Does Propecia Work for Female Pattern Hair Loss?

Hair loss is a common problem, affecting up to 70% of men and 40% of women at some point in life.

But hair loss is different in men and women. Most men lose hair at the hairline and temples, while women typically lose hair diffusely over the top of the scalp. According to the American Academy of Dermatology, more than 30 million women in the US are affected by female pattern hair loss, or FPHL. While FPHL can occur as early as puberty, it is more common later in life, particularly after menopause, when an estimated 38% of women over age 70 experience hair loss. Women who experience hair loss from any cause generally find the situation stressful, and it can lead to social isolation due to self-consciousness.

What Is Today’s Go-to Treatment for Female Pattern Hair Loss?

Currently, the “first-line” treatment for FPHL is 2% minoxidil applied to the scalp daily. While this treatment is convenient, since minoxidil is sold over the counter, it isn’t ideal. In some women, the 2% solution isn’t effective enough, and they can try the 5% minoxidil solution to see if that helps. Also, it takes several months of regular use to make a sound judgment on the effectiveness of minoxidil.

Some doctors prescribe anti-androgen drugs to women whose hair loss appears to be due to higher-than-normal levels of androgen. Now, however, more medical professionals are looking at finasteride, the active ingredient in male pattern baldness drug Propecia, as a treatment for women.

Studies on Finasteride Given at 1 mg per Day

When women were given finasteride at a dose of 1 mg per day (the same dosage in Propecia), results weren’t very good. A study at the University of California at San Francisco found that after a year of therapy with 1 mg per day of finasteride, hair loss continued as before, though the drug was well-tolerated with few reported side effects. Though these results were discouraging, researchers in Europe decided to test the effects of higher doses of finasteride on women with FPHL.

Studies on Finasteride Given at 5 mg per Day

At a meeting of the European Academy of Dermatology and Venereology, Dr. Rui Oliveira-Soares presented research on the effects of 5 mg per day of finasteride on 43 premenopausal women over a period of 18 months. These women had normal serum androgen levels and had no clinical signs of hyperandrogenism (excess male hormones), and they had to be certain they would not want to become pregnant again. Finasteride is linked with serious birth defects, and study participants had to be certain they didn’t want to have more children (they had to take an oral contraceptive as well). After six months of treatment, 58% of the study participants reported a “huge” improvement, and 33% reported “moderate” improvement.

Investigators did blinded assessments of patient photos, and though their conclusions were less enthusiastic, they were still encouraging. Investigators characterized 44% of patients as “very improved,” 17% as “somewhat improved,” and 7% as “unimproved.”

Just under 19% of participants reported decreased sex drive during the trial, while 9% reported transient headaches and nausea, with 9% also reporting transient abnormal menstrual periods. One of the patients had abnormal liver function test results and dropped out of the trial.

Precautions When Taking Finasteride

As mentioned earlier, finasteride is associated with birth defects, and package labeling clearly states that women who are pregnant or who may become pregnant should not handle finasteride, let alone consume it. Additionally, finasteride is extensively metabolized in the liver, and people who have liver abnormalities should be monitored closely if they take finasteride.

Finasteride, the active ingredient in Propecia, has shown promising effects in treating FPHL, but it appears that women must take 5 mg per day to experience improvement. Double-blind, placebo-controlled experiments are needed in order to lock down the level of improvement women can expect. While a finasteride formula for women has not been approved by the US Food and Drug Administration, physicians can prescribe the drug “off-label” if they so choose.

Finasteride must be prescribed with great caution among premenopausal women because of the risk of birth defects that goes along with finasteride use. Women should be certain they’re through having children, and should take an oral contraceptive while taking finasteride to minimize the risk of unplanned pregnancy.

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