The most common finasteride results - what should I expect?

Finasteride works by reducing levels of dihydrotestosterone (DHT), a hormone that causes male pattern hair loss (androgenetic alopecia).

DHT is a type of male hormone called an androgen. When you go through puberty, DHT, along with other androgens, is responsible for the development of male characteristics, like a deeper voice and the growth of body hair.

For those with a predisposition to male pattern baldness, the hormone can damage hair follicles later in life. It does this by binding to receptors in the scalp, shrinking the follicles and preventing the growth of healthy hair.

DHT is created as a by-product of testosterone. Finasteride inhibits the enzymes involved in the conversion of testosterone into DHT, lowering the DHT levels in your body and scalp. This means that DHT can no longer bind to follicles and cause further hair loss.

There is no permanent cure for male pattern hair loss, but finasteride can delay hair loss and reverse some of the damage.

It usually takes a few months to start to see results, with the most visible improvements appearing after a year.

In addition to preventing further hair loss, finasteride may also help with hair regrowth in some men. A 2003 report found that 48% of the men treated with finasteride showed improvement in hair growth at the one-year mark compared with 7% of men receiving the placebo.

This continued through the first two years of treatment, where 66% of men treated with Propecia had an increase in hair growth, while only 7% of men in the control group experienced the same improvement.

After two years, new hair growth began to decline. However, those treated with Propecia still showed improvement when compared with their baseline, pre-treatment levels. In contrast, those in the control group experienced a more rapid rate of hair loss.

Although finasteride begins working immediately, it can take a few months for noticeable results to appear - this is because hair takes time to grow. For men, it usually takes around three months before you need a new haircut!

To know why it takes so long for the treatment to work, it can be helpful to understand the hair growth cycle.

The hair growth cycle encompasses four different stages:

• The anagen phase - this is the ‘growing’ phase. Hair stays in this phase for around 2-7 years.
• The catagen phase - lasting only a few weeks, this is the second stage of the growth cycle, during which hair transitions from actively growing to resting.
• The telogen phase - during this phase, hair remains in the follicles without actively growing. This phase lasts around three months.
• The exogen phase - the strand is released from its follicle and falls out before being replaced with another hair at its early growth stage.

Hair loss can happen when the cycle is disrupted. With male pattern baldness, hair follicles shrink, making it more difficult for hair to grow. The anagen phase, or active growing period, shortens, while the telogen, or ‘shedding’ phase, lasts longer. The result is a reduction in the amount of hair on the scalp. Finasteride can help extend the growth phase and decrease the length of the shedding stage.

The first few months

Finasteride begins reducing the amount of DHT in your bloodstream as soon as you take the first pill, but you likely won’t notice a big difference in the appearance of your hair until after a few months. This is because hair grows slowly - it can take a month for your hair to reach up to a centimetre in length.

After six months

Results can be enjoyed after 3-6 months, with a 2004 study showing significant improvement in men with male pattern hair loss after 12 weeks.

After a year

You will likely experience further improvement up to a year after beginning treatment, with studies showing increased hair count and thickness after 12 months. One study showed a 14% increase in hair count after a year of finasteride compared with the control group.

Results vary between individuals. You may find that you are no longer losing hair, or you may find that your hair thickness has significantly improved.

Finasteride is most commonly associated with sexual side effects, such as erectile dysfunction, lower libido, and a reduced sperm count. Understandably, some men worry about having to choose between their hair or their sex life.

However, side effects are a possibility of all medications, and not everybody experiences them, with studies showing that only 2.1% to 3.8% of finasteride users experience sexual side effects. During clinical trials, only 1.2% of men discontinued treatment due to drug-related sexual side effects. These usually subside after discontinuing treatment but can be permanent in some cases.

Originally developed as an enlarged prostate treatment, finasteride can affect the results of a Prostate Specific Antigen (PSA) test, a type of blood test used to screen for prostate cancer. You should tell your healthcare provider that you are using finasteride so that they are able to accurately interpret your results.

Other side effects include breast tenderness or enlargement, depression, an allergic reaction, or testicular pain.

If you experience any side effects that you find concerning, you should seek medical advice immediately.

Combination treatment

There are many different treatment options for hair loss, but a topical formulation called minoxidil is the only other hair loss medication that is FDA-approved. Combining finasteride with minoxidil makes both medications more effective.

Available over-the-counter, minoxidil is the active ingredient in the hair loss treatment Regaine. It works by increasing blood flow to the scalp, stimulating shrunken hair follicles. The recommended course is normally two daily doses, once in the morning and once in the evening.

Be consistent

It can be discouraging when you do not experience results immediately, but it does take time for the treatment to work. If you stop taking finasteride, all hair retained while using the medication will eventually be lost, which is why it is important that you continue.