Does finasteride cause beard hair loss?
Does finasteride cause beard hair loss ?
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in beard hair growth patterns among finasteride users.
Question
Dear Dr. Donovan,
I am about to start finasteride 1.25 mg per day. I have a thick beard and my beard is very important to me and my culture. I do not want to lose my beard. I have heard conflicting reports if finasteride can affect my beard or not. What is your opinion? Thank you for your time, sir!
Answer
There are really no great published medical studies which attempt to address this question with any clear scientific rigor. The topic is certainly quite emotion-driven and everyone has an opinion on the answer. Not a week goes by that someone doesn’t ask me about the question.
Most beard growth is governed by genetics. If you have the right genetics, you are more likely to be able to grow a beard. If 50 % of the males in the family reunion are sporting beards, there is a good chance you’ll sport one too. Patients of more Northern European ancestry are generally less able to grow thick beards compared to males from other parts of the world. These are generalizations not rules.
Having treated large number of patients over the years, I absolutely do feel finasteride can affect beard hair growth. Fortunately, it seems fairly uncommon. That’s the key message not to be missed here.
DHT stimulates terminal hair growth of the beard hair as well as hair growth in other areas like the trunk and limbs, external ears and nostrils. It’s clear that 5 alpha reductase is expressed in beard hair follicles dermal papilla cells quite significantly. It would seem that finasteride should affect beard hair more than it does - but it doesn’t.
Responses to finasteride in males are extremely varied - actually they are extremely extremely varied. This is not surprising given that levels of DHT and activity of the 5 alpha reductase enzymes are so different among males in general and in different body sites.
Did I mention yet that responses to finasteride are so varied?
Patterns of beard changes with finasteride
There are several effects on the beard that I have seen over the years. I’ll put my best estimates beside it to give some perspective.
Finasteride did not affect my beard hair in any way (95 - 98 % of male users)
Finasteride did affect my beard by causing it to grow more slowly but I could still maintain a pretty good beard (2-4% of male users).
Finasteride did not affect my beard in any way but did thin my chest hair (1 in 300 male users)
Finasteride did affect my beard hair causing it to be thinner and feel less thick. (1 in 200 male users).
Finasteride actually seemed to improve my beard (1 in 500 male users).
We really need better studies pertaining to the effects of finasteride and dutasteride on the beard. These are my experiences treating males with hair loss who have beards. I’ve seen pretty convincing evidence that finasteride can effect beard growth but fortunately I’m equally convinced it’s not common. I think most of what I’ve learned about finasteride and beard growth has come in the last 5 years where males are increasingly likely in North America to grow beards.
I would even say that dutasteride is a bit more likely to cause beard thinning than finasteride but I certainly don’t have near the number of bearded patients on dutasteride to make any reasonable comment. But it seems to point that way. Still, it’s rare.
So what is convincing evidence anyways? Well, convincing evidence means that one notes hair loss or thinning or the beard after starting finasteride or dutasteride and one notes improvement when doses are reduced or stopped and then further thinning again when doses are resumed or increased. This kind of meticulous observation is really what has convinced me over the years that there is in fact a link. Again, it’s rare.
If one needs a thick beard and is not willing to take any chance that their beard will be affected in any way, I would say don’t use oral finasteride. However, if one is willing to accept the extremely small risk that it could have a pretty minor effect on how fast the beard grows then it’s not an issue.
In summary, males using finasteride and dutasteride who have a beard usually don’t notice any changes in their beard. A very small proportion note that it grows slower and a smaller proportion yet notice that it’s thinner than it once was.
I hope this helps and thanks again for the question.