When searching online for information about finasteride and hair, whether it is on specialized sites, forums or blogs like Andro Genetic , it is common to come across all kinds of news, some of which may even contradict each other. This situation can generate confusion, especially for those who are approaching the topic of baldness for the first time and brings with it doubts, anxieties and suggestions, especially among the most sensitive people.
In this article, I will try to answer the most common questions about this drug used to treat androgenetic alopecia , based on serious and reliable studies. In addition, I want to share my personal experience, since I started testing finasteride in 2014, regularly updating my situation in the article Baldness Cure: My Personal Case .
Historical notes
Since the topic of this article focuses exclusively on finasteride and hair, I will not go into a detailed historical analysis, but I think it is useful to provide some background.
If this part seems boring to you, feel free to skip to the next section!
Initially, this drug was developed to treat benign prostatic hyperplasia (BPH) , a prostate condition also associated with excess of the hormone DHT .
The dependence of BPH on dihydrotestosterone was determined thanks to the studies of Professor Julianne Imperato-McGinley , who in 1974 began research on a group of hermaphroditic children from the Caribbean to identify the causes of their anomalous sexual development. These children were born with organs of both sexes, and then developed the male one at puberty. Those interested in the study published in 1997 can consult the link 1) ; however, I will not delve into this topic here, since it is not strictly related to androgenetic alopecia.
In summary, the cause of these abnormalities in sexual development was determined to be a genetic mutation that led to a lack of alpha 5 reductase , and, consequently, a deficiency of DHT .
What caught the attention of the American company Merck , through its then head of research P. Roy Vangelos , was an interesting detail: McGinley’s studies revealed that all individuals with that genetic mutation had a significantly smaller prostate than average. It was therefore plausible to hypothesize that an excess of DHT, or a greater sensitivity of the receptors, could be at the basis of the benign enlargement of the prostate.
In the late 1970s, based on these studies, research began to develop a drug capable of inhibiting type 2 alpha 5 reductase (mostly present in the prostate and hair follicles) in order to treat people affected by benign prostatic hyperplasia .
Thus, Merck synthesized Finasteride and obtained FDA approval for the treatment of BPH with a dosage of 5 mg. It was 1992, and for the first time Proscar was placed on the market , covered by patent until 2006. In Italy, the use of Proscar was authorized starting from 1997.
Finasteride and Hair: Propecia is Born
Now we come to the part that is of most interest to those who visit this site, that is, the use of finasteride for the treatment of androgenetic alopecia . Since the experimental phases with the dosage of 5 mg for the treatment of prostatic hypertrophy, an improvement in the quality of hair was observed in the majority of patients, and in some cases significant recoveries were also found in subjects affected by common baldness.
This, combined with the theories that since 1970 saw DHT as the main cause of androgenetic alopecia, led Merck to propose a product based on finasteride at a specific dosage of 1 mg, therefore lower than the 5 mg of Proscar, but still effective in inhibiting the formation of dihydrotestosterone in individuals affected by male pattern baldness.
In 1997, the Food and Drug Administration (FDA) approved and marketed Propecia at 1 mg, which was authorized for sale in Italy starting in 1999. Propecia remained under patent until 2013, making it impossible to find generics with a dosage of 1 mg on the market.
Finasteride: How does it work?
Finasteride belongs to the category of anti-androgen drugs and works by blocking the enzyme alpha 5 reductase , thus preventing the conversion of testosterone into DHT. This hormone is the main cause of the miniaturization of hair follicles in androgenetic alopecia .
However, there is not a single form of alpha 5 reductase, but two isoforms:
- Alpha 5 reductase type 1 : produces approximately 30% of circulating DHT, is not present in hair follicles and is found mainly in:
- brain
- sebaceous glands of the scalp and face
- chest and back skin
- liver
- adrenal glands
- kidneys
- adipose tissue.
- Alpha 5 reductase type 2 : produces approximately 60% of circulating DHT and is found primarily in:
- prostate
- beard and hair follicles
- seminal vesicles
- scalp.
Additionally, like isoform 1, it is also found in:
- chest skin
- liver
- adipose tissue.
As mentioned, finasteride is an azosteroid inhibitor of type 2 alpha-5 reductase , which is found predominantly in the prostate and hair follicles of the scalp. By inhibiting the enzyme, it therefore prevents the conversion of testosterone into dihydrotestosterone , slowing what is the main cause of androgenetic alopecia .
At the approved dosage for hair treatment, equal to 1 mg per day , it must be taken orally and can inhibit the production of DHT by about 65-70% . Thanks to this ability, the drug has become the cornerstone for all therapies against androgenetic male pattern baldness.
Thanks to its anti-DHT action, the factor responsible for the progressive miniaturization of hair follicles affected by AGA is significantly reduced, allowing them to recover and regain some degrees of dysplasia .
SITRI considers that in 2 degrees of dysplasia a possible recovery of hair may occur following anti-androgen therapies. Therefore, it is essential to act as soon as possible and not wait for miniaturization to reach too high levels, since a hair that has reached the final vellus stage will not be able to return to the Anagen 6 level (healthy hair).
Finasteride Results: How Long to Wait?
When you start a therapy to cure baldness, the anxiety of seeing the first results can be really excessive. However, it is important to maintain maximum consistency in taking it and, above all, to have a lot of PATIENCE . Certainly, the doctor who prescribed the drug will have told you to wait 6 to 12 months before making any evaluations. So, before 6 months, there is no need to be alarmed if you do not notice results.
However, you are probably wondering, “ Can finasteride really work against androgenetic alopecia?” This study shows that, for a good 80 – 90% of users, the drug can slow down , stop , or even reverse the process of androgenetic miniaturization.
Of course, it is not an immediate thing and therefore it takes a bit of patience. Even in my personal case, although I am undoubtedly a good responder to the drug, I noticed the first slight improvements around 4 months , manifested in a better quality of hair and a slight increase in thickness. After 6 months , a clear change was evident, and at 18 months I reached the maximum peak that I am now trying to maintain. However, I repeat that not everyone responds to the drug like me and times can vary.
I would like to point out that, for improvement, it is not necessary to expect regrowth, since, in cases of particularly aggressive baldness, even a halt in miniaturization and stabilization of hair loss should not be underestimated.
Finasteride Suspension and Maintenance Results
If finasteride therapy has given you good results and you have achieved a significant improvement in your hair, I’m sorry… but if you stop taking it, the benefits obtained are destined to disappear miserably.
Androgenetic alopecia , in fact, will resume its course and the action of DHT , no longer blocked by the drug, will begin to miniaturize the follicles sensitive to it. In about 6 months , you may notice the disappearance of about half of the hair recovered thanks to Propecia ; after a year, you will find yourself back to the pre-treatment situation.
If the break is limited to a period of about 3-4 months , when the drug is resumed it will probably be possible to completely recover the hair lost or partially miniaturized during the interruption of finasteride . However, in the case of breaks lasting 12 months or more, the follicles that in the meantime have reached the final miniaturization stage (vellus) will no longer be recoverable.
Indicatively, the intake protocols provide for no breaks for the first 2 years of treatment (during which the maximum result is achieved). Then, at the discretion of the attending physician, breaks of up to 2 months can be evaluated to counteract any side effects.
Personally, after 2 years of therapy, since I have not experienced any side effects, I was not advised to take a break. However, the doctor who follows me tried to reduce the dosage by 50% to see if it was sufficient for maintenance, since the recovery achieved will hardly be able to be further increased.
Can I take Finasteride?
I certainly can’t answer this question for you, and remember that this drug is a prescription drug, so you need to discuss this with your doctor.
However, based on current studies, the ideal “candidate” to use finasteride should have these characteristics:
- Have diagnosed androgenetic alopecia , so the hair loss is not due to other problems (alopecia areata, telogen effluvium, thyroid disease, etc.).
- NEVER have suffered from depression or psychological disorders, as finasteride can amplify the symptoms associated with such disorders.
- Have a balanced hormonal profile . The drug acts on hormones and, although it may be well tolerated by those with normal levels, it could increase any deficiencies or imbalances.
How to take it
This point is much debated in various forums on the web, and in fact you will find people wondering whether to take finasteride on an empty stomach or during meals, to the point of wondering how much time to wait between taking it and the next meal. You can also read about people who have doubts about the time of taking it and the resistance of the gastro-resistant film it is coated with… and so on and so forth!
Personally, I limit myself to reading the leaflet included in each package, where it is indicated that you can take finasteride with or without meals.
If you miss a dose, do not take a double dose to make up for it, but simply resume normally the following day. Obviously, forgetfulness should not become a habit.
Finasteride Side Effects
Finasteride: Contraindications
Contraindications of finasteride should not be confused with side effects . As reported in the package leaflet, these are factors that the doctor must consider if a patient intends to start using this active ingredient.
Therefore, they should not take finasteride:
- Subjects with severe liver failure : since the drug is metabolized in the liver. It is up to the doctor to evaluate the situation and the risk/benefit ratio. If you choose to use it, it is essential to frequently monitor liver values.
- People with hypersensitivity or allergies : In general, an allergy to the active ingredient itself is very rare. However, lactose is also used as an excipient in the tablet, which can cause intolerance problems in many people.
- Pregnant women : as clearly specified in the leaflet, pregnant women should absolutely not come into contact with finasteride, as this could lead to serious malformations in the reproductive system of the male fetus. The antiandrogenic action of finasteride would in fact interfere with the correct formation of the male sexual organs. This explains the use of a film coating on the tablets, designed to prevent accidental contact with the product. In addition, pregnant women should avoid having contact with the seminal fluid of their partner who uses Propecia or an equivalent drug, as specific analyses have detected the presence of traces of the drug in it.
Does Finasteride Affect Athletic Performance?
We have established that this drug has a mode of action that involves some androgen hormones . These hormones, among other functions, are also responsible for the expression and development of muscle strength .
Therefore, many athletes have fears and concerns about the possibility that starting a therapy could compromise their physical performance .
In this regard, we invite you to learn more by reading our articles that deal with the topic of finasteride and bodybuilding and the alleged doping effect of Propecia .
Finasteride Gel: An Alternative Against Side Effects?
To address any side effects that may occur, some formulations are emerging on the market to be applied directly to the scalp, in order to avoid or minimize systemic absorption.
If you are interested in this topic, we invite you to read our article on topical finasteride .
Finasteride: Prescription or Not?
When talking about finasteride and hair , the specific drug is Propecia 1 mg (or equivalent), which unfortunately falls into Class C , that is, entirely at the citizen’s expense. However, the obligation of a medical prescription with a white prescription remains , which can be repeated if necessary.
Those who need dosages other than the standard, or simply want to save compared to the high cost of Propecia , can opt for generic drugs (although the savings remain limited) or for galenic preparation by specialized pharmacies, which can offer finasteride tablets or capsules. Even in this case, the requirement for a white prescription remains .
I remind you that the sale of drugs without a regular medical prescription is a crime, as is purchasing them online if done without a medical prescription.
Is Proscar Better for Treating Baldness?
However, beyond the dosage and the different intended use , what could be the chemical differences?
Since 1992 , millions of people worldwide with androgenetic alopecia have been using Proscar divided into 4 or 5 parts to treat their baldness, and I have been doing so myself for several years. This choice is mainly motivated by economic factors .
However, in the vast world of the Internet, and especially in forums, you can find the most diverse doubts and fears. Some wonder if the cut 5 mg finasteride could be less effective, while others discuss the method of dividing Proscar tablets and the tools to use. Finally, there are also questions about how to best preserve the obtained quarters .
Generic Finasteride: Is It Effective?
As already mentioned, with the expiration of patents (the last one was that of Propecia in 2013 ), numerous brands of generic or equivalent finasteride have appeared on the market , both in the 5 mg format (such as Teva , EG , Mylan , etc.) and in the 1 mg format (for example Finacapil , Carenafinast , Mylan ).
Probably, based on some statements by Doctor Jerry Wong , one of the best hair transplant surgeons in the world, who in the early 2000s strongly recommended his patients not to use generic drugs but to always stay on the original Propecia , the belief has spread that generic finasteride is less effective than the original.
However, it should be considered that these statements were made at a time when, to purchase generic drugs, it was often necessary to resort to online sites and the products came from countries such as India and China , where regulations and controls were not at the same level as those in Italy or Europe. Consequently, there was a risk of coming across under- or over-dosed drugs. Today, when purchasing generic finasteride produced by an Italian company and at an authorized pharmacy, I see no reason to doubt the quality of the product.
In fact, if a company declared that its product contained 1 mg of finasteride and a test revealed a different dosage, it would face serious legal consequences.
For example, in my personal case, since July 2014 I have only purchased 2 packs of original Propecia and 1 of galenic tablets. For the rest, I have always used generic finasteride 5 mg broken into quarters. The results obtained are visible to everyone and I can say that the idea of a poor effectiveness of generic finasteride has been largely refuted.
Are there any natural alternatives to Finasteride?
As you probably understood by reading this page or the information available on the internet, finasteride is a drug that acts on androgen hormones and, in some cases, can cause side effects. Consequently, those who cannot take finasteride due to significant side effects , or those who prefer not to use drugs to combat baldness, often look for natural alternatives.
Given the high number of requests received, I decided to deal with natural active ingredients that, according to studies, have been shown to have an anti-androgenic action similar to that of finasteride, although obviously less powerful.
Undoubtedly, this drug has several detractors, for more or less justified reasons. However, the topic of finasteride and hair remains of fundamental importance for those who want to fight androgenetic alopecia .
Therefore, I advise anyone interested in this topic to inform themselves as much as possible, reading official sources and relying on competent doctors. This is the best way to avoid being influenced by alarmist information circulating on the web.