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Finasteride
Finasteride is a medicine that comes up very often in conversations about hair loss, so a fair amount of imprecise information has built up around it. This text explains what finasteride is, how it is regulated and why it is a subject to be discussed exclusively with a doctor.
Regulatory status
Finasteride is a prescription-only medicine. That is not a formality. For prescription medicines the rules prohibit advertising to the general public, and the decision on whether the treatment is appropriate at all, for whom and under what conditions, is made exclusively by a doctor, based on an examination and medical history.
For that reason you will not find dosing, a regimen, a recommendation, a comparison with other preparations or information on how to obtain it here. This is not caution for its own sake: it is what the law on medicines and medical devices requires, and at the same time the only correct approach towards the reader.
What finasteride is
Finasteride belongs to the group of 5-alpha-reductase inhibitors. In the body this enzyme converts testosterone into dihydrotestosterone, better known by the abbreviation DHT.
DHT is an androgen hormone that plays a central role in hereditary thinning of the hair. In people with a genetic predisposition, follicles in certain areas of the scalp, most often at the crown and along the front hairline, are sensitive to DHT. Under its influence the follicle goes through a process of miniaturisation: with each cycle it becomes smaller, the hair thinner, shorter and lighter, until in the end it is no longer visible. That mechanism is described in more detail in the text on androgenetic alopecia.
Finasteride was developed for a urological indication, and its use in dermatology is based on that same hormonal pathway. It is registered in several countries and is the subject of extensive clinical literature.
Why medical supervision is mandatory
Finasteride acts systemically, that is on the whole body and not only on the scalp. That is why it comes with a list of possible side effects, contraindications and interactions that have to be assessed individually.
A few points that are most often highlighted in public discussion:
- There are reported side effects, including those in the area of sexual function. Their frequency and duration are the subject of scientific debate and are assessed differently by different sources.
- Finasteride affects the PSA value, a laboratory parameter used in monitoring the prostate. A doctor must know this when interpreting results.
- The medicine is contraindicated in pregnancy. Pregnant women must not handle broken or crushed tablets because of the risk to a male foetus.
- The effect, if there is one, is not permanent independently of the treatment: stopping returns the process to its original course.
None of these points can be assessed by reading a text on the internet. That is why a conversation with a dermatologist or urologist is the only way.
Why it comes up so much on forums
Androgenetic alopecia is very common, starts early and is visible. The combination of those factors creates a large online community exchanging experiences. The problem is that in those exchanges individual experiences are passed on as a general rule, often without context about age, health status and concurrent treatment.
Particularly problematic is buying medicines outside the pharmacy, through online sellers. The origin, composition and integrity of such preparations cannot be verified, and there is no medical supervision either. That is a risk with no justification.
Cosmetics and medicines are not the same category
It is important to draw a clear line here, because in practice it keeps being blurred.
A medicine is registered to treat, alleviate or prevent disease, goes through clinical trials and a regulatory procedure, and is subject to a special dispensing regime. A cosmetic product is intended for cleansing, care and maintaining the appearance of skin, hair and nails. Cosmetics, including peptide formulations and scalp serums, by definition do not treat disease and must not be presented as a substitute for a medicine.
From that follows what will not be said in this text: no cosmetic product, including ours, is an alternative to finasteride, is not compared with it and does not take over its role. These are two separate categories with different purposes and different regulations.
What is a sensible first step
If you notice the front hairline receding, thinning at the crown, or shedding that has lasted more than a few months, the first step is not choosing a preparation but a diagnosis. A dermatologist will establish, through trichoscopy and if needed laboratory tests, what type of loss it is, because alopecias differ substantially and require different approaches. Only after that does it make sense to talk about options, any options.
In short
- Finasteride is a prescription medicine; only a doctor decides on it.
- It acts on the DHT hormonal pathway, which is involved in hereditary thinning of the hair.
- It acts systemically, has contraindications and possible side effects.
- Obtaining it outside the pharmacy and without supervision carries a serious risk.
- Cosmetic products are not a substitute for a medicine and are not compared with one.
- The first step with any persistent shedding is an examination by a dermatologist.
This text is informative in character and does not constitute medical advice, a treatment recommendation or advertising of a medicine. For all information about medicines consult a doctor or pharmacist.