Finasteride and Baldness: How It Works

Male pattern baldness, also called androgenetic alopecia, is the most common type of hair loss in men.

Genetics play a major role.

In genetically susceptible hair follicles, DHT can gradually cause a process called follicular miniaturization. Healthy terminal hairs become:

• Thinner
• Shorter
• Less pigmented
• Less visible

Eventually, a follicle that once produced a thick strand of hair may produce a very fine, barely noticeable hair.

This typically creates the familiar pattern of a receding hairline and thinning around the crown and top of the scalp.

DHT is an androgen hormone made from testosterone.

An enzyme called 5-alpha-reductase converts some testosterone into DHT.

DHT has important functions in the body, particularly during male development. But in people genetically susceptible to male pattern baldness, scalp hair follicles can be especially sensitive to it.

Over time, exposure to DHT can shorten the hair-growth phase and contribute to follicle miniaturization.

This is where finasteride comes in.

Finasteride is a 5-alpha-reductase inhibitor.

Rather than directly stimulating the hair follicle, finasteride reduces the conversion of testosterone into DHT.

In clinical pharmacology studies, a 1 mg daily dose of finasteride reduced circulating DHT levels by approximately 65% within 24 hours.

With less DHT affecting susceptible scalp follicles, the miniaturization process can slow.

It can.

Finasteride is often described as a medication that prevents additional hair loss, but clinical studies have also demonstrated improvements in hair growth.

In large controlled trials involving men with male pattern hair loss, finasteride increased hair counts and slowed progression compared with placebo.

Researchers also found that the benefits continued with longer-term treatment.

However, results vary. For some men, the biggest benefit may be maintaining the hair they already have rather than dramatically regrowing areas that have been bald for years.

Hair grows slowly, so finasteride doesn't produce immediate results.

It usually takes several months before meaningful changes can be evaluated. Some men may begin noticing reduced shedding or changes in hair growth within the first few months, while visible improvement can take longer.

Clinical trials have generally evaluated results over periods of one year or longer.

Finasteride has strong evidence for treating hair loss around the vertex or crown and mid-scalp.

It may also help slow progression in other areas affected by androgenetic alopecia. But areas that have already experienced extensive follicle miniaturization may be more difficult to restore.

This is one reason treating male pattern hair loss earlier can be beneficial.

The goal isn't always to recreate a teenage hairline. Often, preventing significant additional hair loss is itself a successful treatment outcome.

Finasteride doesn't permanently remove the genetic tendency toward male pattern baldness.

When treatment stops, DHT levels rise again and susceptible hair follicles are once again exposed to its effects.

As a result, hair that was maintained or gained during treatment can gradually be lost. The prescribing information notes that withdrawal of treatment leads to reversal of its effect within approximately 12 months.

Finasteride therefore generally needs to be continued to maintain its benefits.

Finasteride and minoxidil approach hair loss differently.

Because the medications work through different mechanisms, healthcare providers may sometimes use them together. Finasteride addresses the DHT component, while minoxidil provides a separate growth-promoting approach.

The appropriate treatment depends on the individual patient.

Finasteride is generally well tolerated, but side effects can occur.

In clinical trials of finasteride 1 mg for male pattern hair loss, sexual side effects were uncommon but occurred somewhat more frequently than with placebo. Reported effects included:

• Decreased libido
• Erectile dysfunction
• Ejaculation-related changes

Other adverse reactions have also been reported after finasteride entered widespread clinical use. Patients should discuss new or concerning symptoms with their healthcare provider.

Finasteride also lowers prostate-specific antigen (PSA), which is important for clinicians to know when interpreting PSA testing.

Finasteride is primarily used for male pattern hair loss and requires additional considerations in women.

It can cause abnormalities in the external genitalia of a male fetus and should not be used during pregnancy. Women who are or may potentially be pregnant should not handle crushed or broken finasteride tablets because the medication can be absorbed through the skin.

Treatment of female pattern hair loss follows a different clinical approach and should be discussed with a healthcare provider.

No.

Finasteride controls an important part of the process that causes androgenetic alopecia, but it doesn't eliminate the genetic tendency toward hair loss.

Think of treatment as protecting susceptible follicles from some of the effects of DHT. As long as those follicles remain genetically sensitive to DHT, stopping treatment can allow the balding process to resume.

That's why long-term consistency is usually important.

Finasteride works against male pattern baldness by reducing DHT, one of the major hormones responsible for follicle miniaturization in genetically susceptible men.

By inhibiting 5-alpha-reductase, finasteride substantially reduces the conversion of testosterone into DHT. Clinical studies have shown that this can slow further hair loss and improve hair growth in many men.

Results aren't immediate, and finasteride isn't a permanent cure. Treatment usually needs to be continued to maintain its effects.

For someone noticing a receding hairline, thinning crown, or gradually decreasing hair density, treating androgenetic alopecia earlier may provide a better opportunity to preserve follicles before substantial miniaturization occurs.

At Luma Meds, eligible patients can discuss their hair-loss concerns and available treatment options with a licensed healthcare provider to determine an approach that may be appropriate for their individual needs.