Some patients progress to the point where they lose almost all hair on the scalp. Others have a patterned or nonpatterned thinning but retain a considerable number of hairs on the scalp.
Male pattern baldness takes place when the hormone testosterone is converted into a form called dihydrotestosterone (DHT), which directly affects hair follicles, causing them to shrink, producing progressively finer hair and eventually no hair. Genes determine how rapidly this process happens, and at what age it starts. There are medical treatments for male pattern hair loss, the most popular of which is an oral drug sold under the trade name Propecia.
What causes hair loss?
Doctors don’t know why certain hair follicles are programmed to have a shorter growth period than others. However, many factors may influence hair loss:
- Genes, from both male and female parents, may influence a person’s predisposition to male or female pattern baldness;<
- Stress, illness, and childbirth can cause temporary hair loss;
- Drugs, including chemotherapy drugs used in cancer treatment, blood thinners, beta-adrenergic blockers used to control blood pressure, and birth control pills, can cause temporary hair loss;
- Burns, injuries, and X-rays can cause temporary hair loss. In such cases, normal hair growth usually returns once the injury heals unless a scar is produced. Then, hair will never regrow;
- Autoimmune disease may cause alopecia areata. In autoimmune diseases, the immune system suffers an abnormality causing it to damage and destroy other parts of the body. In most people with alopecia areata caused by autoimmune diseases, the hair grows back, although it may temporarily be very fine and possibly a lighter colour before normal colouration and thickness return;
- Cosmetic procedures, such as shampooing too often, perms, bleaching, and hair discolouration can contribute to overall hair thinning by making hair weak and brittle. Tight braiding, using rollers or hot curlers, and running hair pick through tight curls can also damage and break hair. However, these procedures don’t cause baldness. In most instances hair grows back normally if the source of the problem is removed;
- Medical conditions. Thyroid disease, lupus, diabetes, iron deficiency anaemia, eating disorders, and anaemia can cause hair loss. Most times, when the underlying condition is treated, the hair will return unless there is scarring as in some forms of lupus, lichen planus or follicular disorders;
- Diet. A low-protein diet or severely calorie-restricted diet can also cause temporary hair loss.
What is Finasteride?
Finasteride is a chemical compound, acting as a specific inhibitor of steroid type II
5a-reductase, an intracellular enzyme that converts the androgen testosterone into
5a-dihydrotestosterone (DHT). Dihydrotestosterone is a powerful hormone that causes hair follicles to miniaturise and eventually stop growing hair. In the 1 mg dose (Propecia), it is indicated for the treatment of male pattern hair loss. In the 5 mg dose (Proscar), it is indicated for the treatment and control of benign prostatic hyperplasia.
How does it work?
Genetic pattern baldness is caused by a hormone called dihydrotestosterone (DHT), a by-product of testosterone. Therefore, substances which act as DHT-blockers have been shown to decrease the negative effects of DHT on hair growth. When the body metabolises testosterone, it breaks down into DHT. The enzyme 5-alpha reductase supervises this chemical reaction. Propecia causes 5-alpha reductase to become less effective, reducing the body’s ability to produce DHT. After five years of regular use, almost 50% of men with male pattern baldness showed an increase in hair growth while 90% of men maintained hair pre-treatment levels.
Finasteride taken at 1mg per day has been proven clinically to decrease DHT by nearly 70%. Some experts believe finasteride lowers testosterone levels; however, it has actually been shown in most studies to raise levels by around 9%, which is still in the normal range.
How should I take Finasteride?
You may need to take finasteride by mouth daily for 3 months or more before you see a benefit from taking it.
Try to take your doses at the same time of day, as this will help you to remember to take finasteride regularly. Swallow the tablet whole (without breaking or crushing it) with a drink of water.
Finasteride can be administered with or without meals.
The recommended dose of finasteride is one tablet (1 mg) a day.
Safety and efficacy have been demonstrated in men between 18 to 41 years of age with mild to moderate hair loss of the vertex and anterior mid-scalp area.
Propecia & Finasteride
Will Finasteride work for me?
For most men, finasteride increases the number of scalp hairs in the first year of treatment, helping to fill in thin or balding areas of the scalp. In addition, men taking finasteride may note a slowing of hair loss.
Although results will vary, generally you will not be able to grow back all the hair you have lost. There is not enough evidence that finasteride works in the treatment of receding hairline in the temporal area on both sides of the head.
Male pattern hair loss occurs gradually over time. On average, healthy hair grows only about half an inch each month. Therefore, it will take time to see any effect. You may need to take finasteride daily for three months or more before you see a benefit from taking finasteride. Finasteride can only work over the long term if you continue taking it. If the drug has not worked for you in 12 months, further treatment is unlikely to be of benefit. If you stop taking finasteride, you will likely lose the hair you have gained within 12 months of stopping treatment. You should discuss this with your doctor.
Finasteride is not effective in the treatment of hair loss due to androgenetic alopecia in postmenopausal women. Finasteride should not be taken by women.
Finasteride and Propecia. Are there any differences?
Both contain 1mg of finasteride. There are differences between generic Finasteride and Propecia only in their inactive ingredients, such as the ingredients that bind the drug together in tablet form.
It’s up to you whether you choose to go with name brand Propecia or generic finasteride. Both have the same dosage of the same active ingredient, but the generic costs less. The price per tablet isn’t that much difference between the generic and the name brand, but since the drug must be taken long term, a small difference can add up over time. Some men start with Propecia, and if they’re pleased with the progress but chagrined at the expense, will switch over to the generic with no problem. Either way, there’s no reason to wait, because the sooner the medication is started during the balding process (when follicles are still more active), the better the results tend to be.
Are they looking the same?
While the pills you receive at the pharmacy counter may look slightly different from the brand, generic medicines work the same as costlier brand-name products. They have the same active ingredients, and the manufacturing and packaging must pass the same quality standards.
The Medicines Regulatory Agencies requires generic drugs to have the same performance and quality as brand-name drugs with respect to identity, strength, quality, purity, and potency.”
Generic drugs may differ in:
- Labelling (minor differences).
Why is Finasteride cheaper than Propecia?
You may be wondering how a generic drug can be sold at a much lower price than a brand-name drug.
The difference in price has to do with the different costs drug makers have in bringing generics and brand-name drugs to the pharmacy shelf.
The patent gives a drug maker exclusive rights to produce and sell the drug for a limited time. The average time a brand-name drug is protected by the patent after it hits the market is 12 years.
When the patent ends, other companies are allowed to make and sell a generic version. The generic drug maker’s costs are relatively low because the product has already been developed and tested by the brand-name company.
So makers of generic drugs can pass the savings along in the form of lower prices to pharmacies and ultimately to us. The competition among multiple companies producing a generic version of a drug also helps keep the price low.
In a study in 15 healthy young male subjects, the mean bioavailability of finasteride 1 mg tablets was 65% (range 26-170%), based on the ratio of an area under the curve relative to an intravenous (IV) reference dose. At steady state following dosing with 1 mg/day (n=12), maximum finasteride plasma concentration averaged 9.2 ng/mL (range, 4.9-13.7 ng/mL) and was reached 1 to 2 hours
Finasteride is extensively metabolised in the liver, primarily via the cytochrome P450 3A4 enzyme
subfamily. Two metabolites, the t-butyl side chain monohydroxylated and monocarboxylic acid
metabolites, have been identified that possess no more than 20% of the 5α-reductase inhibitory activity of finasteride.
Following intravenous infusion in healthy young subjects (n=15), mean plasma clearance of finasteride was 165 mL/min (range, 70-279 mL/min). Mean terminal half-life in plasma was 4.5 hours (range, 3.3-13.4 hours; n=12). Following an oral dose of 14C-finasteride in man (n=6), a mean of 39% (range, 32-46%) of the dose was excreted in the urine in the form of metabolites; 57% (range, 51-64%) was excreted in the faeces.
Mean terminal half-life is approximately 5-6 hours in men 18-60 years of age and 8 hours in men more than 70 years of age.
How to use Finasteride safely?
First off, you should talk to a dermatologist. Aside from doing that, there are a number of things you can do to minimise your risks if you’re considering using finasteride.
Get a medical evaluation – You could have a medical issue you aren’t aware of, which could put in danger your safety while on the drug. Getting a full check-up could be a wise move on your part, including some blood and hormonal tests, if possible.
Proceed with caution if you have a mental health issue – Patients with certain mental health problems may be more likely to notice side effects. Before you begin treatment, if you’re having a mental health issue, you may want to talk to a counsellor or therapist, along with your doctor.
Stay positive and have an open mind – If you expect negative side effects, there’s a good chance you’ll have negative side effects.
Finasteride side effects
Like all prescription products, finasteride may cause side effects. In clinical studies, side effects from finasteride were uncommon and did not affect most men. A small number of men experienced certain sexual side effects. These men reported one or more of the following: less desire for sex, difficulty in achieving an erection and, a decrease in the amount of semen. Each of these side effects occurred in less than 2% of men. These side effects went away in men who stopped taking finasteride. They also disappeared in most men who continued taking finasteride.
In general use, the following have been reported:
- Breast tenderness and enlargement;
- Allergic reactions including rash, itching, hives and swelling of the lips and face;
- Problems with ejaculation;
- Testicular pain;
- Breast cancer.
You should promptly report to your doctor any changes in your breasts such as lumps, pain or nipple discharge. Tell your doctor promptly about these or any other unusual side effects.
Best first-line of attack. It can dramatically slow and partially reverse hair loss for a high percentage of men;
Generally well-tolerated. It has been used as a hair loss treatment since 1997. It’s approved and considered safe by the two of the world’s leading hair loss organisations, the International Society of Hair Restoration Surgeons and the American Hair Loss Association;
Can work for years, even decades; is the most effective, long-term hair loss treatment option on the market today;
Easy to use as directed. Taking a pill every day is no big deal for most people. On the other hand, compliance may be an issue with a hair loss treatment like minoxidil, where the solution must be rubbed into the scalp twice daily.
The risks and downsides
- The very small risk of persistent sexual side effects and/or post-finasteride syndrome;
- If you stop taking it, you’ll lose any hair you kept or regrew with the drug within about 12 months.
To make sure Finasteride is safe for you, tell your doctor if you have:
- Liver disease, or abnormal liver enzyme tests;
- Prostate cancer;
- A bladder muscle disorder;
- Stricture of your urethra;
- If you are unable to urinate;
- If you have ever had an allergic reaction to a similar medicine called dutasteride (Avodart).
Who should not take Finasteride?
- Finasteride should not be taken by women;
- Finasteride should not be taken by children;
- Women who are or may potentially be pregnant;
- Anyone allergic to any of the ingredients.
While you are using Finasteride:
If you are about to start on any new medicine tell your doctor that you are taking finasteride;
Do not give finasteride to anyone else, even if they have the same condition as you.
So, do the benefits outweigh the risks? That’s entirely up to you. Finasteride and Propecia contain the same active ingredient. Both are proven, highly effective treatments for male pattern hair loss, approved by the European Regulatory Agencies and trusted, by and large, by the medical community. They stop hair loss in many men and can promote some regrowth in up to 2/3 of their users.
For any questions related to finasteride and hair loss, you can drop us an email at the following address [email protected] or simply call us at 01625 460 621.
- Yim E, Nole KL, Tosti A. 5α-Reductase inhibitors in androgenetic alopecia. Curr Opin Endocrinol Diabetes Obes. 2014 Dec;21(6):493-8; PubMed PMID: 25268732; doi: 10.1097/MED.0000000000000112;
- Venkataram M. Finasteride and sexual side effects. Indian Dermatol Online J. 2012 Jan-Apr; 3(1): 62–65. PMCID: PMC3481923. PubMed PMID: 23130269; doi: 10.4103/2229-5178.93496;
Assured Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected]