What is Finasteride?
Finasteride 1mg is the only FDA approved oral treatment for hair loss. It is taken once per day and grows hair in about 66% of individuals after two years of treatment. Roughly 83% of individuals on the treatment maintain their existing hair after two years as well. I have personally responded incredibly well to the medication and now been on it for 16 years. It immediately stopped any further progression of hair loss and thickened up the entire mid/crown region. I’m thankful I’ve responded well as finasteride is ultimately the secret to my overall success with fighting and beating hair loss.
How does it work?
Finasteride 1mg is branded as Propecia and works by blocking an enzyme used to create the male hormone DHT, the hormone which causes hair loss. Propecia is for men only. It can cause lessening of libido, less semen production, and softer erections in roughly 2% of individuals for each of the three listed side effects. Propecia is expensive however and costs approximately £45-55 per month.
I personally use 5mg Proscar which is how propecia was discovered. I simply cut the tablet into 5ths and this enables me to get 1mg finasteride dose very cheaply. It is exactly the same drug (Finasteride) yet by purchasing it in this form it is significantly cheaper at £200 for 14 months supply.
Propecia 1mg by MSD (Merck Sharp & Dohme)
Brand names include Proscar and Propecia (both Finasteride). And as before, are the only FDA approved oral medication that treat male pattern baldness (androgenetic alopecia).
Genetics and DHT
By the age of 35, 60% of males will experience some degree of this type of hair loss. Men who have male pattern baldness will lose their hair in a defined pattern beginning above both temples and then advancing over time to form a typical ‘M’ shape. Surprisingly we lose 50% of our hair before we realise and then there is the process of ‘accepting’ it. Hair loss can also progress quickly in the crown, gradually advancing until the entire front, top and crown are bald.
Male pattern baldness is caused by the effects of the male hormone dihydrotestosterone (DHT) on genetically susceptible hair follicles located in the front, top, and crown of the scalp. A good guide is to look at your mother’s father as a guide, however it can be a genetic lottery. DHT causes a susceptible hair follicle to shrink in size, both in diameter and length. As a result, the miniaturised follicle produces a small unpigmented vellus hair rather than the usual pigmented normal hair.
How to Take Finasteride
Finasteride is a generic prescription oral medication (in the 5mg, Proscar dose). This formulation is just as effective as the brand name Propecia as is exactly the same medication just a difference size tablet and is about 1/4 the cost.
The general starting dose of Finasteride for the treatment of hair loss is 1mg a day. For this dose, you can either take one 1mg Propecia tablet or one 5th of a 5mg Proscar each day. If you choose to use the 5mg medication, you will need cut the tablet, a pill-cutter can be purchased from any pharmacy for a couple of pounds or use a sharp knife.
Finasteride does not have to be cut into equal parts to be effective. Just cut it into the recommended number of pieces and take one piece each day. Finasteride can be taken any time of the day and with or without food.
What to Expect
You may experience shedding during the first 3-6 months of treatment. This generally, is an indication that the medication is working. Do not stop the medication if you see shedding. It takes up to a full year to see the effects of Finasteride, so be patient.
If you intend to take Proscar make sure you get a prescription from a reliable legitimate source. There are many online stores which in my opinion are not legitimate. A private GP can prescribe you Finasteride easily, affordably and quickly.
How Propecia (Finasteride) Works
Propecia works by blocking an enzyme (5-alpha reductase) that converts testosterone to DHT. Finasteride causes a significant drop in both scalp and blood levels of DHT and its effect is felt to be related to both of these factors. Finasteride 1mg/day decreases serum DHT levels by almost 70%.
Efficacy of Propecia (Finasteride)
Studies have shown that after five years of treatment, 90% of men taking finasteride experienced either a regrowth of new hair or a halt to their hair loss. Specifically, after five years, 48% of men demonstrated an increase in hair growth, 42% were rated as having no new hair loss while the remaining 10% were rated as having lost hair. In comparison, 6% of men treated with a placebo demonstrated an increase in hair growth. 19% were rated as having no new hair loss while the remaining 75% were rated as having lost hair.
In the Hair Count Clinical Study hair counts showed an average gain of 277 hairs per one-inch circle at the end of 5 years. These hairs were significantly larger than the fine, miniaturised hair characteristic of balding. In the Hair Weight Clinical Study a 34% increase in hair weight was observed between Propecia and the placebo at 96 weeks.
Propecia should be taken once daily with or without meals. Patients must take Finasteride for one year or longer before its effects in preventing hair loss and re-growing hair can be accurately assessed. Finasteride takes up to a year or more to exert its full effects in both preventing hair loss and in re-growing hair. During the first six months you may note some thinning of your existing hair. This may be due to either progression of your hair loss before Finasteride has had a chance to work. Or some shedding of miniaturised hair that makes way for the new healthy anagen hair to grow. It is important to be very patient during this period.
Side effects from Finasteride at the 1mg dose are uncommon. However they can occur like side effects can occur with any medication if susceptible. The one-year drug related side effects were 1.5% greater than in the control group. The data showed that 3.8% of men taking Finasteride 1mg experienced some form of sexual dysfunction verses 2.1% in men treated with a placebo. The five-year side effects profile included: decreased libido (0.3%), erectile dysfunction (0.3%), and decreased volume of ejaculate (0.0%). There has also been reports of gynecomastia – male breast tissue growth.
Most reported cases of sexual dysfunction occurred soon after starting the medication as the body is getting used to the new medication. However, there have been reports of sexual dysfunction that have occurred at later points in time. The sexual side effects were reversed in those who discontinued therapy, and in 58% of those who continued treatment. After the medication was stopped, side effects generally disappeared within a few weeks. There have been anecdotal reports where side effects have persisted after discontinuation of therapy.
When Finasteride is discontinued, only the hair that had been gained or preserved by the medication is lost. In effect, the patient returns to the level of balding where he would have been had he never used the drug in the first place. No drug interactions of clinical importance have been identified.
The benefits of Finasteride will stop if the medication is discontinued. Over the 2-6 months following discontinuation, the hair loss pattern will generally return to the state that it would have been if the medication had never been used. I’d recommend speaking to your GP before trying this drug.
Propecia and Hair Transplantation
Finasteride has shown to be useful in complementing hair transplant for several reasons. Propecia works best in the younger patient who may not yet be a candidate for hair transplantation. Propecia is less effective in the front part of the scalp, the area where surgical hair restoration can offer the greatest cosmetic improvement. Propecia can re-grow hair, or stabilise hair loss, in the back part of the scalp where hair transplantation may not always be indicated.
For those who choose not to take Propecia, or who cannot take it due to its side effects, the surgical hair restoration is just as effective. The only difference is that Finasteride can prevent further hair loss whereas surgery cannot. Finasteride is not needed for a hair transplant to be successful or the transplanted hair to grow and be permanent.