Finasteride and Dutasteride

Hair Loss Benefits of Finasteride

Approximately 85% of individuals who routinely use Finasteride see a stabilization of their hair loss or dramatic slowing of the loss.

Over 65% of patients who use this medication see an actual increase in hair numbers. While we typically see a greater response on the crown, it also helps the mid-portion of the scalp and to a lesser degree the frontal region.

The vast majority of patients will see an increase in hair weight. This means more volume of hair even if the actual numbers do not increase.

Side effects are rare and there are no reported medication interactions between Finasteride and other prescription medications. You should always consult with your primary physician before starting a new medication.

About Finasteride and Dutasteride

This category of drugs is known as 5-alpha reductase inhibitors. These medications prevent testosterone from being converted to DHT (dihyrdotestosterone) in the prostate, hair follicles and oil glands. DHT is the active form of testosterone that causes hairloss. The two medications available are Finasteride (Propecia and Proscar) and Dutasteride (Avodart). Neither drug blocks testosterone activity throughout your body as a whole, only in the specific areas that contain these enzymes. Proscar & Avodart are FDA approved to treat benign prostatic hypertrophy (BPH or enlarged prostate). Only Finasteride 1mg is FDA approved to treat hair loss. Dutasteride can be used to treat hair loss, but this is off label.

The vast majority of men (and some women) can benefit from these medications without adverse side effects.

• • Women who are pregnant or potentially could become pregnant CAN NOT take these medications, as they interfere with the developing baby’s hormones.
  • You CAN NOT donate blood while taking these medications, because a pregnant woman might be the one who receives your blood.
  • Tell your doctor you are taking one of these medications as they can lower your PSA score. Your PSA is used to monitor for possible prostate cancer development.
  • Although there is no proven risk to the fetus, men may choose to stop this medication if you and your partner plan to conceive a child.

Finasteride and Dutasteride Side Effects

Decreased sex drive and difficulty in achieving an erection has been reported in ~2% of men using these medications compared to placebo groups. In all major studies the side effects went away upon discontinuing the use of the medication. There have been rare reports of men who claim to continue to have problems after they stopped the medication. In most of these reports, the men continued taking the medication for several years in spite of their symptoms. A class action law-suit is ongoing claiming “Post Finasteride Syndrome.” The true validity of this syndrome is still under debate and research.

Breasts or testicular tenderness can be seen but is rare (<1%) and goes away upon stopping the medication.

Allergic reactions are possible but in over 20 years of prescribing these medications I have not seen a person have an allergic reaction to any of these medications.

Depression – While not reported as a side effect in any of the major studies, there have been rare reports of depression in the literature and on the internet.  The validity of these reports remains unclear.

Decreased sperm counts – While not a reported problem during FDA trials, there have been rare cases reported in the literature and a positive link between use and decreased sperm count. In trials evaluating this side effect, upon discontinuation sperm counts returned to normal within 3 months.

Breast cancer is very rare in men in general and no association between using these medications and breast cancer has been shown.  However, if you experience any lumps, bumps, pain or nipple discharge you should report it to your physician.

Prostate cancer is the 2^nd most common form of cancer in men in the United States and over 15% will be diagnosed with it during their lifetime.  Prostate cancers are graded on a Gleason Score scale from 1 to 10.  The vast majority of prostate cancers are low to mid grade types with Gleason Scores of 6 or less.  In two large clinical trials of these medications there was a 15-25% reduction in the incidence of prostate cancer.  However, if you developed prostate cancer there was a small increased risk that your cancer would be a higher grade Gleason Score 8-10.  For those taking 5mg of Finasteride the risk was 1.8% vs. 1.1% on placebo and for those taking Dutasteride the risk was 1.5% vs. 1.0% on placebo.  The data regarding the link between these medications and possible increased/decreased risk of prostate cancer remains controversial and under intense review.