Finasteride is a prescription-only treatment that comes as a tablet. It is used to treat hair loss in men, but can also be used to treat an enlarged prostate at higher dosages.

How does finasteride work?

Finasteride reduces the amount of the hormone dihydrotestosterone (DHT) in the body. In male pattern balding, the hair follicles shrink. In these smaller hair follicles, DHT is found at high levels. However, when DHT is suppressed, it boosts hair growth and reduces hair loss on the head. It does not affect hair growth in other parts of the body.

When taking finasteride, a 1mg dose per day is prescribed for hair loss treatment. This treatment is often prescribed long term, so you may choose to keep taking it for several months or years, as when you stop, the hair loss will likely start again.

How long does it take for finasteride to work?

When taken as a tablet, finasteride is quickly absorbed into your bloodstream and will start blocking DHT production right away. It can take months to see a change in hair loss because it can take a long while for new hair to appear. If you start taking finasteride you will likely start noticing visible results in about 3 to 4 months.

In studies, about 40% of men were happy with the changes in their hair after one year. Hair thickness, amount of regrowth, and an improved hairline should be more obvious at this point. After 2 years, the percentage of men happy increased to 50% and at 5 years, was 60%. In some cases, there may be no signs of improvement, but not worsening of hair loss. If you do not see any change after a year, you should talk to your doctor. They may be able to advise an alternative, and also check for any other causes of hair loss.

When prescribed for male pattern hair loss, finasteride is taken once a day as a 1mg dose.

Ensure that you stick to your daily schedule by:

• taking your tablet at the same time of day, each day
• swallowing each tablet whole with a full glass of water
• continuing to take your prescription even after visible results if you wish to maintain the improvement in your hair

There are two forms of finasteride tablets available in Ireland. Finasteride 1mg tablets, which have recently been licensed, are taken as one tablet once a day. This dose is only used to treat hair loss.

The other form is finasteride 5mg tablets which are used to treat prostate problems. They are not licensed for use to be for hair loss, however they are widely used because of the availability of the 1mg tablets. The dose when using these is a quarter of a tablet once a day. You should use a pill cutter, which you can buy easily from a pharmacy, to cut the tablets into 4 equal parts. Your pharmacist may also be able to help to cut these for you.

Both options are effective, as you are taking a similar amount of finasteride. The finasteride 5mg tablets are usually more cost effective, however the 1mg tablets are more convenient as they do not need to be cut.

In other EU countries, and in the UK, finasteride 1mg tablets are also found under the brand name Propecia. This particular brand is not available in Ireland.

How should I take finasteride?

Finasteride can be taken with or without food. If you forget to take your dose within 6 hours of the usual time, take it right away. If more than 6 hours have elapsed, skip the missed dose and wait to take the next one as usual. Do not double dose.

It is best to monitor the condition of your scalp regularly. You can do this by taking pictures of your hairline and scalp. Tracking changes will let you know if the treatment is working for you, but be patient as it can take up to a year to see visible results.

When combined with minoxidil, finasteride may be more effective as they work in different ways. Minoxidil is a topical medication for promoting hair growth. If you have had serious hair loss, it could be helpful to combine the use of these remedies for better results. Adding on a hair loss shampoo can also help stop damage to hair follicles and promote regrowth. These treatments will not work for complete hair loss.

Finasteride relies on hair growth which is a slow and gradual process. Do not expect overnight results. Here is a timeline of what you should expect when taking finasteride:

1 to 3 months: DHT levels immediately start to drop by about 70%. This allows excess hair loss to stop and regrowth to begin. While there will be little or no visible signs of regrowth, excess hair loss should slow or stop. In some cases, some hair fall may still occur to make room for newer hair strands.

3 to 6 Months: Hair regrowth will be more visible around the scalp and hairline. Thinning should stop altogether and signs of recovery will be more obvious. Hair volume should be more visibly thicker with any bald patches beginning to fill up.

1 year: This is when the most visible improvements will be seen. You should see improved hair regrowth, better hairline, thickness, and scalp healing. Improvement may continue past this mark with ongoing use of finasteride. Continued use, early treatment, and the age of the patient can help boost results.

2 years: Continued use of finasteride is advised to stop DHT levels from rising again. Several studies have shown that sustained use of the medicine for several years will lead to continued improvement in hair growth. Some showed improvement after 5 years, though the results will differ depending on the type of hair loss.

Finasteride is a prescription-only medication given in tablet form. You will need to consult with a doctor before you can take it. You can choose your treatment with us and have your order reviewed by one of our doctors, who will prescribe your treatment if appropriate. The prescription can then be sent to a pharmacy of your choice, where you can buy the medication.

Finasteride is generally considered safe for use in hair loss treatment. However, just like with any other medication, there are at times side effects that occur.

Uncommon side effects include:

• reduced sex drive
• erectile dysfunction (ED)
• abnormal ejaculation
• feelings of depression

Side effects where the frequency is not known include:

• tender or swollen breasts and nipples
• discharge from the nipples
• lump in the breast or underarm
• testicular pain
• blood in the semen
• anxiety
• palpitations
• bloating in the face and extremities
• change in liver enzymes
• persistent reduced sex drive or erectile dysfunction even after stopping treatment
• male infertility or problems with semen

If you notice any changes in the chest wall such as a lump in your chest wall or under your arm, pain, or discharge from your nipple, you must report it to a doctor as this may be a sign of cancer, a possible serious side-effect.

If you have swelling of your lips or tongue, breathing difficulties, rashes, or difficulty swallowing, you must contact a doctor right away as you may be having a severe allergic reaction.

Hair shedding may continue in the initial months of finasteride use. This may be due to new hair growth pushing out older hair. A syndrome called post finasteride syndrome (PFS) has been described, with some people saying it can occur during and after you stop using the treatment. It is claimed that it can result in multiple sexual, neurological, physical, and mental side effects, including memory loss.

Some side effects are temporary as the body adjusts to the use of finasteride. If symptoms persist or you have other concerns, or if you have depression or chest wall changes, you must consult with your doctor. If you have serious side effects or cannot tolerate your side effects, you may want to stop using finasteride. Consult your doctor about alternative treatment options like minoxidil.

While finasteride can be effective in treating hair loss in men, there can be side effects. There are other options you can consider if you find finasteride unsuitable or too expensive. Here are some options and how they compare to finasteride.

Minoxidil

Minoxidil is the active ingredient in an over the counter treatment called Regaine. Minoxidil can be used to treat both men and women suffering hair loss. The product comes in the form of a lotion, cream, or shampoo that is used on the scalp daily. You can buy this treatment without a prescription from a doctor. Speak to your pharmacist for more advice.

Finasteride is to be used only by men aged 18 years and over. Women and children should not be prescribed this treatment. It may also be unsafe to take finasteride under certain conditions.

Tell your doctor if you:

• have had allergic reactions to any medications, including finasteride
• have bladder or liver problems
• have a pregnant partner

Finasteride can be absorbed through the skin, so women who are pregnant should avoid contact with crushed or broken tablets as this can endanger the health of the unborn baby. It can also get into semen, so you should use a condom when having sex if your partner is pregnant.

You should tell your doctor if you are taking any other medications before taking finasteride, as several medications interact with it.

Always consult your doctor before taking any other medication when using finasteride