A man has decided to start on finasteride \u2013 say, in January. By March, he is in the bathroom assessing his progress under the unforgiving glare of the bulb, twisting his head this way and that, and deciding that, overall, nothing has changed.<\/p>\n
He is likely correct \u2013 in the short term, a mere three months, little is likely to have changed. He may also have failed to consider the subtleties and nuances of the benefits. While he is unlikely to be seeing new growth in his shower, he may well have less on his desk at the end of the day.<\/p>\n
Finasteride is not a magic bullet, a rapid cure, or an instant fix. Its benefits are primarily preventative with a secondary bonus of rebuilding \u2013 to a limited extent \u2013 the density of existing hair. It rarely presents dramatic before-and-after photos; the usual results are more subtle.<\/p>\n
Dihydrotestosterone or DHT is a hormone to which some men are particularly sensitive. In these men, it can cause the follicles on the scalp to shrink over time. First, a robust and healthy follicle produces slightly thinner hair, then, after several cycles, even less, until eventually it is little more than a patch of downy fluff.<\/p>\n
Finasteride<\/a> inhibits the enzyme responsible for converting testosterone to DHT. In particular, a daily 1 mg dose reduces scalp DHT levels by approximately 80%. This is enough for the follicles sensitive to DHT to resume their normal function.<\/p>\n However, it is important to note that it only inhibits the conversion of testosterone to DHT and does not lower overall testosterone levels. It also does not magically cause new follicles to appear; if a man has had a particular spot on his head completely bald for years, medication is unlikely to restore it.<\/p>\n The evidence is largely positive. Large-scale randomized controlled trials with over a thousand men each have shown that, compared to a placebo, finasteride is significantly more effective at maintaining and improving hair density. The men who took the medication either retained more hair or grew it back on average compared to those who took the inactive substance. This was also demonstrated photographically \u2013 the finasteride group generally appeared to have better results.<\/p>\n The most important consideration, however, is that the results are meaningful. While the finasteride group may not have seen dramatic improvements, for some men, an improvement is a large amount of hair on the crown or the ability to continue having a full head of hair five years later if they had not already lost a significant amount.<\/p>\n The crown and the top of the head respond well to finasteride, but the temples rarely show signs of regrowth, especially in men with severe recession. The front is gradually improved, but rarely restored at a mature hairline. The medication is unlikely to do much for the widow\u2019s peak, unless it is not a mature hairline.<\/p>\n One of the most disheartening traits of finasteride is that it requires a seemingly unbending commitment to long-term use. Some men will see few or no visible results for the first six months \u2013 for the first few months, the best results are often seen in the mirror. Fewer hairs are shed, but this is subjective, and it is not uncommon for men to continue to lose hair at the same rate for the first year.<\/p>\n By the fourth to sixth month, some men may see a lessening of shedding or a slight change in the shape of their hair, especially when viewed from the top or when styling. However, these changes are often minimal and largely imperceptible.<\/p>\n The most significant changes are typically seen between six and twelve months. If the medication is to have a noticeable thickening effect, it will usually begin to show around this time. This, in many ways, is the key point in the treatment \u2013 a year later, the dermatologist will be able to assess whether there is enough improvement to warrant further medication.<\/p>\n Our timeline for results on finasteride goes into greater detail on the subject.<\/p>\n It is useful to take regular photos every three months to track progress. It is best to use dry hair when doing this to eliminate excess frizziness, and it is a good idea to take them in the same lighting and at the same angle. Selfies with a phone are often not helpful, as a particularly good or bad haircut can fool the eye.<\/p>\n Taking a photo at the same time every year can be an effective way to track progression \u2013 or the lack thereof.<\/p>\n The medication only blocks the production of DHT while it is in the system. As such, once it is stopped, DHT levels return to their previous norm, and hair loss accelerates. The hair which had been retained or regrown is gradually lost over the next year \u2013 on average, it takes roughly that long for the medication to wash out completely.<\/p>\n Missing one dose will not have a noticeable effect \u2013 simply take one the next day. It is unwise to take an extra dose.<\/p>\n It is this long-term nature that makes the side effects of the medication so relevant \u2013 if the medication is being used for a substantial period of time, then the risks become more pertinent.<\/p>\n It can, but it is not common. In the original year-long trials for Propecia, 1.8% of men who took finasteride reported reduced libido, compared to 1.3% who took the placebo. 1.3% of the finasteride group and 0.7% of the placebo group reported erectile dysfunction, and 1.2% versus 0.7% for ejaculatory dysfunction, respectively.<\/p>\n Pooling all the sexual dysfunction together, the numbers were 3.8% for the finasteride group and 2.1% for the placebo.<\/p>\n What this means is that while there may be some association between the medication and sexual dysfunction, it is not strongly supported. There is a measurable but small effect, potentially exacerbated by expectations, but it is not definitive. Men who take the medication are slightly more likely to report some sexual dysfunction, but it is not a guaranteed result.<\/p>\n In addition, those same trials show that in men who stopped the medication, the symptoms ceased \u2013 and for many, they did not recur. There is also evidence, anecdotal and otherwise, that the medication can cause sexual dysfunction<\/a> long after it has been discontinued. Overall, the risk is very difficult to quantify, but it is a definite possibility that should not be dismissed outright.<\/p>\nHow effective is it?<\/h2>\n
When will results appear?<\/h2>\n
What happens if I stop?<\/h2>\n
Does it cause sexual dysfunction?<\/h2>\n