Finasteride for Androgenic Alopecia
Yes, finasteride 1 mg daily is highly effective for treating androgenic alopecia in men, with the American Academy of Dermatology recommending it as first-line treatment for men aged 18-60 years seeking medical intervention. 1
Efficacy Profile
Finasteride demonstrates robust efficacy with visible improvement typically beginning by 12 weeks and maximal benefit at 1-2 years. 1 The medication works through two critical mechanisms:
- Restorative effect: Produces visible hair growth in up to 66% of men with mild to moderate alopecia 2
- Preservative effect: Stops hair loss progression in 91% of patients, which is arguably more clinically significant than regrowth alone 2
Long-term data demonstrates sustained benefit over 5+ years of continuous treatment, with durable improvements in scalp hair growth while placebo-treated patients experience progressive hair loss. 3 This preservative effect provides strong rationale for early initiation before substantial hair loss occurs. 2
Treatment Algorithm
Initiate finasteride 1 mg daily for men aged 18-60 years with androgenic alopecia seeking medical treatment. 1 The treatment approach should follow this sequence:
- Start therapy early in the disease course to maximize preservation of existing hair 2
- Counsel patients that treatment must be long-term, as hair loss resumes upon discontinuation 1
- Plan for at least 12 weeks before expecting visible improvement, with peak results at 1-2 years 1
- Consider combination therapy with minoxidil for superior results, as these medications work through complementary mechanisms without drug-drug interactions 1
Age-Specific Considerations
Younger patients (≤26 years) demonstrate particularly favorable responses to finasteride. 4 These patients present with higher baseline 5α-dihydrotestosterone levels, which decrease by 50% during treatment, correlating with improved alopecia and increased anagen hairs on trichogram. 4 This makes early intervention in younger men especially advantageous.
Safety and Monitoring
Sexual adverse events occur in approximately 2-4% more patients compared to placebo, including decreased libido, ejaculation disorders, and erectile dysfunction. 1 However, critical context matters:
- These side effects are uncommon after the first year of therapy and reversible upon discontinuation 1
- The magnitude of sexual dysfunction (mean difference of 3.21 points on sexual function scales) is relatively modest compared to natural aging effects (1.26 points per year) 1, 5
- Discontinuation rates due to adverse events are similar between finasteride and placebo groups (6-7%) 5
For men approaching prostate cancer screening age (>40-45 years), obtain baseline PSA before starting treatment. 1 Finasteride reduces PSA levels by approximately 50% after 12 months, requiring PSA values to be doubled when interpreting prostate cancer screening results. 1
Common Pitfall to Avoid
Do not confuse the American Urological Association's statement about finasteride being ineffective in benign prostatic hyperplasia without prostatic enlargement with its efficacy in androgenic alopecia—these are entirely different mechanisms, as hair loss treatment involves DHT inhibition at the hair follicle level, not prostate tissue. 1
Alternative Formulations
Topical finasteride 0.25% daily represents an alternative to avoid systemic therapy, demonstrating efficacy in clinical trials with less marked decreases in serum dihydrotestosterone levels than oral administration. 6 Both topical gel and oral tablet formulations show relatively similar therapeutic effects. 7