The Controversial Drug for Male Pattern Baldness: Is Finasteride Worth the Risk?

Finasteride and Sexual Side Effects (What is the evidence ?)
Finasteride and Hairloss

Lecture by Dr. Shankila Mittal (Dermatologist)

Male pattern hair loss is a common issue that many men face, and one of the most controversial drugs for treating it is finasteride. Finasteride is a 5 alpha reductase Type 2 inhibitor that helps to reduce serum DHT levels and scalp DHT levels, working on the pathogenesis of male pattern hair loss by improving hair thickness and volume. It is more effective on the mid scalp and vertex than the hairline and should be started at a younger age to get maximum benefit.

However, many patients are hesitant to take finasteride due to reports of sexual side effects. It is proven that finasteride can cause a decrease in ejaculatory volume and erectile dysfunction, followed by ejaculatory dysfunction and loss of libido. Other sexual side effects may occur at an early stage of therapy, but they are rarely persistent. While finasteride can cause some changes in DNA or sperm motility, it is less than 2% of cases, and it never disturbs the meiotic pattern.

If a couple is planning pregnancy, finasteride can be given, but if they are already suffering from infertility, it should be refrained from prescribing. Excretion of finasteride in semen is minimal and does not affect the fetus, so no to finide if the partner.

While finaster effects like decreased libido, erectile dysfunction, and ejaculatory disorders are less than 2% of men, they may disappear while the patient is on therapy, and they are comparable to placebo. There is a high incidence of sexual dysfunction in the general population, and patients of androgenic alopecia may already be suffering from sexual dysfunction related to body dysmorphic disorders and depression. Therefore, before prescribing finasteride, it is always recommended to inform the patient about the potential side effects and only prescribe it after an informed decision.

Topical Finasteride vs. Oral Finasteride: Which One Works Better for Hair Loss?

To solve the problems related to oral finasteride, topical finasteride is also available now, which comes in combination with minoxidil as well as standalone in 0.1% and 0.25% formulation. It reduces scalp DHT levels considerably, and the results received with oral finasteride can be maintained with topical finasteride. The sexual side effects have not been reported with topical finasteride.

Another molecule that is coming into the limelight is dutasteride, which is approved in many countries for the treatment of male pattern hair loss. It is more potent than finasteride and causes clinically more effective results. Patients who have already been prescribed finasteride and have a stagnation of results can be given dutasteride to further increase efficacy.

Lastly, oral minoxidil is available for patients have in which the frontal as well as the occipital area is thinning out or are unable to use topical minoxidil. However, it should not be used in patients with cardiac disease as it can lead to tachycardia, dizziness, and pretibial edema. In females, if prescribed before menopause, it can lead to hypertrichosis in the body. It should be used with caution in selected patients.

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