Can Finasteride and Norethindrone Be Given Together in Adult Females?
Yes, finasteride and norethindrone can be given together in adult female patients, as there are no documented contraindications to their concurrent use, and this combination is supported by guideline evidence for specific conditions like hidradenitis suppurativa and acne. 1
Evidence Supporting Concurrent Use
Guideline Support for Combined Anti-Androgen Therapy
The 2025 North American guidelines for hidradenitis suppurativa explicitly recommend using finasteride alongside oral contraceptives (which include norethindrone-containing formulations) in female patients requiring anti-androgen therapy. 1
The 2016 American Academy of Dermatology acne guidelines confirm that oral contraceptives may be used in combination with other oral acne medications without contraindication, and specifically note that concerns about drug interactions between hormonal contraceptives and most medications are unfounded (with only rifampin and griseofulvin causing true contraceptive failure). 1
Mechanism and Rationale
Finasteride works by inhibiting 5α-reductase, blocking conversion of testosterone to dihydrotestosterone (DHT), while norethindrone (a progestin) provides hormonal contraception and additional anti-androgenic effects through different mechanisms. 2, 3
This complementary mechanism of action makes combination therapy logical for conditions like acne, hirsutism, and hidradenitis suppurativa in women with hyperandrogenism. 4
Critical Safety Considerations
Mandatory Contraception Requirement
Finasteride is absolutely contraindicated in pregnancy due to risk of hypospadias in male fetuses, making concurrent use of norethindrone (as contraception) not just safe but actually protective and advisable. 5
The norethindrone component provides essential pregnancy prevention while the patient receives finasteride therapy. 1
Monitoring Parameters
Blood pressure must be monitored at baseline and regularly during norethindrone therapy, as combined hormonal contraceptives increase cardiovascular and thromboembolic risk. 6
Screen for absolute contraindications to hormonal contraceptives including active thromboembolic disease, uncontrolled hypertension, hepatic disease, breast cancer, and migraine with aura. 6
Assess for new-onset depressive symptoms or suicidal ideation, as finasteride has recently been associated with these psychiatric effects by the FDA. 7
Age-Related Considerations
- Women ≥35 years have substantially increased stroke risk with estrogen-containing contraceptives, particularly if they smoke; however, norethindrone-only formulations (progestin-only) carry lower cardiovascular risk than combined estrogen-progestin products. 6
Clinical Implementation
Dosing Approach
Standard finasteride dosing for female patients with hyperandrogenic conditions is 5 mg daily (the BPH dose, not the 1 mg alopecia dose). 4
Norethindrone can be administered as part of combined oral contraceptives or as progestin-only formulations depending on patient-specific factors. 1
Expected Outcomes and Timeline
Clinical improvement in acne or hirsutism may take 6-12 months, as finasteride's effects on hair growth and sebaceous gland activity are gradual. 5, 4
In one study of women with normal free testosterone levels, 75% (9/12) of patients with acne or alopecia benefited from finasteride 5 mg daily treatment. 4
Common Pitfalls to Avoid
Do not assume drug interactions exist between norethindrone and finasteride—no pharmacokinetic interactions have been documented. 2
Do not use finasteride in women who are not using reliable contraception, as pregnancy risk is the primary safety concern. 5
Do not discontinue monitoring for breakthrough bleeding or menstrual irregularities, which are common with norethindrone and require assessment at each visit. 6
Perform mental health screening before initiating finasteride and arrange follow-up with the patient's primary care provider to monitor for new-onset depression or suicidal ideation. 7