Finasteride is a medication used to treat male pattern hair loss (androgenetic alopecia) and benign prostatic hyperplasia (BPH), an enlarged prostate gland. It works by influencing hormone levels.
How Finasteride Functions
Finasteride inhibits 5-alpha reductase, an enzyme that converts testosterone into dihydrotestosterone (DHT). DHT is a potent androgen central to male pattern hair loss and prostate growth. By blocking this enzyme, finasteride lowers DHT levels.
Lowering DHT benefits androgenetic alopecia by reducing its effects on hair follicles. For BPH, decreased DHT helps reduce prostate size, alleviating urinary symptoms.
Effectiveness Over Time
Finasteride demonstrates sustained effectiveness for both male pattern hair loss and benign prostatic hyperplasia. For hair loss, 1 mg/day can lead to durable improvements in scalp hair growth and slow progression over five years. Benefits may continue for over 10 years. Hair counts might increase initially then slightly decline, but typically remain better than baseline over five years.
For BPH, 5 mg/day shows long-term symptomatic improvement. It reduces prostate volume and improves urinary flow rates over several years. Long-term use can also lessen the risk of acute urinary retention and the need for BPH-related surgery. The benefits for BPH typically continue as long as the medication is taken.
Safety Aspects of Prolonged Use
Finasteride is generally well-tolerated by most individuals. However, some may experience side effects, with sexual side effects being common. These can include decreased libido, erectile dysfunction, and a reduction in ejaculate volume. While these issues often resolve after discontinuing the medication or even with continued use, some reports suggest they can persist in a subset of individuals.
Other potential side effects include mood changes, such as depression or suicidal thoughts. If these symptoms develop, stopping the medication immediately and consulting a doctor is advised. Gynecomastia, or enlarged breast tissue in men, is another possible side effect, though it is less common. This can sometimes be painful and may not always resolve completely after stopping the drug, potentially requiring surgical intervention in some cases.
What to Consider for Ongoing Treatment
Regular medical follow-ups are important for individuals on long-term finasteride treatment. This is particularly relevant for monitoring prostate health, as finasteride affects prostate-specific antigen (PSA) levels. Finasteride can decrease PSA levels by approximately 50% within the first year of use. Healthcare providers must account for this reduction when interpreting PSA test results for prostate cancer screening.
If finasteride treatment is stopped, the benefits achieved for both hair loss and BPH will likely reverse. For male pattern hair loss, DHT levels will return to baseline, leading to a resumption of hair loss, typically within months. Similarly, for BPH, the prostate gland may begin to grow again, and urinary symptoms can return. The medication’s effects are dependent on continuous use.
Finasteride is prescribed at different dosages: 1 mg daily for male pattern hair loss and 5 mg daily for BPH. The considerations for long-term use, including potential side effects and the need for ongoing monitoring, apply to both dosages, though some side effects might be more likely with the higher dose. Personalized medical advice from a healthcare provider is important to determine the appropriate duration of treatment and manage any concerns.