Finasteride: Risk Vs Benefits

Finasteride is probably the most famous remedy for male pattern baldness. Available for treatment of the androgenetic alopecia since 1998, this product is prescribed to contain the advance of hair loss by genetic and hormonal causes and help in the recovery of the bald areas.

However, reports of troublesome side effects (which caused finasteride’s own label to be updated more than once) lead many people to fear treatment.

Let’s understand what finasteride is, how it works, what the risks and side effects are (and if they can be avoided), to make the treatment worth opting for.

Discovery of finasteride

The basis for creating the solution was a study published in 1974 , which noted a genetic mutation in children with pictures of pseudohermaphroditism (who had ambiguous genitalia, with a neither fully male nor fully female pattern, but developed normally after puberty).

This mutation indicated that these children had low levels of the enzyme 5α-reductase (“five alpha reductase”), which converts the hormone testosterone to dihydrotestosterone (or DHT – we’ll talk more about this in a moment). The boys had smaller-than-normal prostates, and they also did not develop male-pattern baldness.

From this study, the Merck laboratory tried to develop a drug that mimics this effect and reduces DHT levels in the body, with the intention of using it to treat a condition called benign prostatic hyperplasia , which causes an enlarged prostate and can cause urinary problems.

In 1992, the FDA (Food and Drug Administration Agency that regulates marketing in the United States) approved the marketing of 5 mg of finasteride (which received the trade name Proscar ) for the treatment of benign prostatic hyperplasia.

In 1997, the release of 1 mg (which got the name Propecia ) was authorized for the treatment of androgenic alopecia in the United States, and in 1998 it was authorized for marketing in Spain.

The patent (exclusive right to manufacture and sell the product, for profit and to cover the costs of the research that developed it) that Merck had on 5mg finasteride ran out in June 2006, and that of finasteride of 1mg in November 2013. Since then , several laboratories have developed generic versions of drugs.

How does finasteride work?

The testosterone is considered the main male hormone. It occurs mainly in the testicles, but also in small amounts in the ovaries in women, and in both sexes in the adrenal (or adrenal) glands.

Testosterone has many functions in the body. Promotes the development of the male reproductive system of the fetus within the womb, the changes that males go through during puberty, stimulates muscle growth, preservation of bone density, interferes with energy levels and physical activity, sexual desire, aggression and in many other respects.

In some parts of the body such as the prostate (which is involved in the production of sperm and ejaculation, and may be associated with sexual pleasure in men) and hair follicles (structures in which tufts of hair are produced), about 5% testosterone in the body is converted to dihydrotestosterone, a kind of strong version of the hormone (DHT can be 2 to 5 times stronger than testosterone).

DHT is essential for the formation of the male fetus (more important than testosterone itself), it participates in the maturation of the sexual system of men during adolescence and regulates the functioning of the prostate, but it does not seem to have much influence on growth muscle, bone density, and other systems that testosterone does interfere with.

The problem is that DHT can also cause hair loss.

The hormone connects to the androgen receptors present in the hair follicles and causes the hair growth phase to be shorter, gradually reducing the size and activity of the follicles, and can go to the point of causing it to stop for full. Read more information about this process here .

What finasteride does is inhibit the action of the enzyme 5α-reductase , which converts testosterone to DHT. Therefore, the levels of DHT in the body are lowered, but there is no significant impact on the level of testosterone in the body.

Dutasteride

Finasteride is not the only drug capable of inhibiting the 5α-reductase enzyme. Another drug in this same class, dutasteride (produced by the GlaxoSmithKline laboratory and sold under the brand name Avodart ) is considered more potent than finasteride.

This is because 5α-reductase is present in a few different “versions”. Both finasteride and dutasteride appear to be able to interfere with the activity of types 2 and 3 of this enzyme, but only dutasteride is effective in type 1 (which is the most abundant in the scalp).

Although finasteride is capable of reducing DHT activity in the body by up to 70% , dutasteride can reduce levels by 99% or more . However, while we can expect more intense and prolonged effects with the use of dutasteride, the side effects (we’ll talk about them in a moment) can also be more serious.

Therefore dutasteride, as well as the 5 mg version of finasteride, is currently only marketed for the treatment of benign prostatic hyperplasia. Its use to combat baldness is considered off-label .

Results of finasteride

Finasteride is able to slow the progression of hair loss (make baldness slower or take longer than normal) and allow some of the miniaturizing follicles to recover, which can increase the number of hairs apparent and help improve bald areas.

But you have to be realistic about the possible results before starting treatment with finasteride. Although the drug is effective in most cases, the patient will probably not regain all the hair he has lost in life (several follicles may already have been permanently deactivated). In addition, as the hair only grows an average of 1.25 cm per month, the treatment may take a few months to have visible effects (the maximum gain is usually reached after two years of use of finasteride).

Finasteride works best for mild to moderate baldness, where hair loss only reaches the top of the head (recovery from complete baldness is unlikely). The results are not considered permanent: if the treatment is interrupted, the hair loss can appear again and affect the hairs that have already grown.

Finasteride in women

The use of finasteride in women is controversial: the results do not seem to be as favorable as in men, although there are cases of success in the treatment of female baldness. The biggest problem is that the product can cause malformations in the fetus during pregnancy (the package insert warns that pregnant women should not ingest the product, even the crumbled powder of the tablet could be absorbed to some extent through the skin).

Therefore, finasteride should not be used by women of childbearing age who do not follow rigid birth control during treatment. It is a much safer option in the treatment of women who have gone through menopause or are unable to become pregnant , and is generally only considered as a treatment for female pattern baldness if other alternatives are not effective.

As the label for finasteride contraindicates the substance for women, its use for the treatment of female pattern baldness is also considered off-label .

Side effects of finasteride

Finasteride brochures report certain side effects such as decreased libido , erectile dysfunction , decreased ejaculation volume , increased breast volume and tenderness , lip swelling, and skin rash. The label says that these reactions are considered rare (affecting about 3% of users), that they occurred mildly during the studies, and that they usually disappear in men who stopped treatment and many of those who continued taking. finasteride.

In 2011, the FDA included the occurrence of erectile dysfunction in the US packaging, which remained for months after the end of the use of finasteride. In 2012 the labels were updated again, this time to include decreased libido, ejaculatory and orgasm- related problems , which also persisted months after the end of treatment. It also included reports of infertility and poor sperm quality , which were generally reversed when the use of finasteride was discontinued.

The occurrence of cases of persistent side effects raised concerns that they could become permanent, especially since some affected patients do not achieve good results with hormone replacement therapies aimed at correcting these reactions. The term post-finasteride syndrome was coined to describe these conditions, which can involve other symptoms such as loss of genital sensation, pain in the testicles, memory problems, depression and anxiety.

It is not known exactly how this syndrome occurs in the body, but one hypothesis holds that finasteride could cause interference with the production of some neurosteroids (substances that participate in the activities of the nervous system), which would explain some of the emotional effects and sexual. Another theory says that finasteride can cause the body to develop some resistance or insensitivity to androgens, so symptoms do not respond to hormone replacement.

In 2012, the Post-Finasteride Syndrome Foundation was founded in the United States , whose objective is to help fund research related to Down syndrome and the search for treatments, as well as raise the profile and the public awareness of the problem.

Topical finasteride

It is ideal to enjoy the benefits of finasteride to combat hair loss without the risk of side effects on the rest of the body, because it would be applied only to the hair follicles. Topical formulations (such as gels, creams, and lotions) can be one way to achieve this.

The challenge, in this case, is to find an ideal vehicle for finasteride to penetrate the scalp and hair follicles, but not to go too deep to prevent the product from falling to significant levels in the bloodstream.

Various experiments have been done around the world, such as the use of liposomes, nanosomes, and other methods. The results are promising, but there is still no regulatory approved formula produced on a commercial scale for topical administration.

The hope is even greater because as soon as the efficacy and safety parameters of topical finasteride are established, the next natural step would be to try the same methods for dutasteride (which should be even easier after its patent was won in November. 2015).

If we can achieve the most powerful effect it offers, avoiding its side effects, this can become an extremely powerful solution against androgenic alopecia.

How much does finasteride cost?

Generic versions of finasteride are available in 1 mg and 5 mg strengths from most pharmacies. The values ​​vary according to the pharmacy and the manufacturing laboratory.

The average price of a box of 30 1mg finasteride tablets is in the order of € 50, but pharmacies often make offers and the price could drop between € 15 and € 30. The box of 60 tablets costs on average € 90, but with discounts it is easy to find it around € 40 or € 50.

The 5mg finasteride costs approximately € 70 to € 100 for a box of 30 tablets (which will come to around € 50 with promotions). A box of 60 tablets, around € 130, could go down to € 70 or less depending on the discounts.

The original versions of Merck (brand names Propecia and Proscar) are also found in some pharmacies and can cost 3 to 4 times more than generics.

Since prices fluctuate considerably, the ideal is to compare before making your purchase. In addition to the usual discounts, some pharmacies also run promotions like “Get 3 for the price of 2”, which can be quite worthwhile considering that in most cases the treatment with finasteride is long term.

Many people choose to buy the product through online stores of major pharmacies or on amazon, which often offer very competitive prices and offer free shipping for some cities.

Is it worth using it?

This is a decision that only you and your doctor can make. The ideal is to find a good professional to do a specific and exhaustive analysis of the image, examine your hormonal profile and weigh the risks and benefits of the treatment.

Although the number of people who show the side effects of finasteride is considered small in many studies, we are talking about reactions that are quite serious, therefore, ideally your health is closely monitored by a good doctor throughout the treatment. , get regular exams, observe how your body responds and take the necessary steps to overcome any problems that may arise as soon as possible.

By taking all these safety measures and implementing the appropriate and responsible treatment, finasteride can become your main weapon against baldness. To further increase the chances of success, many doctors combine finasteride with other products such as minoxidil tonics or ketoconazole shampoos .