Hair Loss Blog

Finasteride

Update: December 1, 2008. Miscellaneous Therapeutic Agentssystemic, oral

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Why is this medication prescribed?

Finasteride (Proscar) is used alone or in combination with another medication (doxazosin [Cardura]) to treat benign prostatic hypertrophy (BPH, enlargement of the prostate gland). Finasteride improves symptoms of BPH such as frequent and difficult urination and may reduce the chance of acute urinary retention (suddenly being unable to pass urine). It also may decrease the chance of needing prostate surgery. Finasteride (Propecia) is also used to treat male pattern hair loss (a common condition in which men have gradual thinning of the hair on the scalp, leading to a receding hairline or balding on the top of the head.) Finasteride (Propecia) has not been shown to treat thinning hair at the temples and is not used to treat hair loss in women or children. Finasteride is in a class of medications called 5-alpha reductase inhibitors. Finasteride treats BPH by blocking the body's production of a male hormone that causes the prostate to enlarge. Finasteride treats male pattern hair loss by blocking the body's production of a male hormone in the scalp that stops hair growth.

How should this medicine be used?

Finasteride comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take finasteride at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take finasteride exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you are taking finasteride to treat BPH, you should know that finasteride controls your condition, but does not cure it. It may take at least 6 months before your symptoms improve. Continue to take finasteride even if you feel well. Do not stop taking finasteride without talking to your doctor.

If you are taking finasteride to treat male pattern hair loss, you should know that finasteride controls hair loss, but does not cure it. It may take at least 3 months before you see any benefit. Continue to take finasteride even if you have already seen an effect. Do not stop taking finasteride without talking to your doctor. If you stop taking finasteride, you will probably lose the hair you have regrown within 12 months of stopping your treatment.

If you are taking finasteride to treat male pattern hair loss and have not seen any improvement within 12 months, further treatment will probably not help. Talk to your doctor about whether you should continue your treatment.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking finasteride,

•tell your doctor and pharmacist if you are allergic to finasteride or any other medications.

•tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

•tell your doctor if you have or have ever had liver disease.

•you should know that finasteride is only for use in men. If taken by pregnant women, finasteride can harm the male fetus. Women who are, could become, or may be pregnant should not take finasteride or touch broken or crushed finasteride tablets. If a pregnant woman takes or touches finasteride tablets, she should talk to her doctor.

What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?
Finasteride may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

•inability to have or maintain an erection

•decreased sexual desire

•decreased volume of ejaculate (amount of semen)

•pain in the testicles

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

•changes in the breasts such as increased size, lumps, pain, or nipple discharge

•rash

•itching

•hives

•swelling of the lips and face

Finasteride may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Eur J Dermatol. 2001 Jul-Aug;11(4):304-8.

Androgen responsive genes as they affect hair growth.

Sawaya ME, Keane RW, Blume-Peytavi U, Mullins DL, Nusbaum BP, Whiting D, Nicholson DW.

Finasteride has been shown to be an effective treatment for men with androgenetic alopecia (AGA) as it restores hair growth to miniaturized hair follicles on the top of the scalp [1]. Caspases are regulators of programmed cell death, and very likely some specific caspases may function as mediators of the hair growth cycle. It is unclear whether finasteride influences the regulation of apoptosis via caspases in the hair follicle. Very little information is available regarding the role of caspases present in human hair follicles in normal scalp and in androgenetic alopecia. In this study we have analyzed the family of caspases, 1-10 along with usurpin, and XIAP, in men with normal scalp and in men with androgenetic alopecia before and after 6 months treatment with 1 mg oral finasteride treatment. Caspases 1, 3, 8 and 9 were detected predominantly within the isthmic and infundibular hair follicle area for both normal and AGA patients, however the expression of all factors, especially caspase 3 was greater in the AGA group than in the normal scalp group. AGA men had the same caspase factors but with greater expression. In the same AGA men treated with finasteride for 6 months, the expression of these factors was similar to levels in the normal group. Results from our study indicate caspase 3 to be of primary importance in normal hair homeostasis and that DHT may be signaling greater expression of caspases, inducing apoptosis in androgenetic alopecia. In conclusion, DHT may selectively regulate the caspase genes which play an important role in signaling programmed cell death, affecting the hair growth cycle.

Endocrinol Metab Clin North Am. 1999 Jun;28(2):409-21.

Antiandrogen treatment of polycystic ovary syndrome.

Rittmaster RS.

Although hirsutism and androgenetic alopecia ( pattern hair loss ) are cosmetic problems, they can be psychologically devastating for women. Mechanical hair removal may control the cosmetic appearance of hirsutism, but the underlying problem usually continues to progress. Topical therapies for androgenetic alopecia provide for modest improvement at best, and no topical therapy has been shown to be effective for hirsutism. Antiandrogens, combined with ovarian suppression, offer the best hope for the improvement of hirsutism and androgenetic alopecia in women with PCOS. Improvement will occur in most women. Unless the underlying cause of the PCOS is corrected, medical therapy will need to be continued indefinitely.

Dermatol Surg. 2003 Nov;29(11):1130-4.

Androgenetic alopecia: combining medical and surgical treatments.
Bouhanna P.

BACKGROUND: Medical treatment or surgical reconstruction is used separately to treat androgenetic alopecia. Two drug molecules (5% minoxidil solution and oral finasteride 1 mg) have proven efficacy to stabilize hair loss and promote hair regrowth. Microtransplant of one to three hair follicular unit grafts can provide a definitive hair restoration with a natural appearance. OBJECTIVES: Aesthetic results can be optimized with a combination of drugs and transplantation of follicular unit grafts. The Dynamic Multifactorial Classification is used to select suitable candidates for this combined approach and also to assess follow-up results. RESULTS: Dynamic Multifactorial Classification assists the evaluation of the natural history of androgenetic alopecia evolution and also the effects of treatment. Regression of male androgenetic alopecia from Hamilton type V to type III can be achieved by combining drugs with hair grafts. CONCLUSION: Improvement of investigative methods and especially the Dynamic Multifactorial Classification makes it easier for a patient to follow the results of treatment adapted to their case.

Hair loss blog

Cutis. 2001 Jul;68(1):35-40.

Management of male pattern hair loss.

Sinclair RD.

Department of Dermatology, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia. sinclair@svhm.org.au

Hair Loss Blog

The management of androgenetic alopecia (AGA) has been materially altered by the availability of the 5 alpha-reductase type 2 inhibitor, finasteride. Nevertheless, this agent is only one component of successful management, and an understanding of the role of camouflage agents, surgical options, and other medical treatments is important. Because no treatment completely reverses baldness, it is important to communicate the limitations of each modality to the patient so that he has appropriate expectations of the outcome of any intervention. Patient counseling and support are also often relevant.

J Eur Acad Dermatol Venereol. 1999 May;12(3):205-14.

Management of androgenetic alopecia.

Tosti A, Camacho-Martinez F, Dawber R.

BACKGROUND: Androgenetic alopecia (AGA) is the most frequent cause of hair loss affecting up to 50% of men and 40% of women by the age of 50. METHODS: This paper outlines the current status of diagnosis and offers guidelines for optimal management of AGA in both men and women. RESULTS: The diagnosis of AGA can usually be confirmed by medical history and physical examination alone. A trichogram can be useful to assess the progression of the hair loss. A scalp biospy is diagnostic but usually not required. In women with signs of hyperandrogenism, investigation for ovarian (polycystic ovarian disease) or adrenal (late-onset congenital adrenal hyperplasia) disorders is required. Mild to moderate AGA in men can be treated with oral finasteride or topical minoxidil. Oral finasteride at the dosage of 1 mg/day produced clinical improvement in up to 66% of patients treated for 2 years. The drug is effective for both frontal and vertex hair thinning. Medical treatment with finasteride or minoxidil should be continued indefinitely since interruption of therapy leads to hair loss with return to pretreatment status. Mild to moderate AGA in women can be treated with oral antiandrogens (cyproterone acetate, spironolactone) and/or topical minoxidil with good results in many cases. Hair systems and surgery may be considered for selected cases of severe AGA both in men and in women. CONCLUSIONS: Patients with AGA should be informed about the pathogenesis of the condition. If used correctly, available medical treatments arrest progression of the disease and reverse miniaturization in most patients with mild to moderate AGA.

Int J Clin Pract. 1999 Jul-Aug;53(5):381-5.

Therapeutic approaches to the management of common baldness.

Sommer M, Wilson C.

Common baldness or androgenetic alopecia (male pattern hair loss) is a universal problem, having affected both sexes of all races to different extents for as long as mankind has existed. The progressive androgen dependent hair loss follows specific patterns and is a physiological process, which may take on disease quality due to psychosocial compontents. These should be taken into consideration when discussing the several treatment options available, particularly as a cure cannot be offered. Cosmetic measures range from back-combing over perms to hairpieces and wigs. Medical therapies include systemic antiandrogens and topical minoxidil; surgical options comprise follicular transplantation, scalp reduction and rotation. Before starting treatment, however, careful consideration should be given to the differential diagnosis which includes drug-induced hair thinning, anagen effluvium, diffuse alopecia areata, metabolic disturbances, nutritional deficiencies and acute as well as chronic telogen effluvium.

Arch Dermatol. 1985 Feb;121(2):197-202.

Topical minoxidil therapy in hereditary androgenetic alopecia.

Hair Loss Blog

De Villez RL.

A randomized double-blind trial of topical minoxidil therapy was carried out on 56 patients with hereditary male pattern baldness and hair loss. The subjects selected were required to have a discernible balding patch, a minimum of 2.5 cm in diameter on the vertex of the head where the hairs could be counted and photographed. Minoxidil, 1.0 mL, was applied twice a day to the scalp beginning at the balding vertex and spreading centrifugally around the scalp. Cosmetically acceptable hair growth was achieved in 18 patients (32%). The most notable indicators for regrowth of hair were the number of indeterminate hairs initially present, the duration of baldness, and the size of the balding area. No serious systemic or cutaneous side effects were noted.

Head Neck Surg. 1985 Mar-Apr;7(4):336-9.

Medical treatment of male pattern alopecia (androgenic alopecia).

Tromovitch TA, Glogau RG, Stegman SJ.

Hair Loss Blog

The causes and potential causes of androgenic alopecia (male pattern hairloss ) in men and women are discussed. The scientific attempts at reversing this process are detailed including use of estrogen, thyroid, progesterone, and minoxidil. At present, the practical approach for the clinician is to ascertain in females that an androgen overproduction syndrome is not present. A therapeutic trial of topical progesterone at a 2%-5% concentration appears to be reasonable when the physician and patient appreciate the limitations of this approach.