How does Finasteride treat male pattern baldness?
For around 50 percent of men natural hair loss becomes inevitable with growing age. Among Caucasian men it’s even 80 percent. In 95 percent of cases this phenomenon is caused by male pattern hair loss (androgenic alopecia). This is a genetic, inherited condition and, given how common the problem is, it’s almost as if nature intended for men to go bald when past a certain age.
The underlying hormonal process that causes hair loss is excessive dihydrotestosterone (DHT) production. DHT is generated from converting testosterone and the body’s primary engines of this conversion process are located in the prostate and in the hair follicles of the scalp. DHT production wears out the follicles, over time they get damaged and start shrinking (follicle miniaturization). This in turn causes your hair to fall out and your hairline to recede as the barren, miniaturized follicles don’t grow any new hair.
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Finasteride — also known under the brand name Propecia — effectively blocks most of the testosterone-DHT conversion and thus stops hair follicle damage and balding. In many patients Finasteride even stimulates follicles to regrow new hair.
Finasteride’s effects are not permanent but only last as long as you continue treatment. Several weeks to months after stopping Finasteride your body’s DHT production will pick up again, as will your hair loss. You can’t beat your genes. Your hairline only is protected as long as you take Finasteride.
Therefore, many men use Finasteride as a long-time treatment over the course of many years. It’s a safe and well-tolerated drug, as has been shown in several long-term clinical trials, and its side effects tend to be mild. Talk to your doctor to learn more about Finasteride’s side effects and whether they could affect you.
What results to expect?
After taking Propecia or a generic Finasteride (with a typical daily dosage of 1mg) for 3-4 months hair loss will have stopped in 85 percent of men. You will notice a visible improvement in the volume and quality of your hair; each individual hair also likely will be both longer and thicker. The effect of Finasteride works fastest on the vertex — that is the top surface of your head — but with time a Finasteride treatment benefits all other parts of the scalp, too.
When Merck & Co. first developed and tested Propecia in the 1990s, a 2-year trial with almost 1,900 participating males demonstrated the drug’s success at stopping balding. Moreover, it showed that in 65% of men it even triggered new hair growth. At the end of the two-year period, the men who had taken 1mg Propecia once a day on average had 138 more hairs per 1-inch diameter than the placebo group. After five years that hair count difference had risen to 277 hairs, in part because the placebo group had kept on going bald.
Subsequent studies have corroborated these findings. Even better results were demonstrated for Asian men in Korean and Japanese studies (88% of the above-discussed Propecia study’s participants were Caucasians), with improvement rates of up to 98% at the end of 5-year treatment.
Finasteride studies with durations longer than five years up until now are few in number and typically rely on small sample groups. However, an Italian study with 118 men found that after 10 years of taking Finasteride some 85 percent of users still had their hairline preserved intact, i.e., Finasteride had effectively protected their scalp from balding for ten years. A Japanese study yielded similar results.
How long does it take for Finasteride to work?
Just as balding is a slow and gradual process, so is stopping and reversing it. For the first three months of a 1mg once-a-day Finasteride regime you can save yourself the time of checking your hair in the bathroom mirror every morning. There is nothing to see.
Only into the fourth treatment month will Finasteride’s effect become visible. If your hair follicles respond well to Finasteride and new hair growth is triggered, this improvement in hair volume and quality will be fastest between Month 4 and Month 8 of the treatment. After that period, the rate of improvement starts decelerating again. Toward the end of the first treatment year and early into the second year the effect of Finasteride will peak. Then it mostly becomes a matter of maintaining the hair gains you’ve made in the first year of treatment and prevent new balding.
The progress of a successful Finasteride treatment can be summarized as:
- Month 1-3: Waiting for first signs & keeping your patience
- Month 4-8: Rapid improvement period
- Month 8-15: improvement rate slows
- After Month 15: improvement plateaus out
Keep in mind that Finasteride only benefits you as long as you keep taking it. Once you stop Finasteride, hair loss eventually will resume and any positive effects of your previous treatment will be reversed within up to a year. Even if you then decide to give Finasteride a second go, you’ll likely not return to the hair count you enjoyed during the peak of the first treatment cycle.
Talk to your doctor about how you can start a Finasteride treatment and set milestones and methods that will help monitoring any progress made.
Examples of hair improvement with Finasteride (no copyright-free images)
What if Finasteride doesn’t work for you?
If you don’t notice any improvement at all after 6 six months of Finasteride treatment and your hair loss problem continues as before, ask your doctor to check whether your condition could have underlying causes other than male pattern hair loss.
Although they are rare, there are certain autoimmune conditions that can lead to balding. Hair loss also can be spurred by chronic stress, such as over-work and sleep deprivation. In case of stress-induced hair loss you’ll have to identify and alleviate the causal stress factors.
- Shin, Jung?Won, et al. “Evaluation of Long?term Efficacy of Finasteride in Korean Men with Androgenetic Alopecia Using the Basic and Specific Classification System.” The Journal of Dermatology, 7 Dec. 2018, https://doi.org/10.1111/1346-8138.14719. Accessed 25 Nov. 2019.
- “10-Year Finasteride Study: First to Investigate Long-Term Effects and Safety.” Bernstein Medical - Center for Hair Restoration, 20 Aug. 2012, www.bernsteinmedical.com/research/10-year-finasteride-study-first-to-investigate-long-term-effects-and-safety/. Accessed 25 Nov. 2019.
- McClellan, Karen J., and Anthony Markham. “Finasteride.” Drugs, vol. 57, no. 1, 1999, pp. 111–126, https://doi.org/10.2165/00003495-199957010-00014. Accessed 24 Oct. 2019.
- Adil, Areej, and Marshall Godwin. “The Effectiveness of Treatments for Androgenetic Alopecia: A Systematic Review and Meta-Analysis.” Journal of the American Academy of Dermatology, vol. 77, no. 1, 2017, pp. 136 141.e5, www.ncbi.nlm.nih.gov/pubmed/28396101, https://doi.org/10.1016/j.jaad.2017.02.054. Accessed 25 Nov. 2019.
- Merck Sharp & Dohme Corp., “Propecia - Patient Information”, revised 01-2014, https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020788s024lbl.pdf. Retrieved 25 Nov, 2019.