From the Guidelines
Finasteride is not recommended for women except in specific cases of hirsutism or female pattern hair loss, and only when prescribed by a healthcare provider, due to its potential risks and side effects, as noted in studies such as 1 and 1. The medication works by inhibiting the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone (DHT), a hormone linked to hair loss. For women, finasteride carries significant risks, particularly for those who are pregnant or may become pregnant, as it can cause birth defects in male fetuses.
Some key points to consider when prescribing finasteride to women include:
- The typical dose for women with androgenetic alopecia is 2.5-5mg daily, though lower doses of 1mg may be used, as seen in various studies 1.
- Common side effects include decreased libido, depression, and breast tenderness, as reported in studies such as 1.
- Women considering finasteride should use effective contraception during treatment, undergo regular monitoring, and discuss potential risks with their doctor, as emphasized in 1 and 1.
- Alternative treatments like minoxidil, spironolactone, or anti-androgen medications may be safer options for women with hair loss or hirsutism, as suggested in 1 and 1.
It is essential to weigh the benefits and risks of finasteride in women, considering the potential for birth defects and other side effects, and to discuss these risks with patients before initiating treatment, as noted in 1. Additionally, finasteride may be used in specific cases, such as in the treatment of hidradenitis suppurativa, as seen in 1, but its use should be carefully considered and monitored.
In terms of specific patient populations, finasteride may be considered for women with polycystic ovary syndrome (PCOS) or other conditions characterized by excess androgen levels, as noted in 1 and 1. However, its use in these populations should be carefully evaluated and monitored due to the potential risks and side effects.
Overall, the decision to prescribe finasteride to women should be made on a case-by-case basis, taking into account the individual patient's medical history, potential risks and benefits, and alternative treatment options, as emphasized in 1, 1, and 1.
From the FDA Drug Label
Finasteride tablets are not indicated for use in females. Finasteride use is contraindicated in females when they are or may potentially be pregnant Because of the ability of Type II 5α-reductase inhibitors to inhibit the conversion of testosterone to 5α-dihydrotestosterone (DHT), finasteride may cause abnormalities of the external genitalia of a male fetus of a pregnant female who receives finasteride
Finasteride is not indicated for use in women, particularly those who are or may potentially be pregnant, due to the potential risk of abnormalities in a male fetus. The FDA drug label explicitly states that finasteride is contraindicated in pregnancy and should not be used in females 2 2.
From the Research
Finasteride for Women: Efficacy and Use
- Finasteride is being used to treat hair loss, hirsutism, and other dermatologic conditions in women, with varying reported efficacy 3.
- A systematic review of 65 studies involving finasteride use in women found that most randomized controlled trials evaluated finasteride use in women with hirsutism (48.7%) or female pattern hair loss (34.7%) 3.
- Finasteride has been shown to be effective in reducing hirsutism in women with polycystic ovary syndrome or idiopathic hirsutism, with significant reductions in Ferriman-Gallwey score and hair diameter 4, 5, 6.
Dosage and Treatment Duration
- The dosage of oral finasteride used in studies ranged from 0.5 to 5 mg/day, with treatment durations of 6-12 months being the most common 3.
- A study found that finasteride treatment for 12 months was effective in reducing hirsutism in women with idiopathic hirsutism, while the maximal therapeutic effect was obtained after 6 months in women with polycystic ovary syndrome 6.
Female Pattern Hair Loss
- Finasteride may be considered as an alternative treatment for female pattern hair loss, although clinical studies and use are limited due to its potential teratogenic effects 7.
- Topical finasteride and dutasteride, a new generation 5α-reductase inhibitor, may provide novel therapeutic options for the treatment of female pattern hair loss 7.