You may have read about unwanted finasteride side effects such as erectile dysfunction, depression or infertility and wondered whether Finasteride is worth it. However, it is the most prescribed hair loss medication in the world for a good reason. Ample studies performed on large numbers of patients with male pattern baldness show that Finasteride is not only very effective, but it is also safe to use [1].
Only 1-4% of users report Finasteride side effects and at this time, there is insufficient evidence that Finasteride is directly causing the symptoms they are experiencing [1][4][5]. However, there is abundant proof that with regular use, this treatment can stop the progression of androgenetic alopecia and even improve hair density in 80-90% of its users [1]. So yes, for most patients, Finasteride is safe, effective and worth it.
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While Finasteride may not be able to help men with a different type of alopecia than male pattern baldness (e.g. alopecia areata or telogen effluvium), it is very effective against androgenetic alopecia. Studies show that it stopped hair shedding or even improved hair density in 70% of men with temple hair loss and 83% of men with crown hair thinning [1][2][3]. Moreover, one clinical trial performed on 1879 men with male pattern baldness revealed that after 5 years of taking this medication regularly, 90% of patients experienced these positive Finasteride results [1].
When it comes to risks, Finasteride is deemed safe by the regulatory agencies and the scientific community alike [1]. Only 1-4% of users have reported temporary unwanted side effects in clinical trials [1][4][5] (some studies have found no increased risks at all [6][7]).
Furthermore, you will be happy to know that Finasteride side effects are not permanent, most of them significantly diminish after the first year of treatment. Most symptoms are also likely to resolve once you stop taking this medication, as the short Finasteride half-life makes it leave your system after just a few days.
Hair loss does not only affect a man’s appearance, it can also have a significant impact on his relationships, his self-esteem and ultimately, his mental health [8]. So an effective treatment that can help reduce or reverse this condition and prevent his hair from falling out can significantly increase his subjective well-being and quality of life.
Taking all this into consideration, it is safe to say that for most patients with male pattern baldness, taking Finasteride can be very positive when it comes to hair growth and hair density. However, keep in mind that this medication only works if you are experiencing mild or moderate androgenetic alopecia.
While some companies that sell this drug offer online consultations with physicians who can provide you with a prescription, it is best to have a face-to-face consultation with a trichologist before taking it, so they can give you a proper examination and accurate diagnosis.
There are several factors that influence the development of male pattern baldness, such as your age, your genes and your hormones. But what happens inside your body when you experience this condition is that an enzyme converts too much of your testosterone into a different male hormone called dihydrotestosterone (DHT). Excessive levels of DHT can cause your hair follicles to become smaller and stop producing hair [9].
The follicles on your crown, temples and hairline are the most affected by DHT, which is why androgenetic alopecia often follows a typical pattern: you develop a receding hairline, experience temple hair loss and eventually, a bald spot on the crown [10].
Finasteride works by suppressing the activity of the enzyme involved in DHT production, called 5 alpha-reductase, leading to a lower amount of DHT in your blood [11]. This can diminish or stop your hair loss and in many cases, promote hair regrowth.
A small proportion of Finasteride users have reported unwanted side effects, such as [5]:
However, most of these conditions are self-reported. And clinical trials performed on large numbers of men with androgenetic alopecia revealed an unusual effect. The difference was very small between the number of patients who received Finasteride and reported some of these unwanted side effects and those who received a placebo and also experienced the same adverse reactions [5].
Furthermore, patients who were informed of the sexual side effects of Finasteride before receiving the placebo were more likely to experience them than those who were not. This indicates that while a significant decrease in DHT can negatively influence sexual performance in men with an existing predisposition, another phenomenon may also be involved. I
t is possible that some of the Finasteride users who report unwanted side effects may, in fact, be experiencing a nocebo effect (the body is “tricked” into developing the adverse reactions the mind expects it to experience)[5][12].
Male pattern baldness is a permanent condition. That means it can be kept under control with medication such as Finasteride, but not cured. Normally, a few days after you stop taking it, the levels of DHT in your blood will rise again to their pre-treatment values and your hair will start to fall out once more.
However, you will be happy to know that Finasteride is considered safe for long-term use, so most men can take it for years without experiencing any adverse reactions. It may seem like, after a few years, the medication no longer works as well as it used to, but that may be just because it has reached its plateau.
That means that when you first start taking this drug, it is easy to see visible results, as it stops your hair from falling out and hopefully makes some of it grow back. But after a while, it reaches its peak effect and while it still maintains your hair the way it is, it cannot generate any more improvement in hair density.
Moreover, as the years pass, you may start to experience further hair loss caused by normal, age-related effects (e.g. the blood flow to your scalp may slightly diminish, making it more difficult for nutrients to reach your hair follicles). At the same time, your body may also start to produce more 5 alpha-reductase enzymes, to compensate for the DHT reduction.
While chronologically speaking, there is no age cutoff for starting a Finasteride treatment, it can sometimes be too late to start taking this medication. It works well in most cases for mild and moderate male pattern baldness, but if your alopecia is too advanced, medication alone won’t likely be sufficient to curb it. In that case, your only option may be to get a hair transplant.
That is why it is a good idea to see a trichologist from the first signs of hair thinning and balding. An early diagnosis can significantly increase your chances of stopping hair loss in its tracks and perhaps even achieve some significant hair regrowth.
Depending on the extent of your hair loss, there are some alternatives to Finasteride that you might find effective. Here are the most effective:
Minoxidil can provide a good alternative if Finasteride isn’t working for you because it uses a different therapeutic mechanism. It works by dilating the small blood vessels in your scalp so greater amounts of nutrients and oxygen can reach your hair follicles. You can even try using Minoxidil combined with Finasteride, as using them together enhances their effect.
Dutasteride uses the same mechanism to treat androgenetic alopecia as Finasteride and it has also been found more effective. However, it has not yet been approved by the FDA for treating male pattern baldness, so it can only be prescribed off-label at this time.
If your androgenetic alopecia is too advanced for non-surgical treatment, all may not be lost. You may still have a chance to regain a full, healthy head of hair by getting a natural-looking transplant. The surgery is completely painless and normally performed in just a few hours, with no hospitalisation necessary. Moreover, if you opt for a FUE type of procedure, there is virtually no scarring, so you can get a hair transplant without anyone knowing.
Finally, while medications need to be taken continuously to work, a hair transplant is permanent, so it is an investment in your appearance for years to come. Check out what your hair transplant could look like after 10 years.
If you are worried about your hair falling out and are not sure what the best treatment might be, book a consultation now with one of our top-tier trichologists. They will examine you carefully and perform all the necessary tests to determine the cause of your hair loss and prescribe the best, personalised treatment for your condition.
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