Finasteride: What It Is, How It Works, and What to Expect
Finasteride (also known by the trade name Propecia) is an FDA-approved medication used to treat androgenic alopecia.
What Is Finasteride?
Finasteride, also known as Propecia (trade name), is an FDA-approved medication that treats androgenic alopecia.
How Finasteride Works
Finasteride inhibits the expression of the enzyme 5-alpha reductase type II, which regulates the production of dihydrotestosterone (DHT). By lowering DHT levels in the scalp, it reduces DHT’s harmful effect on hair follicles. Finasteride decreases DHT concentrations in the serum and the scalp by up to 70% and 60%, respectively.
Oral vs. Topical Finasteride
Finasteride was initially approved as an oral pill taken once a day. The usual dose is 1 mg daily, taken with or without food, at any time during the day. A topical formulation of finasteride has been approved, but it has not been found to be as effective as the oral pill.
| Feature | Oral Finasteride | Topical Finasteride |
|---|---|---|
| How It Is Used | 1 mg daily (tablet) | Daily scalp application |
| Relative Effectiveness | Gold Standard | Approved, but not as effective |
| Systemic Exposure | Higher | Lower / localized |
Why Women Should Not Use Finasteride
Finasteride is not indicated for women with female-pattern hair loss, and it is contraindicated during pregnancy, as it may cause abnormalities in the external genitalia of a male fetus.
How Effective Is Finasteride?
When Will I See Results?
Daily use of 1 mg for three months or more may be necessary to prevent hair loss or to stimulate hair growth. Ongoing studies have shown that finasteride decreases hair loss and helps regrow hair in 9 out of 10 men who take it long-term every day.
Can I Stop Once I Have Enough Hair?
There is no controlled clinical data on treatment beyond 12 months. You will likely need to continue treatment indefinitely to maintain benefits. This helps keep hair loss progression at a much slower rate.
What Happens If You Stop?
If a patient stops taking finasteride, DHT levels in the scalp rise again and hair loss is likely to resume. As with most prevention treatments, once therapy is discontinued, the body returns to its natural course of hair loss.
Will I Grow More Hair Elsewhere?
Finasteride is a specific inhibitor of 5-alpha reductase type II, a key driver of androgenic alopecia found primarily in scalp hair follicles. In clinical trials, no effects on hair in other parts of the body were reported.
Side Effects of Finasteride
In clinical trials, finasteride was well accepted in men, and most patients did not report serious side effects. The main side effects reported were decreased libido (1.8% with finasteride vs. 1.3% with placebo) and erectile dysfunction (1.3% with finasteride vs. 0.7% with placebo).
- Decreased ejaculate volume: 0.8% with finasteride vs. 0.4% with placebo.
- Side effects typically resolve after stopping therapy, and many men choose to continue treatment.
- Post-marketing reports include some complaints of depression, but the risk appears to be very small.
Full clinical disclosure and individualized guidance are provided during consultation.
Discuss with a SpecialistContraindications & Special Considerations
In most cases, finasteride is not recommended for women or children. However, it may sometimes be prescribed off-label for post-menopausal women in specific situations. Finasteride is contraindicated in women who are or may become pregnant, and in patients hypersensitive to any component of the product.
Finasteride is not recommended for men who are subfertile. For men planning to have children, some physicians check sperm count before starting finasteride and repeat it after 6 months. If sperm count is reduced, finasteride should be discontinued.
Can Finasteride Be Combined with Minoxidil?
The combination of finasteride and minoxidil is known to produce better results together than using only one at a time. If you are switching from one treatment to another, it may be best to overlap for six months to reduce the chance of shedding from discontinuing the first agent while waiting for the new product to take effect.
Finasteride was evaluated in 3,200 men and was very well tolerated, including patients on therapy for up to two years. Long-term suppression of DHT does not appear to be harmful, supported by extensive research dating back to 1974 on men born with 5-alpha reductase deficiency.