Finasteride

Finasteride is a drug that can be used to treat male pattern baldness. It works by reducing the effects of a compound made by the body called 5-alpha reductase. This is an enzyme which converts testosterone into DHT, a more active form of hormone that can shrink hair follicles and lead to hair loss, if you’re genetically sensitive to its effects. Finasteride blocks the actions of 5-alpha reductase, decreasing the amount of DHT both in the blood and the scalp, which helps to increase hair growth and prevent further hair loss.

Taking finasteride can help to slow down hair loss and in some cases lead to regrowth of hair. Finasteride is available on prescription, but isn’t available on prescription through the NHS.

Male pattern baldness, otherwise known as androgenetic alopecia, is a very common condition in men. It’s caused by a combination of hormones and genetics. Hair grows from follicles and usually takes around three years to grow and then shed (fall out). In a normal hair cycle, when a hair falls out, another one starts to grow in its place.

In male pattern baldness, the hair follicles become smaller than normal and this causes each new hair to grow through thinner than before. It also speeds up the cycle so that it’s lost faster, eventually causing the follicles to become so small, and the hairs so thin that they can’t grow past the surface of the skin.

Normally you’ll notice the hair thinning and receding at the sides of your head, or your temples. It also thins out on the top of your head and you might develop a bald patch in the middle of your scalp. Over time, the sides and the bald patch on top can join together, leaving a patch of hair at the front of your head, which quite often thins out too. Some men are left with a rim of hair around the back of their head, others will go completely bald eventually.

Male pattern baldness is thought to affect over half of men over the age of 50. Onset of male pattern hair loss usually starts between the ages of 20-25. Most men will experience a certain amount of balding as they get older, starting around their late twenties or early thirties, and it’s so common that most men have noticed some hair loss by the time they reach their late thirties.

It’s also possible for women to develop female pattern baldness which has similar hormonal causes, although the distinctive pattern of hair loss is different as is the treatment.

Unfortunately, there is no cure for male pattern baldness at the moment, although there are treatments that can reduce the symptoms and help regrowth. These have to be taken indefinitely because if they are stopped, the hair loss will return.

Propecia is a brand name for finasteride. Both medicines contain the same active ingredients and are used in the same way. Finasteride is also used in higher doses to treat medical conditions such as an enlarged prostate, but 1mg of Propecia and finasteride are both equally effective.

The benefits of finasteride are cumulative and you’ll need to wait a few months before you see any real results. In a year or so, you should see the full effects of the treatment and notice a real difference to the thickness and amount of hair.

Be aware that finasteride needs to be continued long term for the positive results to be sustained. If you want to stop taking the medicine speak to your doctor or pharmacist.

As soon you start losing your hair and it has been diagnosed as male pattern baldness, you can start treatment. Studies have shown that the earlier you start, the better the results.

One controlled five year clinical study revealed that men who were given a placebo for a year before they started using finasteride didn’t have as good results as the men who had been given the finasteride from the start of the study.

One study showed that 86% of men managed to maintain hair density or saw an increase in visible hair growth in the first year of taking Finasteride, while only 42% of men who were given a placebo (dummy) medication instead maintained their hair density for a year.

Over five years, 90% of men showed visible regrowth or maintained their hair density. The majority of men who used finasteride said that they thought their hair loss had slowed down, their bald spot had grown smaller and their hair looked better. The maximum increase in hair count seems to happen in the first two years of treatment.

Adult males experiencing male pattern hair loss who are over the age of 18.

• Women - even if they are experiencing female pattern baldness. There are alternative treatments available for women
• Women who are or could be pregnant, should not even handle the tablets if they are crushed or broken because there’s a possibility that the drugs could be absorbed through the skin and lead to abnormalities in a male baby. It’s safe to handle the whole, coated tablets as long as they are not broken or crushed
• Children and anyone under the age of 18
• Men who are already taking taking finasteride 5mg (Proscar) or any other 5α-reductase inhibitor such as dutasteride (Avodart) for an enlarged prostate.
• Men who are allergic to finasteride
• Men who have been diagnosed with severe liver dysfunction
• Men with a history or suspicion of male breast cancer
• Men who have Galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption

Men who’ve had prostate cancer or blockages in the tubes that drain the kidneys should ask for a specialist's advice before taking finasteride.

If you’re unsure, always ask your doctor’s advice before taking finasteride.

Take one tablet every day, preferably at the same time every day. Finasteride tablets can be taken with or without food.

Carry on taking finasteride every day to see and maintain results. If you forget to take a dose, take the next dose when it’s due, but don’t take a double dose.

Don’t take more than the prescribed dose of the medicine - it won’t make it work any faster or better.

Although side effects aren’t common, fewer than one in 100 men who take it have reported that they’ve experienced a loss of sex drive or erectile dysfunction while taking it. Breast tenderness and depression have also been reported.

Other rare side effects can be breast enlargement (as well as tenderness), male breast cancer, testicular pain, depression, rash, itching, persistent erectile dysfunction, a temporary reduction in fertility and allergic reactions.

Finasteride can affect the results of a PSA (Prostate-Specific-Antigen) blood test which is used to screen for prostate cancer. Please tell your doctor that you’re taking finasteride or Propecia if you have such a blood test done.

If you notice any side effects when you’re taking finasteride, speak to your doctor. You can also report any side effects via the Yellow Card Scheme, at www.mhra.gov.uk/yellowcard.

You shouldn’t donate blood while you’re taking finasteride, or for at least four weeks after stopping treatment as the blood could could harm the development of a male baby if it’s given to a pregnant woman.

Some men have reported a loss of semen quality or infertility - you may want to talk to your doctor if you have any concerns about this before starting treatment.

Finasteride should only be used if it has been prescribed for you by a doctor. You can order it from an online doctor service such as Zava which allows you to order a prescription without making an appointment with your GP but you will still need to complete a questionnaire, which will be reviewed by a qualified doctor.

Buying any medicines online can be dangerous so make sure that you’re using a regulated online doctor service which uses GMC registered doctors authorised to prescribe medicines online.

Yes, finasteride is licensed to treat male pattern baldness and other medical conditions, although it isn’t available on the NHS for hair loss.

Active ingredients - 1mg of finasteride

Other ingredients (propecia - may vary slightly, depending on brand)

• Tablet core: Lactose, microcrystalline cellulose E460, pregelatinised maize starch, sodium starch glycollate, docusate sodium, magnesium stearate E572
• Coating: hypromellose E464, hydroxypropyl cellulose E463, titanium dioxide, talc, yellow iron oxide E172, red iron oxide E172