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Finasteride for hair loss

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 4 minutes read
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Finasteride (also known by the brand name Propecia) is a medication used to treat hair loss in men. It is also used to manage urinary symptoms in men with an enlarged prostate, also known as benign prostatic hyperplasia. Finasteride is used to manage the most common type of hair loss, often associated with ageing, called male pattern baldness or androgenic alopecia. It is commonly used alongside minoxidil liquid or foam, another hair loss medication. Unlike minoxidil, which can only facilitate hair regrowth, finasteride can prevent hair loss as well. Finasteride is considered most effective on the crown area of the scalp, although studies have shown it can benefit all areas of the scalp affected by male pattern baldness. Finasteride is mainly available as tablets to be taken once a day. The best results are seen when the medication is taken every day, and it can take around six to nine months before you see the full effects.

Many people that take finasteride experience a shedding phase early on in their treatment (usually in the first few months). This phase causes you to lose more hair than normal as older damaged hairs are lost. These are then replaced by newer and stronger hairs. Shedding is nothing to worry about, and it shows the medication is working.

Although finasteride can cause hair regrowth, it is considered to be more of a preventative medication for further hair loss. Therefore, it is best to begin finasteride treatment when you first start to notice signs of male pattern baldness. If you have already lost most of your hair, finasteride is unlikely to be useful as it is not usually associated with massive amounts of hair regrowth. Also, any regrowth that you gain is not permanent; if you stop taking finasteride, this hair will fall out again.

How does it work?

Finasteride works by inhibiting an enzyme called 5-alpha reductase. Inhibition of this enzyme blocks the conversion of testosterone to dihydrotestosterone (DHT), a hormone involved in prostate enlargement and hair loss.

Do I need a prescription for finasteride?

Yes, finasteride is a prescription-only medicine in the US. Finasteride tablets are available on prescription for the treatment of benign prostatic hyperplasia or for hair loss. Your insurance may not cover finasteride for hair loss.

Are there any side effects?

As with all medications, some people may experience side effects. Finasteride can sometimes cause sexual problems. Men may be unable to have an erection or they may release smaller amounts of semen when they ejaculate. A decreased sex drive can also occur. Finasteride is also linked with causing depression. If you think finasteride is making you depressed, we recommend you speak with your doctor. Rare cases of male breast cancer have been reported in men taking finasteride. If you notice any changes to your breast tissue, such as lumps, pain, or nipple discharge, you should promptly speak with your doctor.

Some people that have taken finasteride have reported experiencing side effects after stopping the medication. This is described as 'post-finasteride syndrome'. Reported side effects have included sexual problems, muscle problems (like pain, weakness, and cramps), gynecomastia (female-like breast development), chronic fatigue, and many others. The incidence of 'post finasteride syndrome' is rare and scientific evidence for the condition is limited. However, as there are no established cures for 'post finasteride syndrome' and people have reported experiencing problems for many years after stopping their treatment, it is important that people thinking about starting finasteride are aware of the potential existence of the condition.

Who should not take the medication?

Do not take finasteride if you have previously had an allergic reaction to finasteride or another ingredient listed in the medication. Finasteride is not recommended for anyone under the age of eighteen. It is also not usually recommended for women and particularly women of childbearing age. This is because finasteride is teratogenic, which means it can cause birth defects (specifically, finasteride is linked with causing genitalia abnormalities in male fetuses). For this reason, women who are pregnant or are planning to become pregnant should avoid handling finasteride tablets (especially if they are crushed or broken), as finasteride can be absorbed through the skin. A very small amount of finasteride can be found in the semen of men taking the medication. Men taking finasteride that want to try for a baby with their partner are advised to discuss this with their doctor. Temporarily stopping finasteride before conception may be advised.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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