Hair loss finasteride

Numerous (but not all) trials have indicated improvement in BPH symptom scores compared to placebo with 1 to 3 months of therapy. Saw palmetto extract appears to be equally effective as finasteride (see Chapter 63) but is less effective than aj-adrenoceptor antagonists. No information appears to be available on the use of saw palmetto in the prevention of hair loss. 

Finasteride (Propecia) is a 5K-reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (see Chapter 40), the androgen responsible for androgenic alopecia in genetically predisposed men. Oral finasteride, 1 mg/d, promotes hair growth and prevents further hair loss in a significant proportion of men with androgenic alopecia. 

Treatment for at least 3-6 months is necessary to see increased hair growth or prevent further hair loss. Continued treatment with finasteride is necessary to sustain benefit. Reported adverse effects include decreased libido, ejaculation disorders, and erectile dysfunction, which resolve in most men who remain on therapy and in all men who discontinue finasteride. 

In the normal daily dose of 1 mg, which is sufficient to treat male pattern hair loss, finasteride is well tolerated over long periods. There is a very slightly higher incidence of impaired sexual function in users compared with placebo (17). In women too, low doses of finasteride (2.5 mg/day) are well tolerated when used to treat hirsutism (18). However, many of the problems seen... 

Whiting DA, Olsen EA, Savin R, Halper L, Rodgers A, Wang L, Hustad C, Palmisano J. Efficacy and tolerability of finasteride 1 mg in men aged 41 to 60 years with male pattern hair loss. Eur J Dermatol 2003 13 150-60. 

Stough DB, Rao NA, Kaufman KD, Mitchell C. Finasteride improves male pattern hair loss in a randomized study in identical twins. Eur J Dermatol 2003 12 32-7. 

McClellan KJ, Markham A. Finasteride. A review of its use in male pattern hair loss. Drugs 1999 57 111-26. 

A high protein diet providing 1.5-2 g of protein and 17-20 calories per pound of bodyweight daily was commonly considered a must with this cycle example. Post cycle protein intake levels were continued while total calories are reduced to 15-17 calories per pound of bodyweight by those who retained the greatest lean mass tissue and the least adipose (fat) tissue. Since Testosterone converts to DHT fairly easily, hair loss of the scalp was monitored. If this became a concern, 1 mg of Finasteride (Proscar) was often co-administered and believed to be quite prudent (to block DHT conversion). It was almost unanimously said to be mandatory that Deca and Testosterone injections were alternated (Deca on Monday / Testosterone on Thursday) to avoid androgen build-up. By beginning Clenbuterol and Nolvadex/Proviron on week 25, this was noted to be an excellent contest prep cycle. 

Fig. 7. Effects of finasteride in androgenetic alopecia. (A) 5a-Reductase-mediated conversion of testosterone (T) to dihydrotestosterone (DHT) leads to miniaturization of scalp hair follicles and eventual hair loss. (B) Finasteride inhibits continued miniaturization of scalp hair follicles and (C) converts miniaturized follicles back to terminal ana-gen hairs with time, leading to an increase of terminal scalp hair growth and slowing of further hair loss. (Panel A adapted from Randall et al., 1991 panels B and C from Kaufman and Dawber, 1999.)...

Fig. 9. Hair count mean change from baseline ( SE) from combined U.S. and international studies for men with vertex pattern hair loss. FIN 1 MG finasteride 1 mg PBO placebo. (From Kaufman et al., 1998.)...

The phase III Frontal Hair Loss study was conducted in parallel with the phase III Pivotal studies in order to evaluate the efficacy of finasteride 1 mg primarily in the frontal scalp area (Leyden et al., 1999), as opposed to the vertex. The frontal hair loss study used end points similar to those used in the Pivotal studies and demonstrated significant improvements in all predefined efficacy measures with finasteride as compared with placebo. Treatment with finasteride significantly... 

In addition to improving hair growth in younger men (mean age 32 years) with AGA (Kaufman et al, 1998 Leyden et al, 1999), finasteride was recently demonstrated to produce a significant improvement in scalp hair count compared with placebo in older men (mean age 65 years) with AGA (Brenner and Matz, 1999), which indicates that the key role of type 2 5a-reductase and DHT in mediating hair loss in men with AGA is maintained with advancing age. 

Propecia Finasteride 1 mg Tablet Male pattern hair loss A specific inhibitor of steroid type II 5 a-reductase Lactose monohydrate, MCC, pregelatinized starch, sodium starch glycolate, docusate sodium, magnesium stearate, Hypromellose 2910 Merck Co. 

Finasteride Proscar Treatment of benign prostatic hypertrophy, Merck, 1985 also marketed to treat male hair loss... 

C. 5a-Reductase Inhibitors Testosterone is converted to dihydrotestosterone (DHT) by the enzyme 5a-reductase some tissues, most notably prostate cells and heur follicles, depend upon DHT rather than testosterone for androgenic stimulation. This enzyme is inhibited by finasteride, a drug used to treat benign prostatic hyperplasia and, at a lower dose, to prevent hair loss in men. Because the drug does not interfere with the action of testosterone, it is less likely than other antiandrogens to cause impotence, infertility, and loss of libido. 

Stout SM, Stumpf JL. Finasteride treatment of hair loss in women. Ann Pharmacother 2010 44 1090-7. 

Sexual function Adverse effects of finasteride on male sexual function are not uncommon (SEDA-30, 480). These effects are dose related, and in the low doses used to treat hair loss (1 mg/day) they are unusual. However, they can occur in certain instances, as in two patients with azoospermia and severe oligospermia resulting in infertility when they took finasteride 1 mg/ day for hair loss the drug was withdrawn and the sperm count recovered within 3-6 months [112 ]. 

Finasteride, a commonly prescribed medication for male pattern hair loss, has been associated with persistent sexual side effects. In addition, depression has also been added when finasteride 1 mg is used. The drug reduces the levels of several neuroactive steroids linked to sexual function and depression. The current study assessed depressive symptoms and suicidal thoughts in former users of finasteride who developed persistent sexual side effects despite the discontinuation of the medication. 

Former users of finasteride (n=61) with persistent sexual side effects for over 3 months were administered standardised interviews that gathered demographic information, medical and psychiatric histories and information on medication use, sexual function, and alcohol consumption [24. All former users were otherwise healthy men not suffering from any of the pre-said conditions or users of oral prescription medications before or during finasteride use. A control group of 29 men, selected from the community, had male pattern hair loss but had never used finasteride and denied any history of psychiatric conditions or use of psychiatric medications. The primary outcomes were the prevalence of depressive symptoms and the prevalence of suicidal thoughts as determined by the Beck Depression Inventory II all subjects self-administered the questionnaire at tire time of the interview or up to 10 months later. 

Further observations performed in a subset of subjects treated with finasteride for male pattern hair loss seems, also, to indicate that sexual dysfunction as well as anxious/depressive symptomatology may occur at the end of the treatment and continue after discontinuation [26. A possible hypothesis to explain the depression symptoms after finasteride treatment might be impairment in the levels of neuroactive steroids. Therefore, neuroactive steroid levels were evaluated in paired plasma and cerebrospinal fluid samples obtained from male patients who received finasteride for the treatment of androgenic alopecia and who, after drug discontinuation, still show long-term sexual side effects as well as anxious/depressive symptomatology. 

In an open comparative study of androgenetic alopecia in 90 men oral finasteride (1 mg/day for 12 months n = 65) was compared with 5% topical minoxidil solution twice daily (n = 25) (22). The cure rates were 80% for oral finasteride and 52% for topical minoxidil. The adverse effects were all mild, and did not lead to withdrawal of treatment. Of the 65 men given oral finasteride, six had loss of libido, and one had an increase in body hair at other sites irritation of the scalp was seen in one of those who used minoxidil. These adverse events disappeared as soon as the treatment was withdrawn. The laboratory data did not show any statistically or clinically significant changes from baseline values to the endpoint, except for the serum total testosterone concentration, which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were reduced from baseline values. 

---