One of the most concerning issues that male patients discuss with their friends or physicians is hair loss. For many, hair is a sign of virility, and despite the inevitability of male pattern, baldness, which ultimately comes down to genetics, we still fight for that hair tooth and nail. It’s no wonder that hair restoration has grown to be such a huge industry and is rife with therapies that work and others that many claim to be effective but don’t have much data to support the assertion. From micro-needling rollers to caffeine ointment, red light therapy, various essential oils, and medication, there’s an overwhelming amount of information to process and seemingly impossible decisions to make.
Finasteride is a drug known as a five alpha reductase inhibitor. Its main claim to fame is the very effective blockage of dihydrotestosterone (DHT (finasteride blocks upwards of 90% of DHT in the prostate and 70% in the blood)). DHT is essential to the normal workings of our bodies and is instrumental in developing male characteristics. However, excess DHT on our scalp later in life can cause hair follicles to shrink and ultimately die. By controlling the DHT systemically via the oral intake of finasteride or locally through topical applications, we see some of the very best hair regrowth results of any therapy.
It’s worth understanding that finasteride was not developed as a treatment for hair loss but rather to slow the growth of the prostate to fight a natural process known as benign prostatic hyperplasia (BPH) that affects most men later in their lives. However, it soon became clear that men taking this drug grew more hair on their scalps, and you have the ubiquitous drug we are used to hearing about today.
The Side Effects of Finasteride
For all its benefits, Finasteride has some potentially significant side effects. They mostly revolve around the effects of very low DHT, including low libido, reduced general function, depression in some, and even erectile dysfunction. These effects seem more pronounced when finasteride is taken orally, but the topical version can also be problematic. Younger men seem to have greater side effects than their older counterparts. As such, if you are currently using finasteride therapy for hair loss and having difficulty maintaining an erection, you may wish to speak to Dr. Kapadia to understand more about the systemic effects that both the oral drug and, to a lesser extent, topical application can cause.
What Is the Answer?
If you look up the recommended dosages of oral finasteride, you may be shocked to see how varied they are. Dosages from .5 mg up to 5 mg are routinely prescribed. Why so much variance? We all react differently to finasteride; no single dosage makes sense for every patient. However, as with most drugs, we strongly encourage working with your primary care physician, urologist, and hair loss specialist, to take the minimum effective dose. This helps ensure the drug can take effect while minimizing its potential, side effects, and considerations. This dosage can, of course, be modified to find a sweet spot. And patients should be aware of how their body reacts in the days and weeks after changing their dosage.
It’s also important to remember that finasteride may not cause erectile dysfunction and that aging is making it more difficult for you to achieve and maintain an erection during intercourse. In this situation, we can work with you to develop an erectile dysfunction treatment plan, including medication like sildenafil (generic Viagra) or tadalafil (generic Cialis), or for more severe erectile function, problems, course of injections, or even a penile implant.
Most importantly, speak to us about this and any other erectile function issues he may have. While it may feel awkward to have that conversation, we’ve helped thousands of men with the same problem, and want you to rest, assured that it is nothing to be ashamed of. Ultimately, erectile function can be achieved, no matter how bad your condition.