Finasteride Use In Women

Quick Summary: Finasteride & Female Pattern Hair Loss (FPHL)

Finasteride in Women: Mainly used for male baldness, Finasteride’s role in treating female hair loss is complex, especially for those of childbearing age. While it effectively reduces dihydrotestosterone (DHT) levels, its safety and effectiveness for women, particularly postmenopausal, are still under study.

Regulatory and Safety Concerns: Neither the MHRA nor the FDA have approved Finasteride for female hair loss. This is mainly due to safety concerns, including potential birth defects.

Side Effects: Women taking Finasteride need to be cautious of side effects, such as hormonal imbalances. Consulting healthcare providers is crucial for personalised advice.

Topical Finasteride: Emerging research suggests topical Finasteride might be a safer alternative for women, with fewer systemic side effects. However, more research is needed for long-term validation.

Alternatives: Given Finasteride’s limitations for women, other treatments like topical/oral minoxidil, hormone therapy, PRP therapy, and hair transplant surgery should be considered for a comprehensive approach to hair loss.

Hair loss is a condition that affects roughly 8 million women in the UK. It presents as both a cosmetic issue as well as a significant emotional burden. Unlike male baldness, female hair loss tends to be more diffuse and less predictable in its progression.
This article aims to shed light on Finasteride as a potential treatment option, and its applicability for women suffering from hair loss. 

Overview of Female Hair Loss 

Female hair loss manifests in various patterns, primarily as thinning hair across the scalp, which contrasts from the typical male pattern of receding hairlines and bald crowns.
The causes of these various patterns of hair loss are due to genetic predispositions to changes in female hormones. The most common kind of female pattern hair loss (a.k.a FPHL) is androgenetic alopecia. Pinpointing the exact type of hair loss is crucial in effective treatment planning. 

Finasteride: A Brief Overview 

Known for its role in managing male pattern baldness and benign prostatic hyperplasia, Finasteride works by blocking 5-alpha-reductase. This enzyme converts testosterone into dihydrotestosterone (DHT), a key player in hair follicle miniaturisation and hair loss.¹ By reducing DHT levels, Finasteride offers a scientifically accurate approach to managing hair loss, potentially slowing down the rate of hair loss, and stimulating regrowth. This provides a valuable option for individuals exploring treatments for hair preservation.

How Finasteride Influences Hair Health 

In men, Finasteride’s ability to lower DHT levels has been well-documented. Its effectiveness hinges on mitigating the hormonal cause of follicle shrinkage, resulting in hair retention or regrowth.^1,2

The Complexities of Finasteride Use in Women 

The application of Finasteride use in women for hair loss is more complex. The medication’s efficacy and safety profile for females, particularly those of childbearing age, is an ongoing subject of research and debate. Mixed results from studies indicated possible benefits for hair preservation in postmenopausal women. However, beyond this, its impact on FPHL remains elusive.³

Navigating Regulatory Guidelines For Finasteride Use In Women

The use of Finasteride for women continues to face regulatory hurdles. Bodies like the MHRA and FDA have yet to green-light its use for FPHL. This is largely due to insufficient evidence on its effectiveness and concerns over safety.
These concerns centre on its potential to cause birth defects, given its ability to interfere with foetal development.⁴ Therefore, its use is not recommended in pregnant women or those who may become pregnant.
The risk of birth defects, coupled with the variability in female hormonal profiles and hair loss patterns, makes Finasteride a less straightforward option for women compared to its use in men.⁵ In light of this, it is better to consider safer and approved alternatives for managing hair loss.

Understanding the Side Effects of Finasteride 

Understanding the potential side effects faced by women on Finasteride is crucial for anyone considering it as a treatment option⁶: 

Oral Finasteride:

• Decrease in libido, dry skin, mild acne 
• Headaches, irregular menstruation, dizziness 
• Increase in body hair growth
• Rise in liver enzyme levels 

Topical Finasteride: 

In general, beyond a decrease in serum DHT levels, no systemic side effects have been reported by patients with FPHL. This is potentially due to its localised approach with minimal systemic absorption. However, further research is needed for long-term safety confirmation.

Research Highlights on Topical Finasteride 

In contrast to the side effects associated wit oral Finasteride, topical Finasteride emerges as a promising alternative, especially for women experiencing pattern hair loss.

Recent studies have brought to light this topical preparation’s benefits. Key study findings include several key points such as^7,8: 

• Reduced Hair Loss and Improved Growth: Topical finasteride has shown a significant reduction in hair loss rate, increase in hair count, and overall improvement in hair growth.

• Targeted Reduction in DHT: This treatment effectively decreases DHT levels in the scalp, treating pattern hair loss. Notably, this decrease in DHT is localised to the scalp, with no significant changes in systemic hormone levels.

• Minimised Side Effects: Unlike oral Finasteride, the topical variant does not seem to induce systemic side effects. Some minor side effects like scalp irritation were reported, but these are generally mild and well-tolerated.

• Combination Therapy Prospects: The research also explored combining topical Finasteride with other treatments, such as minoxidil, suggesting enhanced effectiveness.

• A Benefit for Female Patients: Given that oral Finasteride is not yet approved for women due to potential hormonal effects, topical Finasteride could be a safer, effective alternative.

Despite these encouraging findings, further research is crucial to confirm the long-term safety and optimal application methods. This growing body of research suggests that topical Finasteride could be a viable and safer option for women grappling with pattern hair loss.

Alternative Approved Treatments for Female Hair Loss 

With Finasteride’s limited applicability for women, exploring approved alternatives becomes paramount⁹: 

• Topical Minoxidil: Approved for female use, this first-line over-the-counter treatment is applied directly to the scalp and can stimulate hair growth and slow hair loss. 

• Oral Minoxidil: Low-dose oral Minoxidil can be an option for women who do not respond to topical treatment.
  It is essential to monitor for uncommon side effects like hirsutism (excessive hair growth) and cardiovascular changes, but it can be an effective alternative with potentially better adherence compared to topical application.

• Hormone Therapy: For women whose hair loss is linked to hormonal imbalances, treatments like oral contraceptives or hormone replacement therapy may offer relief.

Advanced therapies:

• Platelet-Rich Plasma (PRP) Therapy: Although more research is needed, PRP therapy has shown promise in stimulating hair growth by injecting a concentration of a patient’s own platelets rich in growth factors into the scalp. 
• Hair Transplant Surgery: In cases where medical treatments do not yield the desired results, hair transplant surgery might be considered. This involves the transfer of hair follicles from one part of the scalp to another. 

Lifestyle and Nutritional Adjustments: 

• A balanced and nutritious diet, stress management, gentle hair care, hydration, good sleep, and regular scalp massages can support hair health. These act as complementary strategies alongside medical treatments. 

Practical Advice for Women Exploring Hair Loss Medications 

For women navigating the complexities of hair loss treatment, consulting with a healthcare professional experienced in dermatology or trichology is essential. An in-depth assessment can uncover the root cause of hair loss and guide the choice of treatment. While Finasteride may offer hope for some under medical guidance, it remains generally undesirable as a treatment option for women due to its questionable risk-benefit ratio seen in current studies. A tailored approach with a healthcare professional, grounded in an understanding of the individual’s unique hair loss journey, can unveil effective and safe treatment pathways. 

Key Tips for Your Doctor’s Consultation on Hair Loss Treatment:

• Track Your Hair Loss: Note the onset, progression, and any distinct patterns you’ve observed.
• Medications and Supplements: List everything you’re currently taking, as these could influence both your hair loss and potential treatments.
• Health and Family History: Share any relevant personal health issues and family history of hair loss, as these can be important indicators for your treatment plan.
• Essential Questions: Prepare to ask about the suitability of treatments for female pattern hair loss, possible side effects, and any effective alternatives.
• Lifestyle and Hair Care Habits: Discuss your diet, physical activity, and current hair care practices, which might be impacting your hair health.

This preparation will enable a more productive consultation and help your healthcare provider offer tailored advice for your hair loss treatment.

Conclusion 

While Finasteride offers a potential avenue for hair loss treatment, its use in women is nuanced with limitations and concerns.
The lack of approval for female patients underscores the need for caution and thorough consultation with healthcare professionals before considering it as a treatment option. Alternatives like Minoxidil, hormone therapy, PRP, or hair transplantation present viable options for women struggling with hair loss, each with its own profile of benefits and considerations.

The landscape of female hair loss treatment is evolving, with research continually shedding light on new possibilities. Engaging with knowledgeable healthcare providers can help women navigate this journey with informed confidence due to effective solutions and, ultimately, regrowth and renewal.

References:

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2. McClellan KJ, Markham A. Finasteride: A Review of its Use in Male Pattern Hair Loss. Drugs. 1999;57(1):111–26. doi:10.2165/00003495-199957010-00014. Available from: https://pubmed.ncbi.nlm.nih.gov/9951956/  
3. Iamsumang W, Leerunyakul K, Suchonwanit P. Finasteride and its potential for the treatment of female pattern hair loss: Evidence to date. Drug Design, Development and Therapy. 2020 Mar;Volume 14:951–9. doi:10.2147/dddt.s240615. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060023/ 
4. Prahalada S, Tarantal AF, Harris GS, Ellsworth KP, Clarke AP, Skiles GL, et al. Effects of finasteride, a type 2 5‐alpha reductase inhibitor, on fetal development in the rhesus monkey (macaca mulatta). Teratology. 1997 Feb;55(2):119–31. Available from: https://pubmed.ncbi.nlm.nih.gov/9143092/ 
5. Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. Finasteride. 2022 Oct. Available from: https://www.ncbi.nlm.nih.gov/books/NBK582707/ 
6. Oliveira-Soares R, André M, Peres-Correia M. Adverse effects with finasteride 5 mg/day for patterned hair loss in premenopausal women. International Journal of Trichology. 2018;10(1):48. doi:10.4103/ijt.ijt_73_15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803857/  
7. Lee SW, Juhasz M, Mobasher P, Ekelem C, Mesinkovska NA. A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. J Drugs Dermatol. 2018;17(4):457-463. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609098/ 
8. Keerti A, Madke B, Keerti A, Lopez MJ, Lirio FS. Topical finasteride: A comprehensive review of Androgenetic Alopecia Management for men and women. Cureus. 2023 Sept 9; doi:10.7759/cureus.44949. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561660/ 

Müller Ramos P, Melo DF, Radwanski H, de Almeida RF, Miot HA. Female-pattern hair loss: Therapeutic update. Anais Brasileiros de Dermatologia. 2023 Jul;98(4):506–19. doi:10.1016/j.abd.2022.09.006. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334345/