Today, you can maintain the thickness of your hair even if you have a hereditary tendency to baldness. Among the promoted methods of pharmacotherapy is the drug finasteride for hair. Trichologists confirm the effectiveness of this treatment, but argue about its safety. Let's find out what confuses doctors.

Let's start with the fact that finasteride is not originally a drug for hair. It is an antitumor drug for the treatment of BPH (benign prostatic hyperplasia or, more simply, prostate adenoma) in men. It inhibits the enzyme 5-alpha-reductase, which is responsible for converting testosterone into dihydrotestosterone (DHT). With a decrease in the concentration of DHT in the body, the size of the prostate gland decreases. How did finasteride end up on the list of drugs for hair loss?

Let's clarify - not for any hair loss. Finasteride is used only for androgenic (androgenetic) alopecia (abbreviated AGA). Alopecia is partial or complete baldness. Androgenic alopecia is baldness caused by male sex hormones androgens (there are also some in the female body).

There is a fairly large group of people with a genetic predisposition to AGA. Such men and women have hair follicles on their heads with an increased concentration of the enzyme 5-alpha-reductase and with receptors that actively capture testosterone. These are ideal conditions for the local synthesis of dihydrotestosterone. In the presence of DHT, the follicles miniaturize, begin to produce vellus (thin and short) hair, and over time completely atrophy. Due to the fact that finasteride has the property of blocking 5-alpha-reductase, it has also proven effective in the treatment of hair loss. Thus, the drug "migrated" from urology to trichology.

Finasteride - Theshaderoom.com, as a drug for androgenetic hair loss in men, was officially approved by the FDA (the US Department of Health and Human Services' drug controller) in 1997. For trichological purposes, in a dosage of 1 mg, while in the treatment of prostate adenoma, a dosage of 5 mg is used. Since then, the drug has been actively promoted. Almost every international conference of trichologists and dermatologists has a section where speakers recommend finasteride for maintaining hair density in AGA, and give positive feedback on its practical use. However, we note that in the Russian pharmaceutical segment, finasteride drugs (regardless of brand) do not include the solution of trichological problems in the indications for use.

Does finasteride help women with hair

Androgenetic alopecia has no gender "preferences". The only thing is that, compared to women, men start to go bald at an earlier age and more intensively, up to complete hair loss. Women's hair only thins out significantly. As a rule, baldness is noted in the parting area, the frontal hairline is raised, and temple bald spots are formed. The main culprit is considered to be the same enzyme 5-alpha-reductase, which provokes the conversion of testosterone into dihydrotestosterone.

Theoretically, finasteride for hair should also help women with AGA, because it blocks 5-alpha-reductase. However, even abroad, the drug is approved only for men. There are publications on the treatment of female androgenic alopecia, but with the caveats that the studies involved patients in the postmenopausal period, as well as those taking oral contraceptives at the same time. But there were no large-scale clinical trials, so one cannot talk about either safety or effectiveness.

Responsible Russian trichologists categorically prohibit finasteride for hair for women. Especially during pregnancy planning and even more so during pregnancy. There is a high probability that the drug will have a teratogenic effect - it will provoke serious deviations in the development of the fetus.

Attention! If you saw somewhere that finasteride for hair will return a thick braid to the waist, read laudatory reviews - do not self-medicate under any circumstances. This is the #1 drug for the treatment of male androgenic alopecia. And it is #1 in Western countries, where the rules are largely dictated by Big Pharma.

Should men take finasteride for hair?

Classical therapy for androgenic alopecia involves:

powerful blood supply to hair follicles (for their enhanced nutrition);
prevention of miniaturization of follicles (by stimulating growth factors);
inhibition of 5-alpha-reductase (to reduce the synthesis of DHT from testosterone).

Minoxidil, a vasodilator for topical (local, external) use, is traditionally “responsible” for points 1 and 2. Minoxidil, like finasteride, is approved by the FDA for the treatment of androgenic alopecia and is really effective. The mechanisms of action on follicles have not been fully studied. It is known that minoxidil powerfully stimulates blood flow, thereby ensuring the supply of oxygen and microelements to the hair roots. Presumably, it stimulates natural growth factors (keratinocytes, vascular endothelium, and others) that regulate the vital activity of skin cells and follicles.

Oral finasteride is "responsible" for point 3, or at least is promoted as an effective remedy for hair loss. And it really effectively inhibits 5-alpha-reductase, thereby preventing dihydrotestosterone from suppressing hair follicles. But at the same time, it can negatively affect men's health. The final choice, of course, is up to the patient. But if a trichologist prescribes finasteride for hair, he must warn about all possible side effects. And there are many of them, and serious ones.

By the way, with minoxidil, too, not everything is clear. Firstly, it stimulates hair growth on bald spots in only 40% of patients. Moreover, it is possible to understand whether the treatment helps only after six months. Secondly, minoxidil has a strong withdrawal syndrome - here, a course of therapy is impossible, taking a break, the patient loses the hair that was grown with difficulty.

What is the opinion of trichologists about finasteride

Androgenetic alopecia can be treated in the early and middle stages. Although obvious baldness in men appears around 40 years old (on average), the follicles begin to "fail" by the age of 25. That is, men should start taking finasteride for hair at a young age, when AGA is just beginning. If the hair has already thinned out decently, it will be possible to grow back the bald spot, but the hair will not be as thick as at 18. And the hair will not return to the bald area of the head, the only option is a transplant.

It is not known for certain how finasteride affects the body of young people. Initially, this drug is for men over 40, and it was tested on patients 40+. Moreover, the tests were conducted over 2 years, that is, possible side effects for the health of the male reproductive system are indicated specifically for this period of taking the drug.

According to official recommendations, finasteride for hair should be taken for 2 years, probably, it is during this period that patients give positive feedback on the treatment. But androgenic alopecia requires lifelong therapy. It is worth stopping blocking androgens and after some time the hair will begin to fall out again. And what are the side effects of taking finasteride for many years is unknown.

What urologists say about finasteride

From the point of view of urologists and andrologists, finasteride for hair in men is a whim. Even with diagnosed prostate adenoma, this is not a first-line drug. This is "heavy artillery". In trials, 20% of men experienced side effects in terms of men's health, including erectile dysfunction. Moreover, by blocking hormones, finasteride can provoke "drying up" (sclerosis) of the prostate.

In 2016, an independent study of finasteride was published in the journal Andrology. Young Italians under 35 years of age took the drug for 35 weeks. After discontinuation, there was a decrease in the volume of ejaculate and a decrease in the sensitivity of the external genitalia.

The American Society for the Fight against Post-Finasteride Syndrome has filed more than a thousand lawsuits against Merck, which owns the patent for finasteride. Among the complaints were not only complaints about the deterioration of men's health, but also about a decrease in concentration, about anhedonia (loss of joy in life). Compensation payments from Merck exceeded 4 million dollars. So the "rosy" studies of finasteride from Big Pharma should be filtered. The consequences of taking it, especially delayed ones, although they "leak" into the press, are not given much publicity.

Is the game worth the candle even in solving andrological problems? Therefore, andrologists speak with great caution about finasteride, especially as a means of maintaining hair thickness. And many trichologists ask the question: what is more important - hair or a full sexual life?

What to replace finasteride for hair

Today, trichologists increasingly include local peptide drugs and local androgen blockers in AGA therapy instead of minoxidil and finasteride.

Peptides are similar in structure to natural growth factors. Getting into the cells of the scalp and follicles, they start self-healing processes, wake up "sleeping" bulbs, prolong anagen (the hair growth phase in the life cycle of the follicle).

There are local 5-alpha-reductase blockers that prevent the conversion of testosterone to DHT as effectively as oral agents. And at the same time, they are safe for both women's and men's health. Among the most effective are extracts of saw palmetto, sweet white lupine (anagelin), green tea, zinc pyrithione, fluridyl, oleanolic acid.

There are extremely convenient combination products that prevent the miniaturization of follicles and simultaneously block androgens. For example, the ampoule lotion Selencin with a peptide complex and saw palmetto extract.

Let's sum it up

Finasteride is an effective drug for hair loss in androgenic alopecia. It may or may not have side effects. Medicine is always a balance and a choice. The doctor should give a full "layout" of the pros and cons of the therapy. And the final decision is up to the patient.