Besides minoxidil, another substance with proven results in hair loss therapy is finasteride (Propecia, Proscar). The only indication is male pattern hair loss (androgenetic alopecia) in men and women; its action is based on inhibiting the conversion of testosterone into dihydrotestosterone (DHT). The results of this treatment are impressive, as it significantly slows down hair loss and restores lost hair to a certain extent. Hair loss treatment with finasteride can be applied both before and after hair transplantation. The side effects are rare (<1%) and involve reduction of libido and gynecomastia.
Due to the fact that it reduces the levels of PSA (prostate specific antigen), it is believed that it may conceal prostate cancer. Therefore, most international therapeutic protocols recommend the use of finasteride in patients aged 20-40 years and less frequently up to the age of 50; above the age of 50, it is considered better to avoid the use of the drug for hair loss prevention. This hair loss treatment has effects during administration of the drug; the first results appear after 2-3 months, but the problem will gradually return after discontinuation.
General information on hair loss treatment with finasteride
Finasteride (Propecia®, Proscar®) has been successfully used to treat hair loss over the past 15 years. Finasteride is generally well tolerated, even when administered for a long time. It is not indicated for the treatment of hair loss in women of reproductive age and it is forbidden for children.
How does finasteride work and what are its effects?
Finasteride helps to inhibit the process that is responsible for the degeneration of hair follicles and hair loss by decreasing the levels of DHT (dehydrotestosterone). Hair loss treatment with finasteride, as evidenced by a number of scientific studies, has been shown to be effective in the majority of patients. More specifically, 90% of men who were treated with finasteride for 5 years, showed stable or increased hair growth. It has also been observed that finasteride in combination with topical treatment with minoxidil has significantly better results. Especially in cases of crown baldness, treatment with finasteride is even more effective.
Indications and side effects of treatment with finasteride
Finasteride is indicated for young patients between 20-40 years with ongoing hair loss, without however excluding its use for older patients. Therapy with finasteride is considered a very important part of the pre-operative and post-operative protocol for patients who undergo hair transplantation. Treatment of hair loss with finasteride is contraindicated in women of childbearing age and is forbidden for children.
Many patients take finasteride for years without showing any side effects. Although the side effects of finasteride have been widely discussed due to its antiandrogenic effects, in fact the percentage of men who have experienced either a decrease in libido or erectile dysfunction after taking finasteride only amounts to 1-2%. Discontinuation of treatment with finasteride immediately resolve these mild side effects.
Indicated dosage and duration of treatment with finasteride
Finasteride is taken in pill form for oral use. The recommended dosage that is effective for the treatment of hair loss but at the same time is completely safe with regard to the likelihood of adverse side effects, is one 1 mg pill of finasteride daily. In general, daily use has to be continued for three months or more, before hair growth or inhibition of hair loss is observed. This continued use of finasteride is well tolerated by the body and essential for the maximum efficiency of the treatment. If the treatment with finasteride is interrupted, the results will be reversed within 12 months.
To achieve the best results, treatment with finasteride can be combined with topical treatment with minoxidil (Regaine®, Rogaine®, Botafex®) and topical treatment of the scalp with LLLT or Lasercomb (Low Level Laser Therapy). It can also be combined with topical application of PRP (Platelet Rich Plasma).
Provided that no side effects occur during the first months of treatment, the use of finasteride can be continued without problems for many years. The results of using finasteride to prevent hair loss are more prominent in younger patients, 20-30 years old, while the potency of the drug decreases after the age of 40, when the levels of androgens in the blood gradually stabilise and then begin to decline.
At ages over 40, close monitoring is recommended with blood tests for prostate-specific antigen (PSA), which may show low values due to finasteride treatment and thus conceal the possible existence of prostate cancer.