Finasteride (brand name Propecia) is a 1mg pill administered
daily for the treatment of male pattern hair loss. It is
the only FDA approved oral treatment for hair loss. It was
discovered and introduced by Merck & Co in 1992.
Initially, finasteride was prescribed in 5mg doses (called
Proscar) to patients with benign prostrate hypotrophy (BPH).
Some of those men reported increased hair growth and Merck
then initiated a study to exam this side effect. The clinical
study which led to FDA approval was based on three one-year
studies involving 1,879 men aged 18 to 41 with mild to moderate
crown and mid-scalp hair loss. After one year, 1,215 of
those men with crown/vertex hair loss were studied for another
year. Results showed that 83 percent of men taking 1mg of
finasteride maintained and increased hair count. In contrast,
72 percent of the placebo group continued to lose hair.
In another analysis of those studies,
dermatologists evaluated photographic evidence of hair count
in 508 patients after 24 months and determined that 66 percent
saw new hair growth, compared to only 7 percent for the
Many new drugs come at such a high price
that many people can't use them, not so with this one. Men
all over the world would be able to put baldness behind
them, or at least postpone it for some time.
Propecia received marketing clearance
from the FDA in December of 1997 and the medication began
showing up pharmacy shelves in January of 1998. Proscar
had already been available and was being prescribed "off
label" with it's 5mg dose quartered into 4 sections
with a pill cutter by the patient.(1)
Finasteride works by inhibiting the conversion
of testosterone into dihydrotestosterone, the precursor
for hair loss. This conversion takes place with the help
of an enzyme called 5-alpha-reductase. "Finasteride
works by inhibiting the action of 5-alpha-reductase and
thus inhibiting the conversion of testosterone into DHT."
There are 2 types of 5-alpha-reductase.
Type I and Type II. Finasteride only inhibits Type II 5-alpha-reductase,
which means it will never be 100 percent effective in stopping
DHT. There are medications that stop both, which we report
more on here.
Important Facts and Notes about Finasteride:
Finasteride is most effective in halting/slowing hair loss
and regrowing hair on individuals with mild to moderate
hair loss and recent hair loss. Patients with extensive,
long term hair loss may not see much benefit.
Finasteride is most effective on regrowing hair in the crown/vertex
area and mid-scalp portions of the head. It was long thought
to be inneffective against frontal and mid-scalp frontal
hair loss. However, a 1999 study at the University of Pennsylvania
School of Medicine reported: "There was a significant
increase in hair count in the frontal scalp of finasteride
treated patients... Efficacy was maintained or improved
through the second year of the study... Conclusion: In men
with hair loss in the anterior/mid area of the scalp, finasteride
1mg/day slowed hair loss and increased hair growth.
Finasteride is not thought to be effective for temple hair
loss. It is most effective on mild to moderate crown and
mid-scalp hair loss that is recent (within a few years),
and mildly effective for frontal hair loss.
Finasteride can be used with minoxidil to improve results
and outcome. See minoxidil.com for aggressive combinations
of minoxidil and finasteride used together, as well as other
Finasteride used before and after hair transplantation
can improve results. "Visible increases in superior/frontal
scalp hair post-transplant were recorded for 94% and 67%
of patients in the finasteride and placebo groups, respectively."
A little known fact about some early finasteride studies
is that patients were directed to wash their hair with Neutrogena
T-Gel, a medicated shampoo. Other medicated shampoos containing
ketaconozole and Salicylic acid have been studied and are
believed to have some anti-DHT effect or assistance, and
may enhance the results of finasteride and are recommended
by some experts as a good adjunctive treatment that acts
synergistically with finasteride.
- Studies have shown that the use
of a 2% ketoconazole shampoo will reduce the sebum excretion
rate (-6.54%) when used over a six-month period... Salicylic
acid is a keratolytic, i.e. it loosens and breaks up clumps
of keratin (dandruff), allowing them to be more easily
removed from the scalp...Since the salicylic acid can
remove some of the dead skin layers of the epidermis,
the ketoconazole can be more effective in reducing the
DHT in the scalp.
Finasteride in topical form is available from some online
pharmacies. It's efficacy is debated but some experts such
as Dr. Lee of Regrowth LLC, minoxidil.com, firmly believes
that it works on patients and includes it in his products.
Statistics on Effectiveness: Although reports and studies
vary, general figures demonstrate that one-half to two-third
of the men studied REGREW hair, while 83
to 90 percent regrew hair AND/OR maintained hair (no further
hair was lost).
- Decreased Libido
- Decreased Ejaculate
- Impotence/Erectile Dysfunction
- Birth Defects in Women (Not indicated for women).
Statistics on the side effects in men vary widely by source,
but are generally around 2 to 4 percent.
Proscar/Propecia is manufactured by Merck.
- FDA Clears Propecia For
Treatment Of Hair Loss In Men,
Doctor's Guide via docguide.com, December 22, 1997
- Using Finasteride (Propecia®)
as a Hair Loss Treatment, International
Society of Hair Restoration Surgeons, June, 2005
- Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R,
Bergfeld W, Price VH, Van Neste D, Roberts JL, Hordinsky
M, Shapiro J, Binkowitz B, Gormley GJ. Finasteride
in the treatment of men with androgenetic alopecia. Finasteride
Male Pattern Hair Loss Study Group. J
Am Acad Dermatol. 1998 Oct;39(4 Pt 1):578-89.
- Leyden J, et al. Finasteride
in the treatment of men with frontal male pattern hair
loss. Journal of American Academy of
Dermatology. 1999 Jun;40(6 Pt 1):930-7. Complete version
- Leavitt M, Perez-Meza D, Rao NA, Barusco M, Kaufman
KD, Ziering C., Effects
of finasteride (1 mg) on hair transplant.
Dermatol Surg. 2005 Oct;31(10):1268-76
- FAQs - Finasteride,
Minoxidil.com, Dr. Richard Lee