Finasteride and MPHL

How much does generic finasteride cost?

Drug cost: ~ $32 / year *

Dispensing fee: ~ $7-12 **

*Generic finasteride has different pricing through different pharmacies.

**Dispensing fees vary between different pharmacies

These prices represent a rough estimate of the approximate drug cost of finasteride 1.25mg.

What are current treatments for Male Pattern Hair Loss (MPHL)?

A variety of treatment options are available for male pattern hair loss (MPHL), targeting different aspects of the condition. The primary treatments include medications, surgical procedures, and lifestyle changes. It is essential to note that results may vary depending on the individual's response to treatment, the extent of hair loss, and other factors (1).

1. Medications: Two FDA-approved medications for treating MPHL are finasteride and minoxidil.

   a. Finasteride: Finasteride is an oral medication that works by inhibiting the enzyme 5-alpha reductase, responsible for converting testosterone to dihydrotestosterone (DHT). By reducing DHT levels, finasteride helps slow hair loss and, in some cases, promote hair regrowth in men with MPHL (3).

   b. Minoxidil: Minoxidil is a topical solution or foam applied directly to the scalp. It is thought to work by increasing blood flow to the hair follicles, promoting hair growth, and extending the growth phase of hair. While minoxidil does not directly target DHT, it can still help improve hair density and slow hair loss (1, 4).

2. Hair Transplantation Surgery: Hair transplantation is a surgical procedure in which hair follicles are removed from areas of the scalp with healthy hair growth (typically the back and sides of the head) and transplanted to areas affected by MPHL. There are two main techniques for hair transplantation: Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). Both methods aim to provide natural-looking results, but the choice of technique depends on factors such as the patient's hair type, the extent of hair loss, and the desired outcome (1, 5).

3. Laser Therapy: Low-level laser therapy (LLLT) is a non-invasive treatment that uses red light or near-infrared light to stimulate hair growth. Although the exact mechanism of action is not fully understood, LLLT is thought to increase blood flow to the hair follicles and promote cellular activity. Some studies suggest that LLLT can help improve hair density and slow the progression of hair loss, but more research is needed to establish its long-term efficacy (1, 6).

4. Lifestyle Changes: While not a direct treatment for MPHL, adopting a healthy lifestyle may help slow the progression of hair loss and improve overall hair health. Eating a balanced diet, managing stress, getting regular exercise, and avoiding harsh hair care practices can contribute to maintaining hair health and potentially reducing the impact of MPHL (1).

How does Finasteride work?

Finasteride is a potent and selective inhibitor of the enzyme 5-alpha reductase, which is responsible for converting testosterone, the primary male sex hormone, into dihydrotestosterone (DHT) (3). DHT plays a significant role in male pattern hair loss (MPHL) because it binds to hair follicles' androgen receptors, particularly in individuals with a genetic predisposition to hair loss. When DHT binds to these receptors, it triggers a process called miniaturization, which causes hair follicles to shrink, produce thinner and shorter hair, and eventually stop growing hair altogether (2, 3).

By inhibiting 5-alpha reductase, finasteride effectively blocks the conversion of testosterone to DHT, thus reducing DHT levels in the scalp. This decrease in DHT levels helps slow down hair loss progression and, in some cases, promotes hair regrowth in men with MPHL (3). Finasteride has been shown to be more effective in maintaining and improving hair growth in the crown and mid-scalp areas, but it may also have some benefits for hair growth in the frontal hairline and temple regions (4).

How long does it take for finasteride to show results?

The timeline for observing results from finasteride treatment varies among individuals, but most men may start to see improvement in hair growth and reduced hair loss within three to six months of continuous use. It is essential to have realistic expectations and be patient, as hair growth is a slow process, and the full benefits of finasteride treatment may not be apparent until after one to two years of consistent use (4).

It is worth noting that the effectiveness of finasteride can vary depending on factors such as the individual's response to the medication, the extent and pattern of hair loss, and the duration of treatment.

It is worth noting that the effectiveness of finasteride can vary depending on factors such as the individual's response to the medication, the extent and pattern of hair loss, and the duration of treatment. Regular follow-ups with your healthcare provider can help monitor your progress and make any necessary adjustments to your treatment plan (4, 9).

Medications

What is the difference between finasteride and dutasteride?

Finasteride and dutasteride are both medicines that help treat hair loss by stopping the creation of a hormone called DHT. DHT is responsible for male pattern hair loss. However, there are some differences between these two drugs, mainly in how they work and their approval for treating hair loss.

1. How they work: Finasteride focuses on one type of enzyme that creates DHT, while dutasteride targets two types. This makes dutasteride more effective at reducing DHT levels compared to finasteride.

2. Approval: Finasteride (1 mg) is approved by the FDA for treating male pattern hair loss, while dutasteride is approved for treating an unrelated condition called benign prostatic hyperplasia (BPH) at a dose of 0.5 mg. Although dutasteride is not approved for hair loss treatment, some studies show it might be effective due to its stronger DHT-lowering effects.

3. Effectiveness: Some research suggests that dutasteride could be more effective than finasteride in promoting hair growth and slowing hair loss in men because it targets both types of enzymes that create DHT. One study found that dutasteride (0.5 mg/day) was more effective than finasteride (1 mg/day) in improving hair growth and reducing hair loss after 12 and 24 weeks of treatment.

4. Safety and Side Effects: Finasteride and dutasteride have similar side effects, including a decreased sex drive, erection problems, and ejaculation issues. However, dutasteride's stronger DHT-lowering effects might make the risk of side effects slightly higher compared to finasteride.

In conclusion, both finasteride and dutasteride can be used to treat hair loss, but only finasteride is officially approved for this purpose. Dutasteride might be more effective in some cases, but it is not officially approved for hair loss treatment, and the risk of side effects might be slightly higher.

What is off-label use, and why is dutasteride considered off-label for MPHL treatment?

Off-label use refers to prescribing a medication for a condition or in a manner not specifically approved by Health Canada or the FDA. Dutasteride is approved for treating benign prostatic hyperplasia (BPH), but not for MPHL. However, some healthcare providers prescribe it off-label for MPHL due to its effectiveness in blocking the conversion of testosterone to DHT, a hormone implicated in hair loss.

Is dutasteride effective for treating MPHL?

Studies have shown that dutasteride can be effective in treating MPHL by slowing down hair loss and promoting hair regrowth.

What are the risks and side effects of using dutasteride off-label for MPHL?

Possible side effects of dutasteride off-label include sexual dysfunction (such as decreased libido, erectile dysfunction, and ejaculation disorders), breast tenderness or enlargement, and dizziness. In rare cases, dutasteride may increase the risk of high-grade prostate cancer. While these risks are the same for finasteride, we cannot qualify if dutasteride presents a lower risk option. Dutasteride, however, is a commonly prescribed medication and is well-studied. It is also approved for hair loss in Japan and Korea.

Do TeleTest physicians prescribe Dutasteride for MPHL?

Dutasteride can be prescribed at a dose of 0.5mg, provided you understand that the medication is being used 'off-label', and that off-label use carries certain risks. Off-label risk means the drug has not been approved for its use in hair loss and may cause greater unintended harm than an approved agent (i.e. finasteride). These risks include but are not limited to sexual dysfunction, depression or prostate cancer. Hypothetically, we might learn at a future date that dutasteride may result in a higher rate of high-grade prostate cancers compared to finasteride when dosed for hair loss.

How should I take finasteride for MPHL?

Finasteride is typically prescribed as a 1 mg oral tablet for the treatment of MPHL. It is important to take the medication once daily, preferably at the same time each day, to maintain consistent levels of the drug in the body. You should follow your healthcare provider's instructions and continue taking the medication as prescribed, even if you do not see immediate results. Stopping the medication or altering the dosage without consulting your healthcare provider can lead to reduced effectiveness and a reversal of any benefits gained (4, 9).

In some instances, a physician may prescribe a 5 mg tablet, which can be cut into quarters, resulting in a 1.25mg dose. This is higher than FDA approved Propecia at 1mg, but is more cost-effective. The 1.25mg dose is considered off-label usage of the medication.

Dutasteride can be prescribed at a 0.5mg dose.

References

1. R. M. Trüeb, “Male Alopecia. Guide to Successful Management,” Springer International Publishing, 2014.

2. Olsen, E. A., “Androgenetic alopecia,” Disorders of Hair Growth: Diagnosis and Treatment, pp. 257–283, 2003.

3. Kaufman, K. D. et al., “Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group,” J Am Acad Dermatol, vol. 39, no. 4 Pt 1, pp. 578–589, Oct. 1998.

4. Mella, J. M. et al., “Efficacy and safety of finasteride therapy for androgenetic alopecia: A systematic review,” Arch Dermatol, vol. 146, no. 10, pp. 1141–1150, Oct. 2010.

5. Irwig, M. S., “Persistent sexual side effects of finasteride: could they be permanent?” J Sex Med, vol. 9, no. 11, pp. 2927–2932, Nov. 2012.

6. Traish, A. M. et al., “Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients,” J Sex Med, vol. 8, no. 3, pp. 872–884, Mar. 2011.

7. S. M. Belknap et al., “Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis,” JAMA Dermatol, vol. 151, no. 6, pp. 600–606, Jun. 2015.

8. Wessells, H. et al., “Effect of an alpha-blocking agent (phenoxybenzamine) in the management of prostatic obstruction,” Urology, vol. 34, no. 1, pp. 24–28, Jul. 1989.

9. U. S. Food and Drug Administration, “Propecia (finasteride) 1 mg tablet - FDA,” 2011. [Online]. Available: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020788s018lbl.pdf.

10. Gubelin Harcha W, Barboza Martínez J, Tsai TF, Katsuoka K, Kawashima M, Tsuboi R, Barnes A, Ferron-Brady G, Chetty D. A randomized, active- and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol. 2014 Mar;70(3):489-498.e3. doi: 10.1016/j.jaad.2013.10.049. Epub 2014 Jan 9. PMID: 24411083.