- Best Results4-6 months
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistMedical dermatologist
- Duration of ResultsDecades
- Back to WorkNA
Finasteride for Hair Loss
Finasteride & dutasteride are potent blockers of enzymes that convert testosterone to dihydrotesterone. These tablets are highly effective in the management of androgenic alopecia in both males and females. Oral and topical forms are available. Discuss with your treating dermatologist the best option based upon your lifestyle.
FactsFacts on Finasteride & Dutasteride for Hair Loss
- Both are inhibitors of 5 alpha reductase enzymes
- Finasteride is TGA approved for hair loss
- This can be prescribed orally as a tablet or topically as a lotion
- Topical finasteride has lesser side effects compared to oral
- Topical finasteride is often combined with minoxidil
- Both finasteride & dutasteride need to be taken long term to remain clinically effective
- These drugs should also be continued after FUE hair transplantation
How does finasteride & dutasteride work?
Both drugs work by reducing a molecule called dihydrotesterone or DHT. DHT is responsible for male pattern hair loss & causes accelerated shrinkage of the hair follicle. DHT is also partially responsible for female pattern hair loss.
Why is blocking DHT the answer to stopping hair loss?
Androgenic alopecia is caused by DHT—a derivative of testosterone. DHT causes hair follicles to shrink and lose the ability to create long, thick, pigmented hairs in a process called “miniaturization.” Testosterone is converted into DHT by an enzyme called 5-alpha reductase. Finasteride & dutasteride stop the conversion of testosterone to DHT by blocking 5-alpha reductase.
Which is better, topical or oral finasteride?
Initial reports show that oral finasteride was better than topical formulations. On this basis most dermatologists will encourage oral use, however recent papers have shown high efficacy with topical finasteride lotion. Topical finasteride had less side effects.
The combination of minoxidil & finasteride is considered Gold Standard topical therapy for male pattern hair loss.
How long does it take to work?
Results are seen in 3 to 6 months & continue to improve till the 12 month mark. Studies up to 5 years have shown a slight taper with efficacy at 5 years, however still way higher hair counts compared to baseline.
Unlike minoxidil (which increases blood flow to the follicle), paradoxical effluvium or hair fall is not seen with finasteride or dutasteride.
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Which is better, finasteride or dutasteride?
Complex answer. Finasteride is FDA & TGA approved for hair loss, dutasteride is not. The flipside is that dutasteride is a more potent inhibitor of 5 alpha reductase. This results in more inhibition of DHT. Some papers have given the edge to dutasteride, but the outcomes are marginal at 5 years (controversial).
Most dermatologists will gravitate towards finasteride due the fact that more robust studies have been conducted over a longer period of time (however some will prescribe dutasteride because of the advantage in some papers).
In some cases, we prescribe both finasteride & dutasteride together, namely in a ‘pulsed’ manner. For example, finasteride Monday to Friday & dutasteride weekend, alternatively low dose finasteride 1mg daily with dutasteride one day a week.
Can finasteride be used for female hair loss?
Yes, however this is off label. You will need to discuss this with your prescribing dermatologist. Large studies have shown that finasteride & dutasteride are highly effective in improving androgenetic alopecia in 68.9% & 65% of women respectively.
Another option is to use minoxidil 5% & finasteride 0.1%-0.25%. Though most studies show low to negligible serum levels of finasteride, the usual pregnancy precautions apply. Conventional management by specialists include the use of minoxidil orally at 1-2 mg per day, with other anti-androgens including cyproterone acetate & spironolactone.
A more conservate approach is to combine topicals with low level laser devices, thulium laser, as well as micro needling + platelet rich plasma.
What is the best topical for hair loss?
Finasteride can be prescribed in a lotion, with formulations typically ranging from 0.1 to 0.25 mg. Lotions have a much lower side effect profile. Most dermatologists will add topical minoxidil to this solution with concentrations ranging from 3 to 7%. This formulation is considered as the ideal solution for hair loss.
Another option is to use minoxidil 5-7% as a stand-alone solution. In some cases, we add retinoic acid to aid in absorption.
What are the most talked about side effects of finasteride & dutasteride?
The most notorious side effect of these tablets is sexual dysfunction. The relative risk is thought to be 1.39 X the normal population. In the vast majority of cases, this is reversible upon discontinuation. There have been reports of permanent dysfunction. The risks of sexual dysfunction following topical lotions are much less than oral formulations.
What are less common side effects of finasteride / dutasteride?
These side effects have also been reported with finasteride & dutasteride:
- Breast enlargement known as gynaecomastia. This is a rare side effect of both finasteride & dutasteride
- Depression/suicidal ideation
- Decreased sex drive that continued after stopping medication.
- Problems with ejaculation that continued after stopping the medication.
- Testicular pain & erection difficulties
- Male infertility.
- Finasteride & dutasteride are classed as teratogenic & not compatible with pregnancy & lactation. Prescriptions in females are off-label and at the discretion of your dermatologist.
Finasteride & dutasteride can affect a blood test called PSA (prostate-specific antigen), which is used in screening for prostate cancer. An elevated PSA number might be a sign of the disease. These drugs may decrease PSA levels. If you have a PSA test done, tell your healthcare provider you’re taking finasteride; they’ll need to evaluate any changes in your PSA levels. You should also tell your healthcare provider if you haven’t been taking finasteride as prescribed because this may affect PSA test results too.
What are other effective alternatives to finasteride or dutasteride?
The most effective alternative to oral medication is topical finasteride or dutasteride, preferably with topical 5% minoxidil. This is a compounded formulation prescribed by a medical dermatologist. Other effective options include-
- Minoxidil: Liquid or foam, 5% concentration applied to the scalp twice a day to slow or stop the progression of male pattern baldness and thinning hair. It must be used continuously. If you discontinue minoxidil, new hair growth may reverse, and hair loss will continue. Minoxidil can also be taken as an oral medication, 1-2 mg daily.
- PRP or platelet rich plasma. In this treatment, a patient’s blood is drawn and placed into a centrifuge to extract plasma that is injected into the scalp. Growth factors & chemokines found in platelets can stimulate hair growth. A study published in the International Journal of Molecular Sciences found that PRP treatment increased the number of hairs and overall hair density (Gentile, 2017).
- Low-level laser light therapy (LLLT) in the 600 to 1000 nm wavelength is an effective method to treat hair loss. They emit a constant red LED light that is believed to reduce inflammation and increase blood flow to the hair follicles.
- Thulium laser is another effective non-pharmacological method to revive hair counts. The 1927 nm laser stimulates follicles. This is best used with topicals or medical therapy.
- Hair Transplant Surgery: In FUE or follicular unit extraction, donor hairs are removed from the sides and back of the scalp (areas which are more resistant to DHT) and implanted into areas of male pattern baldness.
Who should you talk to regarding hair loss?
Discuss treatment options with your medical dermatologist. Effective & early management is critical as this preserves your remaining hair follicles. In most cases the diagnosis is straightforward, however in some cases hair microscopy & biopsies may be required.
Medical dermatologists can manage all forms of hair loss ranging from androgenic alopecia through to more unusual causes, including telogen effluvium, anagen effluvium, alopecia areata, lichen planopilaris, lupus, diffuse & chronic telogen effluvium as well as rare genetic disorders.
Disclaimer: I am a procedural dermatologist. I may be asked to provide input into challenging cases, namely to provide a diagnosis, however I do not get involved in medical management.
How much are medications for hair loss?
As a guide-
Topical minoxidil: about 50 cents a day
Topical compounded finasteride & minoxidil: about $2 per day
Oral finasteride: about 20 – 30 cents a day (Proscar 5mg break into half)
Oral dutasteride: about $2-2.40 a day
Minoxidil is cost effective. In fact, the price of this topical is only one fifth of the original price two decades ago as Regaine had the patent. Generic lotions are available from most pharmacies. Purchase a 3 to 6 month supply as this is more cost effective.
Finasteride can be bought as Propecia 1 mg or better still as Proscar 5 mg. The 5 mg can be broken down into quarter of half tablets with an average dose of 1.25 mg daily.
Davin’s Viewpoint on Finasteride & Dutasteride
These ‘antihormone’ medications have been the gold standard oral medication for hair loss for over a quarter of a century. In fact, the two main FDA approved medications are minoxidil & finasteride, with dutasteride an off label indication.
The big debate is whether the side effect profile of each is greater than the benefits. In the vast majority of times, side effects are reversible upon cessation, however in the minority, long lasting sequelae are seen. Regardless of the efficacy the side effect ratio of finasteride & dutasteride are similar. A sensible approach may be to consider oral medications (after a discussion with your dermatologist), however a more conserivate approach is to consider topical minoxidil & finasteride.
The studies of both medications show long term efficacy beyond the five-year mark. This applies to male pattern hair loss, however new data also suggests that these medications are equally effective as an off label treatment for female pattern hair loss. The risks of these potentially teratogenic medications need to be discussed with your dermatologist. The flipside is that given the short half-life (between 6 to 8 hours), the drug is out of your system within a month of cessation (even shorter).
I personally use topicals & oral medications to slow down my hair loss, namely minoxidil & finasteride lotion, with dutasteride tablets orally over the weekend. Be guided by your dermatologist as to the best formulation for you.
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