Finasteride

(Generic Propecia & Generic Proscar)

Finasteride Web

Finasteride

Disclaimer: This is not medical advice. You and your physician will determine if (and potentially how) you should take Finasteride.

The Basics

What is finasteride?

Finasteride 1 mg (generic for Propecia) is a medication approved by the FDA to treat male pattern hair loss, also known as androgenic alopecia. Finasteride is also used in a 5 mg dose (generic for Proscar) to treat symptoms of Benign Prostatic Hyperplasia (BPH), or an enlarged prostate.

Finasteride works on both the prostate and scalp because it is in those two areas (and a few others) that finasteride blocks the the enzyme that converts testosterone into DHT. It does not affect a very similar enzyme that converts testosterone to DHT in other areas of the body. This makes it selective and less likely to cause unwanted side effects. Notice, we said less likely; every drug can cause side effects and it is important to understand that when looking into any treatment plan.

Finasteride is one of two FDA approved treatments to manage male pattern hair loss. The other FDA approved medication is topical minoxidil. It comes as a foam or a solution. The exact mechanism of how minoxidil stops hair loss is unknown. However, these two medications work better than either one alone.

How it works

Finasteride works by blocking an enzyme that converts testosterone to dihydrotestosterone (DHT). DHT is the hormone responsible for hair loss in men who are genetically predisposed to lose their hair. By blocking the conversion of testosterone to DHT, finasteride can prevent further hair loss, and may even regrow hair.

It does work well for most men in terms of stopping hair loss. In one European study, men treated with 1 mg finasteride over a five year period “led to a 93% decrease relative to placebo in the 5-year likelihood of developing further hair loss.”

It regrows hair less well but does provide a benefit for some men. In another study, the authors found that “the chances of mild to moderate visible regrowth are 61% on the vertex (the top of the head) (with an additional 5% achieving great visible regrowth) after 2 years and 37% on the frontal area after 1 year.”

When deciding on finasteride, it is best to consider slowing and stopping hair loss as your goal with regrowth a bonus if it occurs.

Some Basics:

It is best to take it each day at the same time. If a dose is missed, the missed dose should be skipped and the regimen continued the next day. Of course, if off by just a few hours, the medication should be taken and the usual daily pattern resumed. It is important to take finasteride without days of interruption, so planning to carry enough when traveling, on vacation, etc., is vital. Finasteride can be taken with or without food.

The pills should be kept dry and at room temperature between 68˚F to 77˚F (20˚C to 25˚C). The bathroom is a moist environment, so choose another place. They must be stored away from children and pets. Also, broken pills can expose the skin to finasteride. This is category X, meaning that it can cause birth defects. Though they are coated and generally considered safe when unbroken, women should never touch these pills.

IMPORTANT SAFETY INFORMATION

Finasteride is for use by MEN ONLY and should NOT be used by women or children.

Read this Important Safety Information before you start taking finasteride and each time you get a refill. There may be new information. This information does not take the place of talking with your healthcare provider about your medical condition or treatment.

What is finasteride? Finasteride is a prescription medicine used for the treatment of male pattern hair loss (androgenetic alopecia). It is not known if finasteride works for a receding hairline on either side of and above your forehead (temporal area). Finasteride is not for use by women and children.

Who should not take finasteride?

Do not take PROPECIA if you:

  • are pregnant or may become pregnant. PROPECIA may harm your unborn baby. Females who are pregnant or who may become pregnant should not come in contact with broken or crushed finasteride tablets. If a pregnant woman comes in contact with crushed or broken finasteride tablets, wash the contact area right away with soap and water. If a woman who is pregnant comes into contact with the active ingredient in finasteride, a healthcare provider should be consulted. o If a woman who is pregnant with a male baby swallows or comes in contact with the medicine in finasteride, the male baby may be born with sex organs that are not normal.
  • are allergic to any of the ingredients in finasteride.

What should I tell my healthcare provider before taking finasteride?

Before taking finasteride, tell your healthcare provider if you:

  • have any other medical conditions, including problems with your prostate or liver
  • Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm.

How should I take finasteride?

  • Take finasteride exactly as your healthcare provider tells you to take it.
  • You may take finasteride with or without food.
  • If you forget to take finasteride, do not take an extra tablet. Just take the next tablet as usual.
  • Finasteride will not work faster or better if you take it more than once a day.

What are the possible side effects of finasteride

  • decrease in your blood Prostate Specific Antigen (PSA) levels. Finasteride can affect a blood test called PSA (Prostate-Specific Antigen) for the screening of prostate cancer. If you have a PSA test done you should tell your healthcare provider that you are taking finasteride because finasteride decreases PSA levels. Changes in PSA levels will need to be evaluated by your healthcare provider. Any increase in follow-up PSA levels from their lowest point may signal the presence of prostate cancer and should be evaluated, even if the test results are still within the normal range for men not taking finasteride. You should also tell your healthcare provider if you have not been taking finasteride as prescribed because this may affect the PSA test results. For more information, talk to your healthcare provider.
  • There may be an increased risk of a more serious form of prostate cancer in men taking finasteride at 5 times the dose of finasteride.

The most common side effects of finasteride include:

  • decrease in sex drive
  • trouble getting or keeping an erection
  • a decrease in the amount of semen

The following have been reported in general use with finasteride:

  • breast tenderness and enlargement. Tell your healthcare provider about any changes in your breasts such as lumps, pain or nipple discharge.
  • depression;
  • decrease in sex drive that continued after stopping the medication;
  • allergic reactions including rash, itching, hives and swelling of the lips, tongue, throat, and face;
  • problems with ejaculation that continued after stopping medication;
  • testicular pain;
  • difficulty in achieving an erection that continued after stopping the medication;
  • male infertility and/or poor quality of semen.
  • in rare cases, male breast cancer. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of finasteride. For more information, ask your healthcare provider or pharmacist.

Keep PROPECIA and all medicines out of the reach of children. General information about the safe and effective use of PROPECIA. 3 Medicines are sometimes prescribed for purposes other than those listed in this Patient Information leaflet. Do not use PROPECIA for a condition for which it was not prescribed. Do not give PROPECIA to other people, even if they have the same symptoms you have. It may harm them.

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see the full Prescribing Information for complete safety information.  

Frequently asked questions

How long does finasteride take to regrow hair?

Finasteride takes 3 to 4 months to show any benefit. It can take up to a year to see the maximum results. Moreover, as finasteride enters the system, it may even cause more shedding of fine hairs. Do not be concerned – this is expected. Also, some men do not respond to the medication; this can be as high as 1 out of every 10 men or more.

As long as you do not experience side effects, it is best to continue medication for one full year before deciding whether the medication is doing all it can for you.

What are the side effects?

Sexual side effects can include a decrease in sexual desire (libido), a decrease in semen volume, or erectile dysfunction (ED). These side effects were noted in 3.8% of men taking finasteride and in 2.1% of men taking a placebo (“sugar pill”) and are the ones that concern men most.

The PDR states, “Resolution occurred in men who discontinued therapy with finasteride tablets due to these side effects and in most of those who continued therapy. The incidence of each of the above adverse experiences decreased to < 0.3% by the fifth year of treatment with finasteride tablets.” This all sounds easy and straightforward—the sexual side effects are transient and manageable—but that is not the point. The point is that these side effects can happen. That is why it is so important to think about what it would mean if you were one of those few men who has an issue. A tiny decrease in semen volume may be trivial, but erectile dysfunction may not be, even if it goes away with time. Lastly, there is the possibility a side effect can persist after the drug is stopped. It is rare, but possible. And again, “rare” is meaningless if it happens to you. There are other side effects and they can reviewed here.

What is Different About Male Pattern Baldness?

The normal hair follicle is more complex than most people realize. Among other elements, it consists of a central primary hair and several secondary hairs, bound together by a very important muscle at the base called the arrector pili muscle. Hair loss begins slowly under the influence of DHT, which is made when testosterone is converted to DHT in the nearby glands.

First, the secondary hairs begin to shed and peel away in Male Pattern Baldness. As you can see in the drawings, all the smaller hairs, or secondary hairs, are lost before that primary hair gives out (Phases 1–3). When the arrector pili muscle shrivels up and loses its grip on that central primary hair, the scalp is bald in that area. With many other types of baldness the arrector pili muscle stays strong so new hairs can crop up even in areas that are totally bald.

In Male Pattern Baldness, that arrector pili muscle shrivels away and is replaced by fat. New hairs will never grow back. That little muscle is what makes Male Pattern Baldness so difficult to manage once it has progressed too far.

That is why so many people will experience thinning hair long before they start to see any true baldness. That is why going bald can sneak up on you. And that is why treating MPB before it progresses is so important.

What this means is that the best time to start to deal with hair loss is before the thinning has progressed too far. To preserve hair, the attempt is best made when the arrector pili muscle–the muscle responsible for holding your hairs–is still attached to that last standing, primary hair.

How does Finasteride work?

Hair loss is due to dihydrotestosterone (DHT), the hormone testosterone becomes when it is exposed to an enzyme called 5 alpha reductase. DHT makes the hair follicles vacate a man’s scalp by slowly destroying clusters of hair follicles. DHT causes the hair follicles to miniaturize over many years. The process may begin slowly but the progression is relentless.

At first, only thinning of hair is noticed, not clear baldness. Some men embrace the process, shaving their heads in response, but many regret the appearance of aging while they still feel young and vital. Fortunately, we have an understanding of how DHT undermines hair growth and finasteride works by blocking the conversion of testosterone to DHT. It does this by inhibiting the ability of 5 alpha reductase to convert testosterone to DHT. That is why it is called a 5 alpha reductase inhibitor.

Will finasteride stop hair loss?

In many cases, finasteride slows or stops hair loss. In some cases, it may even regrow hair.

In one European study, men treated with 1 mg finasteride over a five year period “led to a 93% decrease relative to placebo in the 5-year likelihood of developing further hair loss.”

It regrows hair less well but does provide a benefit for some men. In another study, the authors found that “the chances of mild to moderate visible regrowth are 61% on the vertex (the top of the head) (with an additional 5% achieving great visible regrowth) after 2 years and 37% on the frontal area after 1 year.”

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