An important issue for all patients undergoing hair transplants is how to reduce the chance of losing 'existing' hair on the scalp. Although transplanted hair follicles taken from the back and moved to the front will help provide a permanent improvement in hair density, the existing hair that is "already" there could be lost in future years. At Donovan Medical, patients undergoing hair transplantation are counselled on the use of medications that are scientifically proven to either help stop hair loss or improve hair growth. This includes the use of finasteride and minoxidil.
What is finasteride & how does it work?
- Finasteride is an oral medication (pill) that is used in treating genetic hair loss in men. It is approved by the Food and Drug Administration (FDA) and by Health Canada.
- The dose for hair loss is 1 mg.
- Finasteride works by reducing levels of the hormone dihydrotestosterone ("DHT"). Individuals with genetic hair loss (also called androgenetic hair loss) develop hair loss on account of the action of DHT.
Does finasteride help men with hair loss?
- Finasteride helps about 90 % of men.
- About 50 % of men will notice an improvement in their hair after 1 year of use
- About 40 % of men will notice that they are no longer losing any more hair
- In men under 40 years of age, finasteride helps all areas of the scalp (front and top)
- In men over 40 years of age, finasteride mainly helps the top of the scalp or "crown"
How long does the drug need to be used?
- Finasteride works only while it's taken. If finasteride is stopped, any benefits that a patient received will be lost in 6-9 months. Hair density will return to the way it was before starting the drug.
What are the side effects of Finasteride?
It's important to be aware that most men that take finasteride don't have any side effects. However the following may occur in a low proportion of users
- Sexual dysfunction. Decreased libido (sex drive) and impotence occur in approximately 1-4 % of men.
- In the majority of patients who were studied in clinical trials, these sexual issues improved over time even in men who continued the drug. Nevertheless, Dr. Donovan recommends stopping the drug if these problems occur. Recently there have been increasing reports of men who developed persistent sexual dysfunction even after stopping finasteride. This warning has now been included on the drug label. At present, it is not known just how common of a side effect this is, but it is important for all men on the drug to be aware of this.
- Mood changes (lowered mood, depression & anxiety) in 1:100 men
- Enlargement of breast tissue in men (a phenomenon called 'gynecomastia') - thought to be less than 1:200
- Testicular pain
1. How was finasteride discovered?
The drug finasteride has an interesting history. Researchers in the 1970's reported a group of boys in a specific village in the Dominican Republic that were deficient in the enzyme 5 alpha reductase (5AR). These males had low DHT levels throughout their life. This was associated with two important findings - 1) their prostate glands remained small and 2) their did not develop male pattern balding or acne. From this discovery, researchers worked to created a medication that could block the action of the enzyme 5AR. After years of testing, a drug was released into the market. In 1992, the 5 mg dose of finasteride was approved by the Food & Drug Administration (FDA) for the treatment of prostate enlargement. In 1997, the FDA approved a 1 mg dose of finasteride for the treatment of hair loss.
2. What proportion of men taking finasteride will find that they have 'better' hair?
Clinical studies showed that after 5 years, about 48 % of men demonstrated an increased in hair growth. About 42 % had no change and just 10 % had further hair loss compared to their baseline density. Therefore, finasteride is thought to benefit about 90 % of men overall - helping 50 % to get an improvement and helping about 40 % block further loss
3. Does finasteride work on the front of the scalp too?
Recent research has shown that finasteride helps all regions of the scalp in young men between 18-40. IN men over 40, finasteride mainly helps the crown or top of the scalp
4. How long will it take to see benefits of finasteride?
Benefits of finasteride will be seen between 4-9 months. Generally, results peak around one year.
5. Can finasteride be used with minoxidil?
Yes, the two can be used together and studies suggest the combination works even better than the use of either alone.
6. Can men take finasteride and father a child?
Yes, finasteride levels in semen do not affect a fetus. Men can take finasteride and father healthy children. However, it's important to be aware that finasteride can lower semen volume in some men. Therefore, men may wish to stop finasteride if there is any issues regarding fertility in the couple.
7. Does finasteride affect the PSA test for prostate cancer?
Finasteride can reduce the PSA value. It lowers the PSA test by 50 %. If you take finasteride and your doctor orders the PSA screening test, simply tell the doctor that you take finasteride. Once your doctor gets the results, he or she will simply double the result to get a sense of what the "true" value is
8. Does finasteride cause breast cancer in men?
At present, there is no evidence that finasteride causes breast cancer in men. It is generally recommended that men using finasteride perform routine self exams to check for lumps, pain or nipple discharge. Readers might be interested in a recent blog by Dr. Donovan discussing a study that showed no evidence of a relationship between finasteride and breast cancer.
9. Can patients taking finsteride donate blood?
Patients taking finasteride should not donate blood. If a woman who was pregnant received a blood transfusion and it contained finasteride, the developing baby could be harmed. Patients should tell their blood donor clinic if they use any medications.