Finasteride And Your Hair
Finasteride is a treatment option used to treat male hair loss; specifically androgenetic alopecia. Androgenetic alopecia is more commonly known as male baldness or male pattern hair loss and affects about 50% of men over the age of 50. It is estimated that it will affect about 80% of men over their lifetime; a useful statistic to know if you are one of the men affected by this. If you want to find out a little more about this condition and explore what Finasteride might be able to offer then read on.
Androgenetic alopecia is the most common form of hair loss in men and you may initially notice your hair thinning from the front and sides of the scalp before progressing towards the back of your head. This gives it the recognisable pattern of a horseshoe or M shape around the sides and back of your head. This kind of hair loss is known to affect men earlier and more commonly than women. Incidentally, there are key differences in female androgenetic alopecia and treatment options are different. Finasteride is not used to treat androgenetic alopecia in women. Although hair loss is commonly associated with older men, hair loss and a receding hairline can actually begin in males at any time after puberty. It is expected that hair loss will progress over time in men who do not seek treatment. What is more difficult to predict is how quickly it will progress and whether you stand to lose all your hair. Most men who eventually lose all of their hair may have a time frame of between 15-25 years but some lose all their hair within 5 years. The rates of which this can occur is also unpredictable. Some men experience accelerated rates of loss for up to 6 months followed by quieter periods that can last anywhere between 6 to 18 months. Even seasons can affect hair loss as shedding and thinning of hair may be more noticeable in the autumn and winter months.
Androgenetic alopecia has a genetic component and family history is the strongest risk factor for determining if you will develop this condition. The risk is lower in men with a non-balding father and high in those who have a balding or bald father. This is something you can legitimately blame your parents for.
Androgenetic alopecia is linked to a hormone called dihydrotestosterone (more commonly referred to as DHT). DHT has the ability to cause hair follicles to shrink causing them to produce hair that is smaller in diameter, shorter in length and lighter in colour until eventually the follicles shrink completely and stop producing hair. The hair follicle undergoes a progressive process of miniaturisation which occurs in a stepwise manner with each successive hair-growth cycle. It is well established that androgens (hormones in the body involved in masculinisation) play an important role with men who have androgenetic alopecia. Testosterone is the major circulating androgen in men. Some think that men with this condition have a higher level of testosterone but nearly all men with androgenetic alopecia have normal circulating levels of testosterone. The key difference lies in their hair follicles. In these men, there are increased numbers of androgen receptors and /or increased activity of the enzyme 5-alpha reductase. Understanding this helps to explain why Finasteride can be beneficial in treating this kind of hair loss.
Hair follicles contain an enzyme called 5 alpha reductase. This enzyme acts on testosterone and converts it to dihydrotestosterone. In men who experience this pattern of hair loss, they either have more of this enzyme around resulting in more testosterone being converted to dihydrotestosterone and/ or an increased number of androgen receptors present which means that it gives the follicles more of an ability to react with the existing testosterone circulating. Finasteride inhibits 5 alpha-reductase from working and the key effect it has is to block testosterone from being converted into DHT. Taking Finasteride causes the levels of DHT to drop and significant suppression can occur within 24 hours of dosing. The result? Finasteride has the potential to slow hair loss and help regrowth of hair.
In 2017, the European Dermatology Forum initiated a project to develop evidence-based guidelines for the treatment of androgenetic alopecia. They looked at 25 studies and came to the conclusion that 1mg of finasteride daily led to a significant increase of total hair count when compared to placebo. In an article featured in the Pharmaceutical Journal, Finasteride was reported to be associated with a reduction in hair loss of up to 90%, usually within a month or two of starting
treatment. Within 6 months, approximately 50% of men will experience new hair growth, usually on the periphery of the thinning regions. Within 12 months, the regrowth can be considerable over the entire region.
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How do I get it, how do I take it and when can I expect some results?
The recommended dose for androgenetic alopecia is 1 mg tablet of Finasteride daily. Increasing the dose of Finasteride will not make this drug more effective so there is no benefit from altering the dose. It is a prescription only medicine and is not available from the NHS so you will need to seek out private treatment in order to obtain this. It is not indicated for use in women, children and adolescents. It is expected that you will need to use Finasteride for 3-6 months at a dose of 1 mg daily before hair loss is stabilised. Continuous use is required to keep having the benefit from this treatment.
What happens if you stop taking Finasteride?
FInasteride is quite quickly eliminated from your body. In general, it takes your body about 6 hours to eliminate half the dose that you take daily. That means that you need to keep taking it daily for it to keep working. If you stop taking Finasteride, your body will eliminate it from your body probably within 48 hours. Finasteride is an enzyme blocker, when you stop taking it, the enzyme associated with your hair loss will start to be active again; converting testosterone to dihydrotestosterone and you can expect your hair loss to resume. Once treatment is stopped, any beneficial effects from Finasteride begin to reverse by six months and by the time nine to twelve months have elapsed, you can expect to return to your original state i.e. before you started treatment. Finasteride has no significant effects on hair that is not located on your scalp. So it is not expected to experience effects on the hair on your body or face.
Are there any risks associated with Finasteride?
The decision as to whether Finasteride is the right choice for you should be a considered one. Although Finasteride has been hailed as a holy grail of sorts for hair loss, no medication is without risk and Finasteride is no exception. Finasteride is in general well tolerated but has been
associated with depression, anxiety, palpitations, suicidal thoughts, decreased libido, erectile dysfunction, ejaculation disorders including a decreased volume of ejaculate, breast tenderness and enlargement and testicular pain. It has also been associated with infertility and breast cancer. If you have noticed that you are experiencing side effects including changes in breast tissue such as lumps, pain, enlargement of breasts, or nipple discharge, please seek prompt advice from your doctor.
Crushed or broken tablets of Finasteride should not be handled by women when they are or potentially pregnant due to the possibility of absorption and subsequent risk to foetuses. Finasteride is also excreted in semen.
A final word.
There are many other reasons other than androgenetic alopecia that can cause you to lose your hair. These range from recent severe infection, iron deficiency, low thyroid level, exposure to certain drugs (such as antidepressants, anabolic steroids or chemotherapy), excessive dietary
habits, rapid weight loss, inflammation of the scalp or even damage to the hair itself causing it to be fragile. It is prudent to seek medical advice about the hair loss that you are experiencing.
Hair loss can be a significant change in your life. It can take time to accept and find a path that works for you. If you are struggling to come to terms with it all, get help. Charities such as Alopecia
UK work to raise awareness, provide support and improve the lives of those dealing with hair loss.
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References
- British Association of Dermatologists 2012 [online] http://www.bad.org.uk/shared/get-file.ashx?id=153&itemtype=document [Accessed October 2018]
- Piraccini, B.M. and Alessandrini, A. 2014 Androgenetic alopecia. Giornale Italiano di dermatologia e venereologia. 149(1), 15-24
- Clinical Knowledge Summaries 2018 [online] https://cks.nice.org.uk/alopecia-androgeneticmale [Accessed October 2018]
- V. Kanti A. Messenger G. Dobos P. Reygagne A. Finner A. Blumeyer M. Trakatelli A. Tosti V. del Marmol B.M. Piraccini A. Nast U. Blume-Peytavi Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men 2017 European Academy of Dermatology and Venereology [online] https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.14624 [Accessed October 2018]
- McClellan, K.J. & Markham, A. 1999 Drugs 57: 111.
- Electronic Medicines Compendium 2018 [online] https://www.medicines.org.uk/emc/product/2194/smpc [Accessed October 2018]
- Jankovic S. 2012. Crowning glory: treating hair loss. The Pharmaceutical Journal. Community Matters, Vol. 4, p10 URI: 11103559