Finasteride is one of the most commonly prescribed hair loss medications. It works by decreasing the levels of a particular form of testosterone known as DHT. This hormone affects hair follicles, causing them to shrink and to spend less time in the growing phase. The effects of DHT are considered to be largely responsible for male pattern hair loss, which affects 70% of men as they age.
It comes in both a topical form, which is a liquid that’s applied to the scalp once or twice per day, and an oral form, which is a pill that’s taken daily. The oral form of finasteride is FDA- approved for treating hair loss in men. However, studies comparing topical and oral finasteride have generally shown that the two forms are equally effective.
Because finasteride works by altering hormone levels, there are some concerns about the side effects that it can produce. When it’s taken orally, finasteride can sometimes cause sexual or mood-related side effects. The topical version is expected to cause a much lower risk of these effects; however, it can still have some impact on levels of DHT in the blood, and we need more research to confirm that the risk of systemic side effects is reduced. The most common side effect of topical finasteride is irritation of the scalp.
Finasteride is in a class of medications called 5-alpha reductase inhibitors. It was initially approved for a condition of the prostate known as benign prostatic hyperplasia, in which the prostate grows too large. Later, its effectiveness for treating hair loss was discovered, and it’s now commonly used for this purpose.
5-alpha reductase is an enzyme that converts testosterone into a more potent form known as dihydrotestosterone, or DHT. This enzyme is present in many tissues throughout the body, including in the scalp. Finasteride inhibits this enzyme, leading to a decrease in the level of DHT.
DHT has a variety of actions throughout the body, and it has an impact on hair follicles. Over time, it causes them to shrink, which means that the hair that’s produced is very fine. This makes the hair less visible, which produces the appearance of baldness. In addition, DHT causes hair follicles to spend more time in the resting phase and less time in the growth phase. This means there are fewer hairs on the scalp at any given time.
In different people, the hair follicles have different levels of sensitivity to DHT. This is why some men begin to experience hair loss in their late teens or early 20s, while others don’t start losing their hair until their 50s or 60s. The sensitivity of your follicles to DHT is largely determined by genetics, so it’s something that can’t be changed. However, finasteride can alter the levels ofDHT that your hair follicles are exposed to, so that even if they’re highly sensitive, they’ll be protected from its effects.
Oral finasteride is widely used for hair loss in men, and it’s been established that it’s a very effective treatment. Although the topical version has not been as widely studied, the evidence that we have indicates that topical finasteride is also effective for hair loss.
In one study, patients used topical finasteride daily for 16 months. 73% of them reported that daily use of topical finasteride was “highly effective” at treating their hair loss. By contrast, in a control group treated with a placebo (an inert gel without finasteride), most people reported that there was no effect at all. A few other studies of topical finasteride in men have also found that it produces increases in hair density after several months of treatment.
More research is still ongoing, but the evidence that we have now is highly encouraging. Topical finasteride seems to be a very effective option for treating hair loss in men.
Although hair loss is more common in men, women can also experience hair loss as they age. Because it works by modifying testosterone levels, it’s reasonable to question whether finasteride would also be effective for women with hair loss. However, women’s bodies do produce testosterone as well, which can be converted to DHT by 5-alpha reductase. This means that finasteride could have an effect for women with hair loss.
There have not been many studies of topical finasteride in women. One study showed that topical finasteride produced significant increases in hair density in women over a 16-month period, while another showed that adding topical finasteride to topical minoxidil produced a small increase in the efficacy of the treatment. However, we need more studies to be sure about how effective topical finasteride is for female pattern hair loss.
For women, finasteride is generally not considered to be the first line of treatment for hair loss. Minoxidil is FDA-approved for hair loss in women, while finasteride is only approved for men. However, if minoxidil alone doesn’t work for a particular woman, then adding finasteride might help to increase the efficacy.
It’s important to note that finasteride is considered unsafe to use during pregnancy. While the majority of women experiencing female pattern hair loss have already gone through menopause, younger women should ensure that they’re using reliable birth control if they’re using finasteride in any form.
Any medication that changes hormone levels has the potential to cause side effects. When finasteride is taken orally, there can be a variety of side effects related to the decrease in DHT levels. The side effects of oral finasteride are most commonly related to sexual function, including decreased sex drive, erectile dysfunction (trouble getting or maintaining an erection), or ejaculation disorders (like premature ejaculation, delayed ejaculation, or an inability to reach orgasm). It can also cause mood-related side effects, including an increased risk of depression and suicidal thinking.
Topical finasteride is believed to have a much lower risk of these side effects than oral finasteride. By delivering the medication directly to the scalp, the effects are more limited to the target tissue. This method allows an effective dose of finasteride to be delivered to the hair follicles, while causing less exposure of the medication to other parts of the body. In fact, the most common reported side effect of topical finasteride is scalp irritation, which results in itching and redness of the scalp.
However, we can’t truly say that topical finasteride only affects the scalp itself. In fact, it does still have some effect on DHT levels in the blood, although this effect is far smaller than that produced by oral finasteride. Because of this, there could still be some risk of sexual and mood-related side effects from topical finasteride, although this risk is likely smaller than for the oral version. There have also been reports of a few other rare side effects, including headaches, testicular pain, liver damage, and dizziness.
Overall, topical finasteride is a highly effective option for people experiencing hair loss. The risk of side effects is likely small, but it’s not zero. Each person must decide for themselves whether the benefits of this treatment are worth the potential risks.
Oral finasteride is one of the few treatments that’s FDA-approved for treating male pattern hair loss, while topical finasteride has not yet received FDA approval. Some people wonder whether this means that topical finasteride is not as effective.
Studies have generally shown that the results of treatment with finasteride are equivalent with oral or the topical version. In fact, a study that directly compared these two options revealed that the effects were the same with either method of administration. Even though topical finasteride is not currently FDA-approved, this doesn’t mean that it doesn’t work for hair loss.
For many men, when they consider taking a medication that affects testosterone levels, they may be particularly worried about sexual side effects. Because of this, some men are concerned that finasteride could affect their sexual function.
It’s true that this can happen. In fact, impacts on sexual function are the primary side effects that have been found for oral finasteride. These include decreased sex drive, erectile dysfunction (trouble getting or maintaining an erection), and ejaculation disorders (such as premature ejaculation, delayed ejaculation, or inability to reach orgasm). These issues occur about twice as often in men taking finasteride as they do in a control group of men who are taking a placebo (a pill without the medication, which is used for comparison).
Although this may sound concerning, it’s important to note that most men taking finasteride don’t have any impact on their sexual function. Sexual side effects occur in less than 2% of men taking oral finasteride, and only 1.2% of men stop taking finasteride because of them. Similarly to men, women who take finasteride can also experience a decrease in sex drive.
Fortunately, the sexual side effects of finasteride have generally been shown to be reversible. Most of the time, if a man experiences sexual side effects from finasteride, these will go away after he stops taking the medication.
It’s definitely possible to combine topical finasteride with other hair loss treatments, and this approach has been studied. For example, one study found that adding topical finasteride to topical minoxidil treatment gave better results than topical minoxidil alone. None of the patients experienced any major side effects, and there was only a minimal effect on DHT levels in the blood for the patients using finasteride.
For those who have concerns about finasteride in general, and would prefer not to alter hormone levels in order to regain their hair, there are other options. These include other prescription medications, such as minoxidil, along with more natural options, such as topical caffeine. If you’re thinking about using a treatment for hair loss, it’s best to talk with a qualified dermatologist. This will allow you to get personalized advice about your options and to ask any questions that you have, so that you’re empowered to make your own decision about hair loss treatment.
