Non-surgical Options for Men

Information on Finasteride for Men

For Registered Patients of the Donovan Hair Clinic

CONSENT FORM FOR USE OF FINASTERIDE

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.    

FINASTERIDE

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

Common Questions on Finasteride for Patients of the Donovan Hair Clinic.

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

Reference: Olsen EA et al. Global photographic assessment of men aged 18 to 60 with male pattern hair loss receiving finasteride. J Am Acad Dermatol 2012 67: 379-86.

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? 

This information should be frequently reviewed with the prescribing doctor for updated information as it may change over time as new information emerges. At the present time, there is no evidence that use of finasteride by men increases the risk of birth defects in his children. 1-3 % of all children in the world are born with birth defects and this rate at present seems similar in finasteride users compared to non users. About 1 out of every 100 men who use finasteride while fathering a child will have a baby with a birth defect of some kind - but that rate is similar to men who did not use finasteride.

Several agencies currently advise that finasteride not be used by males whose partners are trying to conceive. Several agencies state that there is no reason for it to be stopped. There is no evidence at present to support either the recommendation not to take or the recommendation to take. References are stated below this page.

Finasteride: Does it affect spermatogenesis and pregnancy?

Men with a genetic deficiency of 5 alpha reductase (i.e. men with genetic mutations) may have hypospadias (abnormal opening of urethra), cryptorchidism (undescended testes) and abnormal genitalia. These side effects do not appear increased in men using finasteride based on information available today. Many of these side effects are common in the general population. For example, 3 % of all boys in the world are born with cryporchidism making it a very common abnormality in the world’s population. Similarly 1 in 200 boys are born with hypospadius making it also one of the more common birth defects. In fact, hypospadius is the second most common congenital abnormality after cryptorchidism. We do not have evidence at present to suggest that men using finasteride have a higher than 3 % risk of having a boy with cryptorchidism or higher than a 1:200 risk of hypospadius. At present, all evidence would suggest that 3% of all men who use finasteride would have a baby boy born with cryptorchidism -the same rate as the general population. Similarly, all evidence would suggest that 1 in 200 men who use finasteride would have a baby boy born with hypospadius - the same rate as the general population.

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.  Women, however, must never use finasteride during pregnancy and must never touch crushed tablets.

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. 

NO LINK BETWEEN FINASTERIDE AND DUTASTERIDE USE AND BREAST CANCER IN MEN

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. 

References

1. Amichai B, Grunwald MH, Sobel R. 5 alpha-reductase inhibitors—a new hope in dermatology? Int J Dermatol1997;36:182-4.

2. Mowszowicz I, Melanitou E, Doukani A, Wright F, Kuttenn F, Mauvais-Jarvis P. Androgen binding capac- ity and 5 alpha-reductase activity in pubic skin fibro- blasts from hirsute patients. J Clin Endocrinol Metab1983;56:1209-13.

3. Cather JC, Lane D, Heaphy MR Jr, Nelson BR. Finasteride: an update and review. Cutis 1999;64:167-72.

4. Merck Frosst Canada & Co. Propecia—discontinuation prior to/during pregnancy. Dorval, Que: Merck Frosst Canada; 2000.
5. Overstreet JW, Fuh WL, Gould J, Howards SS, Lieber

MM, Hellstrom W, et al. Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. J Urol 1999;162:1295-300.

6. Imperato-McGinley J, Guerrero L, Gautier T, Peterson RE. Steroid 5α-reductase deficiency in man: an inherited form of male pseudohermaphroditism. Science1974;186:1213-5.

7. Walsh PC, Madden JD, Harrod MJ, Goldstein JL, MacDonald PC, Wilson JD. Familial incomplete male pseudohermaphroditism, type 2. Decreased dihydrotestosterone formation in pseudovaginal perineo- scrotal hypospadias. N Engl J Med 1974;291:944-9.

8. Katz MD, Kligman I, Cai LQ, Zhu YS, Fratianni CM, Zervoudakis I, et al. Paternity by intrauterine insemination with sperm from a man with 5 α-reductase 2 deficiency. N Engl J Med 1997;336:994-7.

9. Ivarrson SA, Nielsen MD, Lindberg T. Male pseudoher- maphroditism due to 5 alpha-reductase deficiency in a Swedish family. Eur J Pediatr 1988;147:532-5.

10. Moghetti P, Castello R, Magnani CM, Tosi F, Negri C, Armanini D, et al. Clinical and hormonal effects of 5 α-reductase inhibitor finasteride in idiopathic hirsutism. J Clin Endocrinol Metab 1994;79:1115-21.

11. Serafini P, Ablan F, Lobo RA. 5 alpha-reductase activity in the genital skin of hirsute women. J Clin Endocrinol Metab 1985;60:349-55.