Finasteride, Good or Bad Treatment Option?

Over 10 years ago at a dermatology congress in Sydney, Australia Kieth Kaufman and colleagues presented a study done with over 1,800 men aged 18-41 with stage 2 or higher androgenic alopecia. The men were treated with Finasteride (Propecia) during a 12 month period. The study revealed that baseline hair counts increased significantly while the placebo groups hair counts continued to be lower. This study was perhaps the first to clearly demonstrate the positive effects of Finasteride in people suffering from hair loss. There have been multiple studies since then, all with beneficial results. Of the side effects found, the most common was decreased libido found in 1-8% of patients. Erectile dysfunction was more common in the treatment group vs the placebo group (1.3% vs 0.7%).

Finasteride is also one of the most commonly used treatment options for benign prostatic hyperplasia (BPH) due to the common physiopathology between androgenic alopecia and BPH. An article published in 2003 performed at the University of Texas Health Science Center in San Antonio showed that the use of Finasteride prevents or delays the appearance of prostate cancer by 24.8%. The study included over 18,000 men over 55 years of age who were assigned Finasteride 5mg or placebo during a 7 year period. The overall incidence of prostate cancer after the 7 year period was 18% in the Finasteride group, compared to 24% in the placebo group.

Finasteride has been approved for the treatment of androgenic hair loss and is attractive because it inhibits the conversion of testosterone to its more potent form dihydrotestosterone inside the prostate. According to the authors of the study, the greater reduction in risk of prostate cancer incidence must be weighed against the smaller sexual side effects encountered.

Finasteride, good or bad treatment option

The use of 5mg/day of Finasteride (Proscar) for BPH is known to lower serum concentrations of Prostate Specific Antigen (PSA). PSA is used to measure prostate activity and risk of prostate cancer.

A randomized controlled trial published in Lancet Oncology in 2007 aimed to assess the effect of Finasteride 1mg/day (Propecia) and its effect on PSA serum levels. Over 350 men aged 40 to 60 with androgenic hair loss were enrolled in the study and assigned 1mg/day of Finasteride and followed during a 48 week period. The results showed a median PSA level decrease of 40% in the Finasteride group compared to a 0% difference for the placebo group.

The study concluded that in men 40 to 60 years of age with 1mg/day of Finasteride during a 48 week period lowers PSA.

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