Male pattern hair loss, also known as androgenetic alopecia, is a widespread condition affecting many men. It typically manifests as a receding hairline, thinning at the temples, and hair loss on the crown of the scalp. Finasteride, an oral medication, is a recognized treatment for this condition. This article will discuss finasteride’s effectiveness in regrowing hair on the crown, along with expected results, potential side effects, and long-term commitment.
How Finasteride Addresses Male Pattern Hair Loss
Androgenetic alopecia is primarily a genetic and hormonal condition. In susceptible individuals, hair follicles become sensitive to dihydrotestosterone (DHT), a potent male hormone. DHT forms when the enzyme 5-alpha-reductase converts testosterone. Elevated DHT levels in the scalp contribute to hair follicle miniaturization, leading to shorter, finer hairs and eventual growth cessation.
Finasteride functions as a 5-alpha-reductase inhibitor, targeting the Type II isoenzyme. By inhibiting this enzyme, finasteride prevents testosterone’s conversion to DHT. This action significantly reduces DHT concentrations in both serum and scalp (up to 70% and 60% respectively). Lowering DHT levels helps reverse miniaturization, allowing hair follicles to produce thicker, longer hairs.
Regrowing Hair on the Crown: Expectations and Timeline
Finasteride effectively addresses hair loss on the crown. Clinical studies indicate it treats hair loss in this area more effectively than the front of the head and temples. For men with crown hair loss, studies showed improved hair growth in 48% of finasteride users after one year, increasing to 66% after two years.
One study indicated that men with crown hair loss had a 61% chance of experiencing mild to moderate regrowth, with an additional 5% achieving substantial hair growth. Finasteride has also been shown to increase hair density, with many users seeing increased hair density in 60-70% of cases. Hair counts in studies showed that 83% of finasteride recipients maintained or increased their hair count after two years, compared to 28% of placebo recipients.
Patients typically begin to observe initial changes within three to six months of daily use, including reduced hair loss and early regrowth. More noticeable improvements in hair thickness and density become apparent around six to twelve months. Maximum benefit is achieved after 12 months or more of continuous treatment, with some studies showing continued improvement even at 48 months. If no visible results are apparent after one year of consistent use, significant regrowth is unlikely.
Potential Side Effects and Safety Considerations
Finasteride can cause side effects, most commonly related to sexual function. These include decreased libido (sex drive), erectile dysfunction, and ejaculatory dysfunction. In clinical trials, decreased libido was reported by approximately 1.8% of men using finasteride 1mg, compared to 1.3% on placebo. Erectile dysfunction occurred in about 1.3% of finasteride users versus 0.7% in placebo groups, and ejaculation disorders by 1.2%.
These sexual side effects are typically mild and may resolve even with continued use or upon discontinuation of the medication. Some studies suggest side effects ceased in patients even when they continued finasteride. However, in rare instances, persistent sexual dysfunction after discontinuing treatment has been reported.
Other less common side effects include breast tenderness or enlargement (gynecomastia), which can occur due to hormone imbalances. Around 4.5% of users may experience gynecomastia, and stopping the medication may not always reverse the breast tissue once formed. Mood changes, such as depression, have also been reported, and patients should monitor for such symptoms.
Finasteride is contraindicated for women, especially those pregnant or who may become pregnant, as it can cause abnormal development of external genitalia in a male fetus. Pregnant women should also avoid handling crushed or broken finasteride tablets due to absorption risk. Always consult a healthcare professional before starting finasteride to discuss individual risks and benefits.
Maintaining Hair Regrowth
Finasteride is a continuous management therapy for hair loss, not a permanent solution. Its benefits depend on consistent daily use, as the medication works by maintaining suppressed DHT levels to support hair follicle health.
If finasteride treatment is discontinued, the hair loss process will likely resume. DHT levels begin to rise within weeks, and any regrown or maintained hair will gradually be lost as the natural progression of hair loss resumes within 6 to 12 months. Sustained results therefore require a long-term commitment to the medication.