What is the use of Finasteride?

From the Guidelines

Finasteride is primarily used to treat benign prostatic hyperplasia (BPH) and male pattern baldness by inhibiting the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone (DHT), a hormone that contributes to hair loss and prostate enlargement. The recommended dose for BPH is 5mg daily, and for male pattern baldness, it is 1mg daily. According to the study by 1, finasteride has been shown to improve standardized symptom scores, such as the International Prostate Symptom Score (IPSS), by 3 to 4 points, and this improvement can be maintained for 6 to 10 years. Key points to consider when using finasteride include:

• It can take 3-6 months to see noticeable results, and treatment needs to be maintained long-term as symptoms can resume if the medication is stopped.
• Finasteride reduces DHT levels, which helps prevent further hair loss and can promote some regrowth in many men.
• Potential side effects include decreased libido, erectile dysfunction, and decreased ejaculate volume, which occur in a small percentage of users.
• Women who are pregnant or may become pregnant should not handle crushed tablets due to potential risks to male fetuses.
• Regular follow-up with a healthcare provider is recommended to monitor effectiveness and any adverse effects. It is also important to note that finasteride can affect prostate-specific antigen (PSA) levels, and patients should be informed of alterations in PSA due to the medication, as stated in the study by 1. After 1 year of finasteride therapy, the measured serum PSA value should be doubled to accurately gauge disease progression. In terms of prevention, the PLESS study suggested that 5-ARI therapy, including finasteride, can be utilized in appropriately enlarged prostates as prevention for BPH, as it alters the natural history thereof, as mentioned in the study by 1. However, the use of finasteride for prostate cancer chemoprevention is still a topic of debate, with some studies suggesting a potential increased risk of high-grade cancers, as seen in the study by 2. Overall, finasteride is a useful medication for the treatment of BPH and male pattern baldness, but its use should be carefully considered and monitored by a healthcare provider.

From the FDA Drug Label

Finasteride, a synthetic 4-azasteroid compound, is a specific inhibitor of steroid Type II 5α -reductase, an intracellular enzyme that converts the androgen testosterone into 5α -dihydrotestosterone (DHT). The use of Finasteride is not explicitly stated in the provided drug labels.

• The labels discuss the mechanism of action, pharmacology, and potential risks associated with finasteride, but do not directly address its intended use.
• Therefore, no conclusion can be drawn about the use of finasteride based on the provided information [3] [4].

From the Research

Uses of Finasteride

• Finasteride is used in the treatment of benign prostatic hyperplasia (BPH) by reducing prostatic dihydrotestosterone (DHT) levels and prostate size, resulting in improvements in peak urinary flow rate and urological symptoms 5, 6, 7.
• It is also used to treat androgenetic alopecia (male pattern hair loss) by inhibiting the conversion of testosterone to DHT, leading to significant improvements in hair growth and density 8, 9, 6.
• Finasteride has been shown to be effective in stopping male baldness, particularly in men aged 20-40 years, with 85% of patients stopping hair loss when given the treatment 6.
• Additionally, finasteride has been used to treat haematuria from BPH by interacting with vascular endothelium growth factor and preventing new bleeding 6.
• Experimental uses of finasteride include prostate cancer prevention and treatment, although its efficacy in this area is still being researched 6, 7.

Benefits and Side Effects

• The benefits of finasteride therapy appear to outweigh the risks, with most adverse events being related to sexual dysfunction, such as decreased libido, ejaculation disorders, and impotence, which occur in a small proportion of patients (about 2-3%) 5, 8, 6.
• Finasteride is well-tolerated and has a favourable adverse event history, making it a safe treatment option for patients with BPH and androgenetic alopecia 5, 8, 9.