How finasteride works?
Androgenic alopecia (male pattern baldness) occurs due to the effect of DHT (dihydrotestosterone) hormone on vulnerable hair follicles, especially on the crown, top and front (but not on the sides and back). Hair loss is triggered because DHT shortens the growth phase of hair, which causes follicles to miniaturize. The affected hair often grows much more slowly and eventually stops growing, as the result, hair on those area will become finer and shorter, until it disappears. An enzyme called 5AR directly affects hair loss as it acts as a catalyst in converting testosterone into DHT. There are two types of 5AR enzyme:
• Type I. It is commonly found in fibroblasts, keratinocytes and sweat glands. Its effects on hair growth are not yet determined. However, it is known that 5AR Type I acts as a catalyst in the conversion process of testosterone into androstenedione, a hormone that is believed to be related to the sebum production.
• Type II. It is found in hair follicles on the scalp and many areas of skin. Experts believe that 5AR Type II has a stronger impact on hair loss and its action can be blocked by certain drugs, such as finasteride.
Finasteride can make 5AR much less effective, by reducing the DHT production. When the drug is taken orally, it will immediately enter the bloodstream and eventually reach hair follicles on scalp, which immediately lowers DHT level in this area. About 1 mg of finasteride each day is clinically proven to reduce DHT level by nearly 70 percent. There is a common misconception that finasteride can also lower testosterone level, but in fact, it can increase the serum testosterone by about 10 percent, which is in most cases still considered to be in a normal range.
Effectiveness of finasteride
Finasteride is commonly sold under the brand name of Propecia and sold at the 1 mg dose, and it is proven clinically to be highly successful in treating men with pattern hair loss. In general, after five years of daily use, nearly half of men show noticeable hair growth and a large majority of them maintain most of the hair in common thinning areas. Only ten percent of men showed steady hair loss despite regular use of Propecia. Those who didn’t take the drug, have 75% risk of losing their hair steadily. At any age, 1 mg of Propecia each day is enough to preserve most of the hair, however it is more effective on younger male and those who start to lose in the past 2 years. Sometimes those above 50 years old experience some hair regrowth with finasteride, but it is actually an exception instead of something that can be regularly expected. You should be aware that finasteride only works effectively if you take it each day. Within three to six months of discontinuing finasteride treatment, the hair loss pattern will return to the state before the medication was taken. FDA approves the use of finasteride for balding and hair thinning on the frontal scalp, although some doctors believe that the drug may have little effect on that particular area. However, treating the frontal area of the scalp with finasteride can be effective and regrowth is to be expected if the hair has just entered the early phase of thinning. Finasteride blocks the action of DHT, which is the cause hair loss on the frontal scalp, but if the extent of damage is already moderate or serious, you shouldn’t expect too much improvement or at all. To determine the overall effectiveness of finasteride, you should take the medication each day for about one year, before the doctor can make a complete assessment of your response to the treatment. It is usually a good sign if, after the first six months, you see new growths on the thinning area, which replace the sickly miniaturized hair. The progress may appear to be slow, but actually it is a significant one, so you should be patient during this phase of the treatment.
Finasteride for Women
Many doctors argue that finasteride has little effect on women. A research showed that on post-menopausal women, the effectiveness of finasteride may cease after one year of the treatment. Another research showed that a higher dose of finasteride (2.5mg/day) may be more effective on women. Currently, finasteride is not approved for women yet, in fact they shouldn’t be near finasteride in the first trimester of pregnancy, because a minute amount of the drug can cause problems on male fetus, especially when we consider the fact that it can be inhaled and absorbed through skin. Luckily, men who take finasteride can safely impregnate their wife.
It is quite rare to find side effects on people who take 1 mg of finasteride each day, and if they do appear, they won’t be permanent. About five percent of male patients may experience sexual dysfunction, such as reduced amount of semen, erectile dysfunction or decreased libido), compared to about 2 percent of people treated with placebo. Men who reported sexual dysfunction after taking the drug, usually experience the symptoms for about a few months. On some men, the symptoms won’t disappear as long as the medication is taken, but once stopped, all sexual problems usually disappear in just a few weeks. Men who get possible sexual side effects, should talk with the doctor immediately, the doctor may advise to stop the drug temporarily to remove all possible side effects and then restart at a lower dose (.25 or .5 mg/day). If no side effects reappear after a few weeks, you may resume the 1 mg/day dose. However, if side effects still appear on a reduced dose, the doctor may ask you to quit the treatment completely.
Some men can also experience breast enlargement or breast tenderness (gynecomastia). It happens on 0.5 percent of men who take 1mg/day of finasteride. The breast is only slightly enlarged and it won’t be visible when you use normal clothing. Other rare minor side effects are swelling on face, testicular pain, hives, itching and rash. Some also reported mood changes and, at this moment, there is no report on the interaction between finasteride and other drugs.
Finasteride treatment can cause lower PSA (prostate specific antigen) level in the blood to about 50 percent. PSA is often used to determine the likelihood of prostate cancer and prostate enlargement. It is often important to notify your other doctors that you’re taking finasteride, so they can take into account the lower PSA level. A research showed that men who are treated with 5mg/day of finasteride for seven years are 25 less likely to have prostate cancer. As the result, it commonly believed that finasteride can in fact delay or even prevent prostate cancer. Those above 50 years old should inform their urologist if they take finasteride each day to treat hair loss.
If finasteride is prescribed for hair loss, 1 mg/day is effective and safe in most cases, as long as no side effects are detected. However, if you get side effects on normal dose, lower doses are still effective, but less so. 1 mg/day is indicated as an optimum dose, there are little evidences that higher doses are more effective, although some doctors prefer higher dose in some circumstances. Proscar, the brand name for 5 mg of finasteride is cheaper than five Propecia (1 mg of finasteride). You may use pill cutter to divide Proscar pills into four pieces, but there is no scientific data that shows 1.25 mg is better than 1 mg. Don’t handle crushed or broken finasteride tablets if your wife is pregnant, as particles can be absorbed through the skin. Foods don’t affect finasteride, so you can take it anytime you want, however because testosterone level is higher in morning, it is advisable to take it immediately after you wake up.
Finasteride and minoxidil
If taken together, both medications can give you increased effect. Finasteride blocks the negative effects of DHT on hair loss, while minodixil directly stimulates hair follicles. Because, there are no contraindications, you can ask your doctor to prescribe both for you.