For around 50 percent of men a degree of hair loss becomes inevitable with advancing age. Among Caucasian men, up to 80 percent will experience hair loss. In 95 percent of cases this phenomenon is caused by male-pattern hair loss (androgenic alopecia). This is largely a genetic condition, and is therefore inherited from a parent or grandparent in most cases.
The underlying hormonal process that causes hair loss is excessive dihydrotestosterone (DHT) production. DHT is generated from the conversion of testosterone to dihydrotestosterone by and enzyme known as 5-alpha reductase. 5-alpha reductase is produced primarily in the liver and it's effects are responsible for an enlarged prostate, as well as male-pattern baldness. DHT shrinks hair follocles over time, a process known as follicle miniaturization. This eventually causes your hair to fall out and your hairline to recede as the barren, miniaturized follicles will not grow any new hair.
Finasteride — also known under the brand name Propecia — effectively blocks 5-alpha reductase, thereby blocking conversion of testosteone to DHT. This in turn can stop 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. Your hairline is only protected as long as you take Finasteride.
Many men use Finasteride as a long-term treatment for male-pattern hair loss. It is generally safe and well-tolerated, which has been demonstarted in several long-term clinical trials.
Talk to your doctor to learn more about Finasteride’s side effects and whether they could affect you.
After taking Propecia (or generic Finasteride), at a daily dosage of 1mg, for 3-4 months, hair loss will stop in 85 percent of men. Visible improvement in the volume and quality of hair will becoma apparent and 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, Finasteride can benefit all areas of the scalp.
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 continued to go 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-years of 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. Meaning, Finasteride had effectively protected their scalp from balding for ten years. A Japanese study yielded similar results.
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 2 years of treatment and prevent new balding.
The progress of successful Finasteride treatment can be summarized as:
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 will be reversed within approximately one 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 Finasteride treatment and set milestones and methods that will help monitor any progress made.
Examples of hair improvement with Finasteride (no copyright-free images)
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.