Is Finasteride A Legitimate Hair Loss Treatment?

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Finasteride is a medicine that is known for its uses in regards to treating disorders related to male hormones. It is used to treat benign prostatic hyperplasia, hair loss and prostate cancer in men. Finasteride slows down the hair loss in male pattern baldness and also promotes the hair growth.
Is Finasteride a legitimate hair loss treatment? The simple answer to that question is, yes it is! Finasteride is used to treat hair loss and a lot of people have benefitted from its effects. However before reaching this early conclusion so easily there are many things to consider while getting treated with Finasteride. Let’s discuss in detail the exact working of wonder drug Finasteride.
It won’t be wrong to call finasteride the Holy Grail in the treatment of hair loss and baldness in men. We know that Finasteride has absolutely no effect in women and in placebo studies it was found out that the drug had no effect on women with hair loss problems. Finasteride comes under two of the most popular brand names; Propecia and Proscar. Propecia comes in a dose of 1mg and Proscar comes in a dose of 5 mg. Both Propecia and Proscar are manufactured and marketed by Merk and Co.

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Finasteride’s use for hair loss has a history to it. Proscar (finasteride 5mg) was the initial drug marketed by Merk for treatment of benign prostatic hyperplasia. As we know that Finasteride is a Dihydrotestosterone blocker. It helps in prostatic hyperplasia by blocking the unwanted side effects of dihydrotestosterone on the body and helps with easing the difficulty in urination associated with prostatic hyperplasia. Proscar was marketed in 1992 for the treatment of prostatic hyperplasia. In 1997 Proscar was undergoing more clinical trials and studies, during these studies it was found that it helped bald men in the study with hair loss and also improved the quality and hair count on the head especially the vertex or top of the scalp. Mark accidentally discovered the effect of finasteride on hair loss treatment. After this discovery, it was brought to market in 1998.
Currently, only two drugs are approved for the treatment of hair loss and they are; Finasteride and Minoxidil (Regain topical solution). There is another drug by the name of Dutasteride for hair loss but it is not yet approved for male pattern baldness, although it is used in Japan and a few other countries without a prescription and as over the counter drug but in the USA and European countries it is yet to be approved for hair loss.

 

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How does Finasteride work?

We have hailed Finasteride as the Holy Grail for the treatment of hair loss. Let’s see how it works that have made it become a wonder drug –
Finasteride is an enzyme blocker. It blocks 5 -Alpha-reductase inhibitor type I and II. 5 – Alpha-reductase is an enzyme that converts free testosterone in the male body to dihydrotestosterone. There are two types of testosterone in the male body one is free and the other one is bound to sex binding proteins in the blood or albumin. Bound testosterone is not readily available for its effect but free testosterone is readily available and converts to dihydrotestosterone.

Why do we want to block this dihydrotestosterone (DHT)?

The reason is that DHT occurs in various parts of the male body. It occurs in the prostate gland, hair follicles and skin. DHT is a potent metabolite of testosterone and although the effect of DHT in baldness or hair loss is not yet fully understood it is proposed that DHT has an adverse role on hair follicles and are responsible for shrinkage of hair follicles. They also pre-maturely push the hair cycle into the telogen phase which is hair shedding phase and as a result, the anagen phase is reduced. In men with androgenic alopecia or male-pattern baldness, DHT binds to follicles on the top of the scalp and causes the scalp to lose hair and makes the hair very thin. It is thought that hairs on the sides of the head are generally more resistant to DHT, as a result, there is a characteristic pattern of hair loss in men with genetic baldness. This pattern is called as M pattern with a receding hairline and thin hairs on the sides of the head and complete loss of hairs on the vertex or top of the scalp. A Hamilton -Norwood scale is present to determine the amount of hair loss taken place on the head and treatment is then done accordingly.
Other problems that DHT causes in men are prostate cancer and benign prostatic hyperplasia. Finasteride is also used to treat benign prostatic hyperplasia and eases the symptoms of difficulty to urinate with benign hyperplasia and reduces chances of a surgery in men in the long term.
Finasteride reduces the levels of dihydrotestosterone in the scalp by 60% and in the blood serum by 70%, this makes it quite effective in stopping testosterone from converting to DHT. Finasteride is best taken with food.

Prescribing Finasteride for hair loss

Finasteride dosage for treating hair loss is once daily dosage of 1 mg. In the UK it is not available without prescription the reason being that the doctor first assesses the patient for the condition, makes a proper diagnosis and then prescribes according to that.
There are different types of hair loss and each hair loss has a different reason behind it. A few types of hair loss are;

Thinning of hairs (Telogen effluvium)Finasteride is not prescribed for this condition.

This condition is caused by lack of nutrients, sedentary lifestyle, trauma or emotional shock and also postpartum after pregnancy

It is usually treated by giving sufficient nutrients to the patient like iron supplements, vitamins, minerals

By regulating diet and including fresh fruits and vegetables in the diet

By encouraging the patient to give up on sedentary and unhealthy lifestyle and incorporate exercise into their daily routine

In postpartum by taking better nutrients and drinking milk every day
Hair loss due to medications, radiations, therapy etcHair loss can also be due to radiations or medications

Radiations destroy hair follicles because they stop the rapidly dividing cells

Chemotherapy is also responsible for hair loss and baldness

Finasteride is not prescribed for this condition

When is reversed or cut off from the contact the hairs grow back

When chemotherapy treatment is stopped the hairs regrow again.
Male pattern baldnessFinasteride is prescribed for this condition only.

Prescribed for genetic baldness

Prescribed for androgenic baldness (hormone related baldness)

Male pattern baldness can be hereditary or influenced by hormones

Testosterone and Dihydrotestosterone are key culprits in hair loss in men.

Finasteride is effective for this condition only provided there is no inflammation, redness, pain etc.

Prescribed when hair loss is in a classical pattern and not patchy or in spots
Female pattern baldnessFinasteride is not prescribed to women as it has no effect in women hair loss.

Is termed as a category X drug in pregnancy which means it should not be handled in pregnancy in any way.

Has teratogenic effects on the foetus.
Alopecia areataFinasteride is not prescribed

It is an auto-immune disease. The defence cells of the body destroy its own hair follicles.

Hair fall is in patches. Also called as Spot baldness.

Can be self - limiting or permanent depending upon the situation.

Treatment is by injecting corticosteroids in the scalp
Hair loss due to infectionsFinasteride is not prescribed

Infections can be Fungal or bacterial

For fungal infections, Griseofulvin is prescribed

For bacterial infections, antibiotics are prescribed

Shampoos are the best topical treatment for scalp infections

Hygiene is of utmost importance

Side effects of Finasteride

Finasteride is generally a well – tolerated drug. It not only stops the hair from falling out but has also shown to improve the hair count on the head up to 200 hairs per square inch (in a normal healthy scalp there are approximately 2000 hairs per square inch). The effect of finasteride is slow. A person may start to notice the effect after three months 3. The hairs don’t fall as much when the pill is taken but they fall out again once the pill is stopped. There are certain side effects associated with finasteridefhow and they are as follows;

Sexual dysfunction:

Finasteride may cause sexual dysfunction in young men. Because the drug blocks the activity of dihydrotestosterone which is an important hormone in men and imparts sexual characteristics to men, blocking the hormone might interfere with men’s sexual health. These side effects are mostly seen in young males. Some men have reported low libido, lack of orgasms and premature ejaculation. It is also known to affect the sperm count and quality of the sperm. Therefore it is usually not recommended for men in their childbearing age or someone who is planning to have a baby. FDA says that men may continue to experience libido side effects, orgasm and ejaculation disorders up to three years after discontinuing the drug. Therefore finasteride should always be purchased on prescription with proper consultation from the doctor.

Gynecomastia:

It is another side effect that a few men may experience after a therapy with finasteride. Gynecomastia is a hormonal disorder caused by blockage of dihydrotestosterone and manifests itself as enlargement of breasts in men. The condition is reversible and a person feels back to normal once the therapy is stopped.

Other side effects include:

Depression, allergic reaction, itchy lips, and hives

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Contraindications of Finasteride:

Use of finasteride in women and children:

Finasteride is for the use only in men and NOT in women or children. Children don’t have hormones that give them secondary sex characteristics so should never be prescribed for them.
Whereas women who are pregnant or may potentially get pregnant should not swallow or even handle a crushed tablet that may absorb through skin containing finasteride.
If used by such women it may potentially cause damage to the male foetus causing defects in his external genitalia or sex organs. In animal studies, it has been shown that the drug doesn’t cause any effect in the female foetus.
Finasteride doesn’t have any benefit on the hair loss in women. Even in women suffering from hair loss after their menopause showed no better results than the placebo.

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Use by men suffering from sexual problems:

Men suffering from sexual or fertility problems should not use finasteride as it may make the situation worse. Finasteride is a hormone blocker and blocking testosterone in this condition is not desirable. It is reported that finasteride even after discontinuation of its use causes sexual problems in men. It causes ejaculation disorders, orgasm disorders and even problem with erections. It also reduces the sperm count and quality of sperm is also affected. Women in their childbearing age and especially those trying for a baby should not take finasteride.

Hepatic or Renal insufficiency:

Patients who suffer from liver or kidney problems should be given finasteride with caution. Finasteride is extensively metabolised in the liver so in case of a liver disease it should be given with caution or not at all. The Kidneys are responsible for the clearance of finasteride from the body so care should be taken in taking the drug if kidneys are compromised

 

How to Increase Efficacy of Finasteride

Finasteride is a once-daily pill and comes in a dosage of 1mg. It usually takes three to four months of regular usage of the drug before its effects are visible. Although effects are slow they are prominent and not only hair count is improved but hair regrowth is also seen. Ideally, finasteride should be taken with food. It should not be taken more than once daily as increasing the dose won’t have any effect on the hair growth 4. It takes two to three months for the pill to show its effect. There are however a few things that can be done to increase the efficacy of finasteride. These are as follows;

Taking finasteride with Vitamins:

Although vitamins have nothing to do with increasing or decreasing the efficacy of finasteride neither do they increase its blood levels. Vitamins especially Vitamin B complexes, Iron and some minerals like Zinc etc. can greatly influence the hair growth. They also improve the quality of hair. Sometimes hair fall can also be due to the nutrient deficiency in the body. Addressing the nutrient deficiency along with proper therapy greatly impacts the overall results. These vitamins can also be taken from good diet and importance of eating fresh fruits and vegetables can’t be emphasized enough.

Using finasteride with a topical solution of Minoxidil:

Minoxidil and finasteride are two only FDA approved drugs used for the treatment of hair loss. Both of these drugs are used for androgenic alopecia. Minoxidil unlike finasteride is available over the counter and comes in a topical solution for hair loss. Using it simultaneously with finasteride has shown to greatly influence the hair growth. It not only stops the hair loss but also helps to grow the hairs. Patients who have used finasteride along with a topical solution of minoxidil have seen very good results in less time. Minoxidil comes in two strengths of 2% and 5% (extra strength). It should be applied directly to the balding spots of the scalp twice a day.
While both of these drugs have positive reviews by the patients who use them, it should be remembered that the hair loss may return back as soon as the treatment is stopped.

 

Conclusion

Finasteride has a lot of positive reviews from the patients who use them. While this drug is highly effective in treating the hair loss, it should not be expected to see the results overnight. It takes a few months before the drug actually shows its effects. The effect of these drugs is gradual but it is promising. But it should be remembered that a good diet and a healthy lifestyle has an impact on our health that no drug can replace.

 

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References:

  1. https://www.drugwatch.com/propecia/
  2. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020788s018lbl.pdf
  3. https://www.rxlist.com/proscar-drug.htm#side_effects
  4. https://www.forhims.com/blog/3-ways-to-speed-up-the-results-from-finasteride

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