I had an interesting conversation with my 3-year-old the other day. She wanted a treat before dinner and had what she thought was a pretty fantastic argument about why she should get one. 

I said no. 

Not one to be deterred, she asked again. And again…and again...and again.

I realized that each time she asked, she changed her question, altering the wording and introducing new variables, hoping that if she asked the question the right way, my answer would change to ‘yes’. It wasn’t a bad gamble. On another day my patience might have given in. 

What I really admired was how she used her questions not only to expand her knowledge of the problem (why she wasn’t getting a treat) but to test the logic of my answers. Asking questions really is the ultimate way to learn.  

So, in celebration of questions, we’ve tackled your top eleven queries to Dr. Linkov about the popular hair loss medication finasteride. Below you’ll find honest truths about what can be a fantastic treatment option for your hair loss. Always keep your questions coming!

Do minoxidil (Rogaine) and finasteride (Propecia) work the same way? 

It’s understandable why people would ask this question (or one of this question’s many iterations). Both medications are prescribed for hair loss, can be taken orally or even applied topically. 

They are not the same and in fact work through different cellular mechanisms of the hair growth/loss cycle. Whereas minoxidil encourages growth by increasing the density and length of hairs, finasteride prevents future hair loss by reducing levels of DHT (dihydrotestosterone). (Side fact: This DHT reducing property of finasteride is why it can also be used to treat an enlarged prostate). 

Minoxidil and finasteride are complementary therapies that work well as a first line of defense when prescribed together, tackling both future hair loss and increasing hair density. 

But say you’re someone not keen to take both minoxidil and finasteride, or you’re not yet ready for any medical intervention. Are there alternatives to Finasteride? Unfortunately, no. Though there are other therapies, such as PRP (plasma rich platelets), micro needling, and low-level laser therapy, which can all help stimulate growth and fullness, they will not preserve hair. And as far as supplements go? They could possibly help but it’s really a big maybe. The evidence just isn’t there. 

What is the safest dose of finasteride? 

The standard dose for finasteride is 1 mg/day. That’s the dose that is most well tolerated and works well to preserve hair. Lower doses are possible if a patient is concerned about side effects, but they’re less effective at preventing hair loss. As to those side effects? We’ll talk more about those a bit later. 

Help! My finasteride stopped working! What do I do?

Sometimes patients find that their finasteride treatment becomes less effective over time. A fix can be as simple as switching to the name brand for finasteride, Propecia. In the case of finasteride, the formulation of the drug found between makers can make a big difference, and the Propecia formulation can be more effective. Another option is the more potent version of finasteride, Dutasteride (approved in South Korea for hair loss, off label in USA). However, the potential risk of side effects, including a decrease in sex drive, more than doubles. 

Where can I get finasteride? 

Oral finasteride is a prescription medication so the only place to get it is through a doctor. Trying to get it another way isn’t safe. We like to point out that our online platform, feel confident, allows you to get prescriptions shipped right to your door safely, easily, and affordably. Compare the cost at your pharmacy and with other online platforms. 

Do I need finasteride if I’m getting a hair transplant? 

It depends but usually yes. The goal of a hair transplant surgery is (usually) to bring fresh hair into a DHT sensitive zone. But the transplant does nothing to preserve the original hairs still left in the recipient area - that’s where finasteride comes in.

Finasteride also protects the donor supply, and as FUE (follicular unit extraction) hair transplant surgery becomes more popular, protecting the donor site is more critical than ever. FUE hairs are harvested broadly outside the traditional DHT safe zone, and these other areas can experience hair loss over time. Basically, finasteride is a great way to maintain results and get the most out of a hair transplant. 

What about those side effects?

If you experience side effects on finasteride, stop the medication and speak to your health care provider. Finasteride can cause a range of mostly mild symptoms, but the most distressing and commonly reported is sexual dysfunction and decreased sex drive. Always investigate with your health care provider if it’s the prescription causing your symptoms. Once side effects resolve, a lower dose (0.5 mg every 3 days) can be tried. And if side effects persist? A less potent topical solution is available. 

Can finasteride cause depression?

Whether or not finasteride could be dangerous to your mental health is a controversial topic. Some studies (and individuals) report an increased risk of depression. It’s possible due to finasteride’s ability to disrupt biochemical pathways linked to depression, particularly the dopaminergic system. The problem is the data just isn’t a slam dunk. There are a lot of inconsistencies, meaning that different researchers and experiments show different results. A link, if it exists, is far from obvious. Still, it’s worth considering a history of depression, and the potential for depression to worsen, even if we don’t fully understand the underlying biochemical mechanisms at this time. The most comprehensive research on the topic Dr. Linkov could find can be found here.

Does finasteride increase my risk of prostate cancer? 

Did you know that finasteride can be used to treat an enlarged prostate (also thought to be caused by an abundance of DHT)? Shrinking prostates is a big yes for finasteride, but as to increasing your risk for prostate cancer? That would be a big no. 

Why does this concern persist? Early research suggested there might be a link between finasteride use and high-grade prostate cancer, but those theories have since been disproven. Finasteride does come with side effects but a risk for prostate cancer is not one of them. 

How long do I need to be on finasteride? 

There is no way around it, finasteride is a long-term commitment. Often people start finasteride expecting hair to regrow and look fuller, but as we discussed above, that’s not really how it works. Finasteride prevents hair loss by reducing levels of DHT helping to lock in existing hair follicles. Since the accelerated phase of hair loss happens young (early 20s to mid 30s), starting treatment at the earliest signs of hair loss can help maintain hair. 

Once you’re out of your 30s, however, hair loss slows significantly. Some patients do go off finasteride in their 50s (after taking it for decades) to see what happens, since by then their hair patterns are more stable. But early on? This treatment is for the long haul. 

Can Women Take Finasteride?

Sometimes. Finasteride is not for premenopausal women and women who are pregnant (finasteride causes birth defects in male fetuses), may become pregnant, or are breast feeding. There is also a caution for patients who have an elevated risk of breast cancer. Postmenopausal women and women who don’t plan on having children can be candidates. 

I’m trying to have a baby. Should I stop finasteride? 

YES. This goes without saying if you’re a woman trying to conceive as finasteride is contraindicated for pregnancy. But men should stop as well a few months before trying as finasteride can reduce sperm count. 

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Written by

Kristi Charish

Edited by

Dr. Gary Linkov

The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.