What is the recommended treatment for male pattern baldness using Finasteride (generic name)?

Finasteride for Male Pattern Hair Loss

For men aged 18-60 years with male pattern hair loss, initiate finasteride 1 mg once daily, which slows hair loss and improves hair growth with visible improvement typically beginning by 12 weeks and maximal benefit at 1-2 years. 1

Dosing and Timeline

• The standard dose is finasteride 1 mg once daily for male pattern hair loss, as recommended by the American Academy of Dermatology 1, 2
• Visible improvement typically begins by 12 weeks, with maximal benefit achieved at 1-2 years of continuous treatment 1
• Long-term efficacy is maintained over 5+ years with continued treatment, but hair loss resumes if treatment is discontinued 2, 3
• The 1 mg dose produces similar DHT suppression (approximately 50% reduction) as the 5 mg dose used for benign prostatic hyperplasia 2

Efficacy Evidence

• At 48 weeks, 58% of men treated with finasteride 1 mg showed improvement based on global photographic assessment, compared to only 6% with placebo 4
• After 2 years of treatment, 66% of men showed improvement in hair growth on global photographs versus 7% with placebo, and 83% had no further hair loss compared to baseline versus 28% with placebo 5
• Treatment leads to durable improvements in scalp hair over five years with continued use 3

Sexual Side Effects Profile

• Sexual adverse events (decreased libido, ejaculation disorders, erectile dysfunction) occur in approximately 2-4% more patients compared to placebo 1
• The overall incidence of sexual function disorders is not significantly different between finasteride and placebo when accounting for aging effects, with a mean difference of 3.21 points on sexual function scales compared to 1.26 points for each year of aging 1
• Sexual side effects are uncommon after the first year of therapy and are reversible upon discontinuation 1
• All sexual adverse events resolved in many patients who continued therapy 5

Critical PSA Monitoring Consideration

• Finasteride 1 mg reduces PSA levels by approximately 50% after 12 months of therapy, identical to the 5 mg dose used for benign prostatic hyperplasia 1, 2
• PSA values must be doubled after 12 months of therapy when screening for prostate cancer in men taking finasteride for hair loss 1, 2
• Consider obtaining a baseline PSA before starting treatment in men approaching prostate cancer screening age (>40-45 years) 1

Combination Therapy Option

• When combined with minoxidil (topical or oral), patients may achieve superior results compared to monotherapy, with no drug-drug interactions between these medications 1
• The combination works through complementary mechanisms: finasteride blocks DHT conversion while minoxidil promotes hair follicle growth through vasodilation and direct follicular stimulation 1

Topical Finasteride Alternative

• Topical finasteride (0.25% spray or 1% gel) provides similar efficacy to oral finasteride 1 mg when comparing mean change from baseline (20.2 vs. 21.1 hairs/cm²) 6
• Topical formulations reduce systemic side effects, with adverse events localized to the application site (scalp pruritus, burning, irritation, contact dermatitis) 6
• Topical finasteride may be considered for patients concerned about systemic sexual side effects 6

Common Pitfall to Avoid

• Plan for long-term treatment from the outset, as efficacy requires continuous use and hair loss resumes upon discontinuation 1, 2
• Counsel patients on realistic expectations: this is a maintenance therapy that slows progression and improves existing hair, not a cure 1