From the Guidelines
Finasteride is the clear choice for treating male pattern baldness and enlarged prostate, as it has been proven to be effective in reducing symptoms and improving quality of life, whereas transposing is not a relevant concept in this context. Finasteride is a prescription drug that works by inhibiting the enzyme 5-alpha-reductase, which converts testosterone to dihydrotestosterone (DHT), a hormone linked to hair loss and prostate growth 1. The typical dosages are 1mg daily for hair loss and 5mg daily for prostate issues, and side effects may include sexual dysfunction, depression, and breast tenderness 1.
Some key points to consider when prescribing finasteride include:
- The decrease in PSA levels by 5-ARIs must be taken into account when judging the significance of a PSA level, with finasteride lowering the PSA by 50% after 12 months of therapy 1
- Finasteride reduces the risk of subsequent acute urinary retention and the need for BPH-related surgery, with the absolute benefit increasing with rising prostate volume or serum PSA 1
- The most common adverse effects of finasteride include impotence/erectile dysfunction, decreased/abnormal ejaculate volume, decreased libido, gynecomastia, and incontinence, with the majority of these effects being reversible and uncommon after the first year of therapy 1
In terms of treatment duration, finasteride should be given for 7 years if used for primary prevention, although ongoing trials may provide more information on the optimal duration of treatment 1. Overall, finasteride is a well-established and effective treatment for male pattern baldness and enlarged prostate, and should be considered as a first-line treatment option for patients with these conditions.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Finasteride and Its Effects
- Finasteride is primarily used to treat benign prostatic hyperplasia (BPH) and male androgenetic alopecia (MAA) 2.
- The use of finasteride has been associated with an increased risk of erectile dysfunction (ED) in some studies, particularly in patients with BPH 2.
- However, other studies have found that finasteride is not correlated with ED in patients with MAA 2.
- Finasteride has also been reported to cause other side effects, including male infertility, ejaculation problems, and loss of libido 2, 3.
Therapeutic Options and Medical Implications
- Finasteride is a 5α-reductase inhibitor that has significant outcomes in the treatment of androgenic alopecia (AGA), but it can also exert significant side effects in a subset of patients 3.
- The literature describes three distinct situations regarding finasteride administration, including studies that show finasteride to be very safe with minimal or no side effects, studies that recognize side effects but consider them disputable, and studies that are concerned about the potential for persistent side effects 3.
- Factors such as individual tolerance and predisposition to adverse reactions may explain the inconsistency regarding finasteride's therapeutic and side effects 3.
Use of Finasteride in Androgenetic Alopecia
- Finasteride was approved in 1997 as the first oral pharmacologic therapy for the treatment of men with androgenetic alopecia (AGA) 4.
- The optimal dose of finasteride for AGA is 1 mg/day, which has been shown to be effective in treating the condition 4.
- Long-term use of finasteride has been studied in a placebo-controlled clinical trial environment, with results showing a well-established, excellent safety profile 4.
Psychiatric Disorders and Finasteride Use
- A population-based case-control study found that finasteride users with BPH and AGA had a low rate of adverse mental health effects, with no increase in psychological sequelae in BPH patients and a slight increase in anxiety and depression in AGA patients 5.
- The study found that finasteride was a risk factor for anxiety and depression in AGA patients, but the overall rate of psychiatric disorders was still relatively low 5.