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How does finasteride work?
In androgenetic alopecia, certain hair follicles are sensitive to dihydrotestosterone (DHT). DHT can contribute to follicles becoming smaller over time and producing shorter, finer hairs. Finasteride inhibits type II 5-alpha-reductase, an enzyme involved in converting testosterone to DHT. [1]
This mechanism explains why finasteride is discussed mainly in hereditary hair loss. The effect is not immediate because hair grows in cycles. Whether finasteride is suitable depends on age, sex, medication, family planning, medical history and tolerability.
Evidence
Finasteride is one of the best-studied ingredients in male androgenetic alopecia. In clinical studies, hair counts and photographic assessments improved or stabilized compared with placebo. [1] The evidence is strongest for oral use in men; topical forms have growing clinical evidence. [2]
Results still vary from person to person. Some people respond well, while others respond little or not at all. Timing also matters: in areas where follicles have been inactive for a long time, expectations need to be more cautious.
Oral and topical forms
Finasteride can be used orally or topically. The oral form acts systemically, while the topical form aims more directly at the scalp. Studies of topical finasteride have examined whether local use can influence DHT activity on the scalp while reducing systemic exposure. [2]
This distinction is medically relevant, but it does not replace physician judgment. A physician must assess whether finasteride is suitable at all and which form is appropriate in the individual case. For details, read the comparison of topical and oral finasteride.
Safety
Finasteride can cause side effects. These may include sexual dysfunction, breast symptoms, skin reactions and mood symptoms. [3] Such symptoms should be taken seriously and discussed with a physician.
Special caution applies during pregnancy or possible contact with pregnant people. Finasteride should not be handled unprotected in this context. Existing liver disease, laboratory values and other medications can also matter for the medical assessment.
Physician assessment
Finasteride is not a lifestyle product. It is a prescription ingredient that requires medical review. Treat hair loss online in Switzerland: with orva, you start with a medical questionnaire. Licensed Swiss physicians review your information. If medically appropriate, the physician may issue a prescription.
When it may be used
- Androgenetic alopecia when appropriate after physician review
Drug Category
5-alpha-reductase inhibitorDosage
These entries are general examples from medicinal product information or physician-prescribed forms. Your actual use depends on the package leaflet or physician instructions.
| Form | Strength | Frequency | Prescription Required |
|---|---|---|---|
| Oral (tablet) | 1 mg | 1x daily | Yes |
| Oral (tablet, low dose) | 0.2-0.5 mg | as directed by physician | Yes |
| Topical (solution or spray) | 0.005-0.25% | as directed by physician | Yes |
Side Effects
Common Side Effects
- Decreased libido
- Erectile or ejaculatory dysfunction
- Breast tenderness
Uncommon Side Effects
- Skin rash
- Mood changes
- Hypersensitivity reactions
Rare Side Effects
- Depressed mood
- Testicular pain
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Get startedNot suitable for
- Pregnancy, breastfeeding or possible contact with pregnant people
- Hypersensitivity to finasteride
- Severe liver disease
- Children and adolescents
Warnings & Precautions
Finasteride requires a prescription and should only be used after physician review.
People who are pregnant or may become pregnant should not handle broken tablets.
Finasteride can affect laboratory values such as PSA. Tell physicians if you use it.
Effects can only be assessed after several months of regular use.
Hair loss may increase again after discontinuation.
FAQs
References
- [1] Kaufman KD, Olsen EA, Whiting D, et al.. (1998). Finasteride in the treatment of men with androgenetic alopecia. Journal of the American Academy of Dermatology. https://doi.org/10.1016/s0190-9622(98)70007-6
- [2] Piraccini BM, Blume-Peytavi U, Scarci F, et al.. (2022). Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.17738
- [3] Lee S, Lee YB, Choe SJ, et al.. (2019). Adverse Sexual Effects of Treatment with Finasteride or Dutasteride for Male Androgenetic Alopecia: A Systematic Review and Meta-analysis. Acta Dermato-Venereologica. https://doi.org/10.2340/00015555-3035