Finasteride

Certainly this drug finds many detractors, for more or less right reasons, but the fact is that the topic of finasteride and hair undoubtedly collects a fundamental importance for those who intend to undertake a fight against androgenetic alopecia . Therefore I suggest to anyone who cares about this topic to get as much information as possible by reading official and authoritative sources and relying on expert and competent doctors in order to avoid, as far as possible, being influenced by the terrifying things that are read on the web.

In our own small way we try, as far as possible, to report the sources of the information we write on helphairless.

 

When you are looking for information on the subject of Finasteride and Capelli on the web , whether they are specific sites, forums or blogs like this you are reading, you will find the most varied and sometimes even contradictory news . This can create extreme confusion in those who are facing the problem for the first time and create doubts, anxieties and suggestions in particularly sensitive individuals.

In this article I will try to give the answers to the most frequently asked questions about this drug for the treatment of androgenetic alopecia , based on serious and reliable studies and, not least, on the fact that I have been testing it on my skin since 2014 by updating the situation in Article Baldness treatment: my personal case .

Since the topic of this article concerns only the finasteride and hair field , I will not dwell on an in-depth historical analysis, but it is right to mention some hints.

Initially this drug was designed to counteract benign prostatic hypertrophy (BPH) , a prostate disease also attributable to an excess of the hormone DHT .

This dependence of BPH on dihydrotestosterone was determined thanks to the studies of Professor  Julianne Imperato-McGinley who in 1974 began a research on a group of hermaphroditic children in the Caribbean to determine the causes of their abnormal sexual development since they were born with organs of both sexes. to then develop the male one at puberty. Anyone interested in the study published in 1997 can consult link 1) , but I will not go into detail here as it does not have much to do with androgenetic baldness.

In synthesis it was determined that the cause of these anomalies related to sexual development was precisely a genetic mutation that caused a low presence of alpha 5 reductase and consequently a deficiency of DHT .

What attracted the attention of the American company Merck , in the person of the then head of research P. Roy Vangelos, however, was a particular: McGinley’s studies had found that all individuals with that genetic mutation turned out to have a much smaller prostate than the average. It was therefore likely that it was an excess of dht, or an increased sensitivity of the receptors, to cause benign enlargement of the prostate.

At the end of the 70s, on the basis of these studies, the study of a drug able to inhibit type 2 alpha 5 reductase (mainly present in the prostate and hair follicles) was started in order to treat people who suffered from BPH.

Thus it was that Merck synthesized Finasteride and obtained FDA approval for the treatment of BPH with the 5mg dosage. It was 1992 and for the first time Proscar was put on the market covered by a patent until 2006. In Italy the use of Proscar was authorized starting from 1997

Finasteride and Hair: Propecia is born

And now we come to the part that certainly interests most those who are on this site, namely the use of finasteride for the treatment of androgenetic alopecia . Since the experimental stages of the 5 mg dosage for the treatment of prostatic hypertrophy, an improvement in hair quality was noted in most individuals and in some cases also significant recoveries in subjects affected by common baldness.

This combined with the theories that from the 70s saw DHT as the main cause of androgenetic alopecia, led Merck to propose a product based on finasteride but with a specific dosage of 1mg, therefore lower than the 5mg of Proscar, but suitable to inhibit the formation of dihydrotestosterone in individuals affected by male pattern baldness .

In 1997 it was then approved by the Food and Drugs Administration (FDA) and marketed Propecia 1 mg whose sale in Italy was authorized starting from 1999. Propecia was under patent until 2013 and therefore it was impossible to find 1mg dosage generics on the market. .

Finasteride: how does it work?

Finasteride belongs to the category of anti-androgen drugs and works by blocking the alpha 5 reductase enzyme thus preventing the conversion of testosterone to DHT. This hormone is the main cause of hair follicle miniaturization in androgenetic alopecia.  

However , there is not a single type of alpha 5 reductase , but 2 isoforms :

 

  1. alpha 5 reductase type 1: produces about 30% of the circulating DHT, is NOT present in the hair follicles and is found mainly in:
    • brain
    • sebaceous glands of the scalp and face
    • chest and back skin
    • liver
    • adrenal glands
    • kidneys
    • adipose tissue.
  2. alpha 5 reductase type 2: produces about 60% of the circulating DHT and is found mainly in:
    • prostate
    • hair follicles of beard and hair
    • seminal vesicles
    • scalp
    • Furthermore, as isoform 1 it is also found in:
    • chest skin
    • liver
    • adipose tissue

As mentioned, finasteride is an azosteroid inhibitor of type 2 alpha 5 reductase which is found largely in the prostate and hair follicles of the scalp. By inhibiting the enzyme, it therefore prevents the conversion of testosterone into dihydrotestosterone, thus curbing what is the main cause of androgenetic alopecia.

At the approved dosage for hair, equal to 1 mg per day, it should be taken orally and is able to inhibit the production of DHT by about 65-70%. Thanks to this ability, this drug has become the backbone for all treatments against androgenetic male pattern baldness .

Therefore, thanks to its anti-DHT action , the factor responsible for the progressive miniaturization of the hair follicles affected by AGA is enormously reduced and therefore they are able to recover, recovering some degrees of dysplasia.

The SITRI sees in 2 degrees of dysplasia the possible recovery of the hair following antiandrogenic therapies, for this reason it is important to act as soon as possible and not to wait for the miniaturization to reach too high levels, since a hair that has reached the final stage of vellus is impossible. that can return to the level of an Anagen 6 (healthy hair).

Finasteride Results: How Long to Wait?

When starting a therapy to treat baldness , the anxiety of seeing the first results can be really excessive, but it is important to have the utmost consistency in taking it and above all a lot of PATIENCE . Certainly the doctor who prescribed it for you told you to wait 6 to 12 months before doing any evaluation, so before 6 months there is absolutely no need to be alarmed if you do not see results.

But, most likely, the question you are asking yourself at the moment is: “ can finasteride really give results against androgenetic alopecia?”.

This study 2) shows how, for a good 80 – 90% of users , the drug can slow down , block or even reverse the process of androgenetic miniaturization.

Obviously it is not instantaneous and therefore it takes a little patience. Even in my personal case, although I am undoubtedly a good responder to the drug, you will see how the very first SLIGHT improvements I started to see them around 4 months in the form of better hair quality and slight improvement in thickness. After 6 months a clear change of gear was evident and at 18 months I reached the maximum peak that I am now trying to maintain. But I repeat that not everyone has a response like mine to the drug and therefore the times may be longer.

I specify that for improvement it is not necessary to expect a regrowth since, in cases of particularly aggressive baldness, even an arrest of the miniaturization and stabilization of the fall is not something to be underestimated absolutely.

Finasteride Suspension and Maintenance of Results

If the finasteride therapy has given you good results and you have achieved a significant improvement in your hair, I am sorry … but if you stop taking it the benefits obtained are doomed to disappear miserably .

In fact, androgenetic alopecia will resume its path and the action of DHT no longer blocked by the drug will resume miniaturizing the follicles sensitive to it. In about 6 months , about half of the hair recovered thanks to Propecia will disappear , and after about a year you will find yourself in the pre-treatment situation.

If the break is limited to a period of approximately 3-4 months, it will probably be possible to fully recover the hair lost or partially miniaturized during the discontinuation of finasteride when the drug is restarted. While in the case of breaks lasting 12 months or more, the follicles that in the meantime have reached the final stage of miniaturization (vellus) will no longer be recoverable .

Indicatively, the recruitment protocols foresee not taking any breaks for the first 2 years of treatment (in which the maximum result is achieved). Then at the discretion of the treating physician, breaks of up to 2 months can be evaluated to counteract any side effects.

Personally, at 2 years of therapy, since I do not suffer side effects, I was not advised to take a break. However, the doctor who follows me tried to reduce the dosage by 50% to see if it is sufficient for maintenance since the recovery obtained will hardly be further increased.

Can I take Finasteride?

I certainly can’t answer this question for you and I also remember that this drug is prescription only, so you need to discuss this with your doctor.

However, based on current studies, the ideal “candidate” to use finasteride should have these characteristics:

  • Having diagnosed androgenetic alopecia and therefore hair loss is not due to other problems (alopecia areata, telogen effluvium, thyroid disease, etc …)
  • NEVER have suffered from depression or psychological disturbances . This is because finasteride can amplify the symptoms associated with these disorders
  • Have a balanced hormone profile. The drug acts on hormones, and if this can be well tolerated by those with normal levels, it could increase any deficiencies or imbalances.

Method of recruitment

Also this point is much debated in the various forums on the web and in fact you will find those who have problems whether to take finasteride on an empty stomach, or during meals, to get to ask how much time to pass between intake and the next meal. We also read about people who have doubts about the time of recruitment, about the resistance of the gastro – resistant film it is coated with

Personally, I limit myself to reading the leaflet present in each package where it is simply written that you can take finasteride indifferently during and between meals .

In case you happen to miss a dose , do not take a double dose to recover, but simply resume normally the following day. Obviously, forgetfulness doesn’t have to become a habit.

Finasteride Side Effects

Whether we are talking about Proscar 5 mg, Propecia 1 mg or related generic drugs, that of the side effects of finasteride is certainly one of the most controversial topics when looking for information on the internet.

Given the importance of the topic and the vastness of the issues to be addressed in the field of sides, you will find many insights in the article dedicated to the side effects of finasteride .

Finasteride Contraindications

The contraindications of finasteride should not be confused with the side effects but, as reported in the leaflet, are factors that the doctor must take into account if a subject intends to start using this active ingredient.

They should therefore not take finasteride:

  • subjects with severe hepatic insufficiency : since the drug is metabolized in the liver. It is therefore up to the doctor to evaluate the situation and the risk / benefit ratio. If you opt for use, the liver values ​​should be monitored very often.
  • hypersensitivity or allergies: in general an allergy to the actual active ingredient is very rare, however lactose is also used as an excipient in the tablet which, on the other hand, can cause intolerance problems for many people.
  • pregnant women: as well specified in the package insert, pregnant women must absolutely not come into contact with finasteride  as it could lead to serious malformations of the productive apparatus  not so much themselves, but of the male fetus they carry in their womb . This is because the antiandrogenic action of finasteride would prevent the correct formation of the systems in males. This explains the reason for the coating filmof the tablets which serves to avoid accidental contact with the product. For the same factor, pregnant women should avoid contact with the seminal fluid of the partner who uses Propecia or equivalent, since specific analyzes have found that traces of the drug are present in it.

Does Finasteride Affect Sports Performance?

We have ascertained how this drug has a mode of action that involves some androgens. These hormones, among their various functions, are also responsible for the expression and development of muscle strength.

Therefore, many athletes are afraid and worried that starting a therapy could compromise their physical performance.

To this end, I invite you to learn more by reading our articles dealing with the topic of finasteride and bodybuilding and the alleged doping effect of Propecia .

 

Finasteride Gel: alternative against sides?

Precisely in order to cope with any unwanted effects that may arise, some formulations are appearing on the market to be applied directly to the scalp in order to avoid, or reduce as much as possible, systemic absorption.

If you are interested in the subject, I invite you to read our article on topical finasteride .

Finasteride: Recipe or Not?

Both finasteride 5 mg (Proscar or equivalent) and finasteride 1 mg (Propecia or equivalent), are always and in any case drugs subject to medical prescription and therefore can only be purchased in pharmacies upon presentation of a regular prescription.

In the case of Proscar 5 mg (or equivalent) prescribed for benign prostatic hyperplasia, it is a Class A drug and as such can be prescribed with a red prescription reimbursed by the NHS.

On the other hand, when it comes to finasteride and hair, the drug is Propecia 1 mg (or equivalent) and unfortunately it falls into Class C , that is, it is the total responsibility of the citizen . In any case, the obligation to obtain a medical prescription with a repeatable white prescription remains.

On the other hand, those who need different dosages from the standard, or simply to save money compared to the high cost of Propecia, can opt for generics (the savings are still limited) or for the galenic preparation of finasteride tablets or capsules by specialized pharmacies. Also in this case the obligation of a white recipe remains .

I remind you that the sale of drugs without a regular medical prescription is a crime , as well as the online purchase if it is made without a medical prescription.

Better Proscar in the treatment of baldness?

In my view it makes no sense to define Propecia as “better” than Proscar or vice versa, as it is always finasteride and in addition these 2 drugs are both produced by the same company.

Obviously we saw at the beginning of this article that Proscar is the 5 mg version marketed for the treatment of prostatic hypertrophy while Propecia has a dosage of 1 mg and is indicated for the treatment of male pattern baldness.

However, apart from the dosage and the different intended use, what chemical differences could there ever be ?

Around the world since 1992 millions of people suffering from androgenetic alopecia have been using Proscar cut into 4 or 5 parts to treat their baldness and I have been doing it myself for several years now. The motivation is essentially due to economic factors .

However, in the internet world and above all in the forums you can read the most disparate doubts and fears ranging from an alleged lower efficacy of the cut 5 mg finasteride, to then also involve the method with which to break the Proscar tablets and the tool used … to finally arrive at the existential doubts on how to keep the quatrains obtained.

The information obtained is so many that, in order not to burden this general guide on finasteride, I thought it appropriate to write the article Proscar or Propecia for those wishing to learn more.

Generic Finasteride: is it effective?

As previously mentioned, with the expiry of the patents (the last was propecia in 2013), several brands of generic or equivalent finasteride appeared on the market, both in 5 mg (Teva, EG, Mylan, etc …) and 1 mg (Finacapil, Carenafinast, Mylan).

Probably based on some statements of Dr. Jerry Wong , one of the best surgeons in the world specializing in hair transplants, who in the early 2000s strongly advised his patients not to use generic drugs but to always stay on the original Propecia as he rated it best, the belief has taken hold that generic finasteride is less effective than the original .

However, it should be considered that this statement was made at a time when it was necessary to shop online to find generic drugs and the products came from India and China where regulations and controls are certainly not at Italian or European levels and it was certainly possible to find facing over or under dosed drugs . Nowadays if you buy generic finasteride manufactured by an Italian company and from an authorized pharmacy, I don’t see the reason why you should expect lower quality.

In fact, if a company declares that its product contains 1 mg of finasteride and then a control results in a different dosage, it would be in trouble.

I always take as an example my personal case where from July 2014 I bought only 2 packs of original Propecia and 1 of galenic tablets. For the rest I have always used generic finasteride 5mg broken into quarters . The results obtained are visible to anyone and I would say that the thesis of poor efficacy of generic finasteride has found its answer .

Are there any natural alternatives to Finasteride?

As you have certainly been able to understand from what is written on this page, or from the numerous information available on the internet, it is still a drug that acts on the hormonal structure and in some cases can cause side effects. It therefore appears evident that those who are unable to take finasteride due to significant sides, or do not wish to take drugs to combat baldness, are always looking for alternative products of natural origin.

Given the numerous requests received, I decided to treat what, in my view, are the natural active ingredients that studies have shown to have an anti-androgenic action similar to that of finasteride, albeit much milder as it obviously is.

If you want to learn more about this, I invite you to read the article on serenoa repens , or the review on the Vitaminity DHT Blocker supplement, a recently formulated supplement that contains the best natural extracts with anti-dht action.

 

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