Categorized | Medical treatment

Finasteride

Finasteride is one of only two drugs produced for sale that has been proven to prevent male pattern baldness.  This drug is sold under a number of different brand names including Propecia, Appecia, Prosteride, Cipla, Finax, Finast, Finalo, Finara,, with Propecia being the brand name of the original manufacturer.  This drug acts on one of the key links of this problem by decreasing the production of dihydrotestosterone.  This is achieved by inhibiting a special enzyme called type II 5α-reductase which converts testosterone into dihydrotestosterone.  Decreased levels of dihydrotestosterone prevent such conditions as male pattern baldness and benign prostatic hyperplasia.  Regretfully, this type of treatment is only temporary since it does not eliminate the main cause of the problem which is a greater responsiveness of the cells to dihydrotestosterone. It should be noted that this drug cannot be used to treat any other type of baldness in men – only male pattern baldness.  However, it can be used by women to treat female pattern baldness as this is also caused by raised levels of dihydrotestosterone.  Women can also use this drug to treat hirsutism (excess growth of hair) caused by polycystic ovary syndrome.  It is necessary to keep in mind that the use of this drug for female pattern baldness is not FDA approved even though it can still be prescribed by a physician.

Effectiveness of finasteride

The effectiveness of Finasteride has been shown in a number of major studies including a five-year study conducted by the University of Pennsylvania School of Medicine, Philadelphia, USA.  This study studied men who took 1 mg of Finasteride daily over the course of five years and compared their results to the results of a control group.  While all men in the control group continued to lose hair with age, 42% of men who took Finasteride had stopped losing hair and 48% of those men started to regrow  some of their hair.  This leaves 10% of the men taking Finasteride resistant to therapy. The effect of Finasteride only lasted as long as the person continued to take this drug.  After discontinuing the drug for 6 to 12 months, the hair loss resumed. It has also been shown that Finasteride was successful in treating hairline baldness but  most benefits were observed with treating baldness on the crown of the head. Another ten-year study was conducted by The Department of Dermatology and Plastic Surgery, University “Sapienza” of Rome.  This study included 118 men who took 1 mg of Finasteride every day.  During those 10 years, 86% of these men experienced regrowth of hair, 14% experienced further hair loss.  Interestingly, the regrowth of hair continued throughout all of the treatment in 69% of the men, even if they reached a very mature age.  Moreover, it should be noted that the amount of hair regrowth during the first year correlated with the rate at which the hair regrew after 5 years.  During this study, 5.9% of the patients  experienced side effects, with no patients reporting to have gynecomastia or depression.

Side effects of finasteride

Side effects of Finasteride usually appear when Finasteride is used to treat benign prostatic hyperplasia.  This is due to the fact that for this condition, the dosage of Finasteride is raised to 5 mg per day. A four-year clinical study with 3040 subjects receiving 5 mg of Finasteride per day, had results showing  the most common side effect was sexual dysfunction.  This appeared in 3.7% of the patients in contrast to the 2.1% in the placebo group. Another 12-month study done by The Oxford University in 2002, encompassing 3000 patients, had results also showing  the main adverse effects were: decreased libido (5% in the Finasteride group in contrast to 3% in the placebo group), erectile dysfunction (8% vs 3%), and ejaculation disorder (2% vs 0.6%). Now let us go over all side effects in detail:

  • Sexual side effects A Swedish Medical Products agency conducted a study in 2008 and found that Finasteride can lead to irreversible sexual dysfunction, which means that it persisted even after the person had stopped taking this drug.  The UK’s Medical and Healthcare Products Regulatory Agency has reported similar results.  In April 2011, the warning labels for Finasteride in The United States included a warning that this drug can lead to erectile dysfunction which persists after discontinuing use.  In April 2012, additional information was added to the warning labels to include the reports of persistent ejaculation disorders, libido disorder and decreased libido.
  • Prostate cancer Despite the fact that the FDA has placed a warning label on 5α-reductase inhibitors stating there was an increased risk of high-grade prostate cancer, that information is very misleading.  In opposition, The Prostate Cancer Prevention Trial conducted in 2005  determined that a dosage of 5 mg of Finasteride per day actually reduced the likelihood of prostate cancer by 25%.   The reason the FDA ruled such a label mandatory was that it  was felt doctors were more likely to detect prostate cancer in patients taking Finasteride because benign prostatic hyperplasia hinders the doctors’ ability to detect aggressive-looking cells and cancer nests.Another study conducted in 2008 by The Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA,  examined 500 prostates after being surgically removed.  This study  concluded that Finasteride did not promote the growth of high-grade prostate cancer but actually decreased the likelihood by 30%.
  • Anxiety and depression In a study conducted in 2006 by The Clinical Pharmacy Laboratory, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, researchers found that Finasteride significantly increased the scores  patients received when being assessed using The Beck Depression Inventory and Hospital Anxiety and Depression Scale.  They determined this medication should be administered with caution to patients with previous history of depression. 
  • Male breast cancer Despite FDA placing a warning label on Finasteride stating that it may increase the risk of male breast cancer, there is no solid proof that this is true.  However, scientists are also unable to exclude this possibility and why the warning label was created.
  • Teratogenicity Finasteride should never be taken by pregnant women since it is known to cause major birth defects. Moreover, women who are pregnant or who are planning to become pregnant should not handle broken or crushed Finasteride tablets since it can be absorbed through the skin.  There is no data on whether Finasteride can pass into breast milk and, for this reason, breastfeeding women should avoid any contact with Finasteride.  Although Finasteride can pass into the semen of men, the semen itself presents no concern for women who are pregnant.  This drug should also be avoided by blood donors.
  • Interference with doping assays People participating in competitive sports should avoid taking Finasteride since it has been used in the past by athletes to mask steroid abuse.  This is why it was banned by the World Anti-Doping Agency in 2005.  Later in 2009, Finasteride was removed from this list, making it legal once again.

In conclusion Finasteride is one of the few drugs that can actually prevent a man from losing his hair.  It can either be administered orally or topically.  Topical application of Finasteride is less effective and it has been found to cause fewer side effects.  Regretfully, the effect of Finasteride  lasts only for as long as the drug is taken.  This drug has the potential to cause some unwanted side effects, sexual dysfunction being the most common.  Although this drug can  be successfully used to treat benign prostatic hyperplasia, it should be noted that the best method of treating this condition is by the removal of the periurethral glands.  This operation is well-tolerated and is relatively inexpensive.  It can have the side effect of decreasing a man’s fertility but it should still be the number one choice of men who suffer from benign prostatic hyperplasia.