What Should I Know Before Starting Hair Loss Medication?

Written by Adrian Blackwell, MD

If I am going bald, what can I do to treat it? Is hair loss medication safe and effective?

Why am I losing my hair and what is “Androgenic Alopecia”?

There are lots of reasons why men lose hair. Probably the most common cause of hair loss is androgenic alopecia - which is a fancy way of saying, male pattern baldness. This is a slow and steady loss of hair on certain areas of your head. As hair is lost, it results in some pretty common and recognizable patterns like the “widow’s peak.”

This type of hair loss can start as young as the teenage years. Typically it starts to unfold for men in their mid-life years from 30 to 40 years old. Usually it will steadily get worse over the years.

This happens because of testosterone breakdown. The body breaks down testosterone into something different called DHT, which is an androgen. This is the product that harms hair growth - it makes hair grow slower, fall out faster, and makes new hair thin and fine. The hair loss medicine - Finasteride - is used to block testosterone from turning into DHT.

Other causes of hair loss in men

There are many causes of hair loss and you can read about some of them here. It is important to see a doctor if you are losing hair, because it can have several other causes. Your doctor will look at your hair and talk with you to see if special testing needs to be done. Most men do not need special testing for their hair loss.

However, some men need to see a skin specialist (a dermatologist) to dig a little deeper with special tests. This is true if hair loss happens very fast or if the skin on top of your head (scalp) is painful to touch or has a lot of itching and burning. If the hair loss is patchy and on other parts of your body you’ll need that looked at as well. Fast hair loss, patchy hair loss, and scalp rashes are not typical in male pattern baldness.

Treating male pattern baldness

The good news is that there are multiple treatments for male pattern baldness. There are two medicines that have been well studied for this problem: minoxidil and finasteride. These medicines are proven to improve hair growth in men who suffer from male pattern baldness and you can read more about the studies here

Some men may need to have hair restoration surgery - commonly known as a hair transplant. This type of procedure involves removing hair from the back of the head and then placing those hairs to the balding parts of the scalp.

What is Minoxidil?

Minoxidil is a topical hair loss medicine, which means it comes in a foam or a spray that you rub on the top of your head and hair. This medicine does not need a prescription from a doctor. You will typically find it at your local pharmacy labeled as Rogaine.

Learn about Finasteride

Finasteride is a medicine that blocks the breakdown of testosterone. The medicine is used for two primary issues: First- men that have large prostates - also known as “Benign Prostatic Hyperplasia” or BPH for short; and second, male pattern baldness which is also known as Androgenic Alopecia. A much higher dose of finasteride is used to treat prostate problems (5mg) then the amount used to treat hair loss (1mg).

Since it has two different categories of treatment at two different doses - it has two different names you might see too. The brand for prostate treatment is called Proscar, while the brand for hair loss is called Propecia. They are both finasteride, but contain different amounts of finasteride in a single pill.

What are the side effects of finasteride?

The good news here is that potential side effects of finasteride are not common, are mostly pretty mild, and will go away if you stop taking it - for the most part. Less than 1% of men have to experience the side effects below while taking finasteride:

  • Erectile Dysfunction (0.6%)
  • Decreased libido (0.5%)
  • Decreased volume of ejaculate (0.4%) - does not negatively impact sexual function in and of itself
  • Depression (< 1%)
  • Allergic reactions (< 1%)

There are some other reported side effects for finasteride. These side effects seem to be a problem for men who are taking the higher dose of finasteride that is used to treat prostate problems (5mg for prostate enlargement, 1mg for hair loss treatment). The side effects linked to higher doses of finasteride are still very uncommon, but can include:

  • Breast changes (discharge from the nipple, lumps, enlargement, and tumors)
  • Male breast cancer (very rare association)
  • Testicular pain
  • In men over the age of 55 years old, using 5mg of finasteride for an enlarged prostate, it might cause an aggressive type of prostate cancer ( 0.7%)

You can read more about finasteride - Proscar (prostate drug) and Propecia (hair loss drug), respectively - here.

Who should not take Finasteride?

Finasteride has not been studied for use in children or women. It should not be used to treat hair loss in women. In animals, finasteride has been shown to affect the development of genitalia of unborn males. So this is especially dangerous in pregnant women. Since the liver is responsible for breaking down finasteride in the body - anyone with a history of liver problems or known liver problems should not take this medicine.

Finasteride falsely lowers your PSA

PSA is short for prostate specific antigen. This is a blood test that your doctor may use to check and see if you have prostate cancer or to monitor current prostate cancer. Finasteride can decrease your PSA level on lab tests - that is, it makes the PSA look lower than what it really is. If your doctor orders this test it’s important that they know you’re taking finasteride.

Accurate Information

In order for us to assess your visit and determine if hair loss medicines make sense for you - it is very important that you provide full and accurate health information. If you have any questions about what something means, or how to get certain information just message us in the secure chat or call us and we can help. We need real data and it is important that you provide accurate information for your own safety.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of HeyDoctor, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

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