Finasteride, safe and effective against alopecia

1.- Finasteride is the only drug approved by the health authorities for the oral treatment of male androgenetic alopecia at a dose of 1 mg daily. Since 1997, when we use it on a regular basis, it has proven its effectiveness in most cases.
2.- Like all drugs, finasteride has beneficial effects, but it is not without side effects. To date, all the adverse effects it produces are dose dependent and reversible when the drug is discontinued.
3.- In a meta-analysis (Liu, 2016), recently published on 17,494 patients, it is concluded that finasteride is not significantly associated with alterations in sexual functionin people treated for androgenetic alopecia at a dose of 1 mg / day. On the contrary, there is an association when it is used in the treatment of benign prostatic hyperplasia at doses greater than 5mg / day.
4.-One of the aforementioned side effects, the risk of suicide, has been published in the journal ‘JAMA’ in the last month of May (Welk, 2017) as a result of a retrospective study that includes 93,197 male patients treated with inhibitors of the 5alpha reductase due to benign prostatic hyperplasia (higher doses than those used for androgenetic alopecia), in which a significant increase in the risk of suicide is not demonstrated . The risk of self-harm and depression is assessed, which is higher during the first 18 months of treatment.
5.- Other treatment options for androgenetic alopecia are being used, with more or less acceptable results, but none have shown in scientific studies superior efficacy to 5 alpha reductase inhibitors .
6.- Hair transplantation is one more treatment option that involves a little bloody surgery with very good results in selected cases. It does not replace medical treatment, which in most cases is maintained post-transplant for a more lasting result over time.

In conclusion, we consider finasteride an effective and safe drug in the treatment of androgenetic alopecia. The alarm generated about the use of finasteride in recent weeks is simply a social alarm that is not supported by any scientific study.

It is important, and it is up to us dermatologists, to make a correct selection of the patient. In the first place, with respect to its underlying pathology, the degree of its alopecia, and the patient’s expectations and, secondly, considering possible associated comorbidities.

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