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Dr. Cole is commited to patient education.
He will review the details, effectiveness, and side effects of finasteride and minoxidil as part of your medical consultation, helping you to determine if one of them should be part of your treatment program.
Finasteride (brand name Propecia™)
Finasteride 1mg taken daily by mouth, is usually recommended for consideration by patients who still have some significant hair remaining on their scalp. This can slow or stop the balding process, or even enhance the existing fullness. Younger patients, who are losing their hair more quickly in their 20’s and 30's are usually strongly encouraged by Dr. Cole to consider finasteride as part of their treatment program, and may even be all that they require if seen early enough in their balding process.
Patients over 40, whose hair loss is more stable, may still consider it as an adjunct treatment along with a hair transplant. Since finasteride helps to maintain and sometimes improve and thicken the existing hair in the balding areas of most men, it can assist in creating a fuller look when combined with hair transplantation. |
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Finasteride FAQ
What is Finasteride used for?
Finasteride is used for the treatment of male (only) pattern hair loss on the vertex and the anterior mid-scalp area.
Finasteride/Propecia is for use by MEN ONLY and should NOT be used by women or children.
What is male pattern hair loss?
Male pattern hair loss is a common condition in which men experience thinning of the hair on the scalp. Often, this results in a receding hairline and/or balding on the top of the head. These changes typically begin gradually in men in their 20s. We believe male pattern hair loss is due to heredity and is dependent on hormonal effects. This type of hair loss is described as androgenetic alopecia.
Will Finasteride work for me?
For most men, finasteride increases the number of scalp hairs in the first year of treatment, helping to fill in thin or balding areas of the scalp. In addition, men taking finasteride may note a slowing of hair loss. Although results will vary, generally you will not be able to grow back all of the hair you have lost.
Male pattern hair loss occurs gradually over time. On average, healthy hair grows only about half an inch each month. Therefore, it will take time to see any effect.
You may need to take finasteride daily for six months or more before you see a benefit. Finasteride can only work over the long term if you continue taking it. If the drug has not worked for you in twelve months, further treatment is unlikely to be of benefit. If you stop taking finasteride, you will likely lose the hair you have gained within 12 months of stopping treatment.
Finasteride is not effective in the treatment of hair loss due to andro-genetic alopecia in postmenopausal women. Finasteride should never be taken by women.
How should I take Finasteride?
Take one tablet by mouth each day.
You may take finasteride with or without food.
Who should NOT take Finasteride?
Finasteride is for MEN ONLY and should not be taken by women.
Finasteride should not be taken by children.
What are the possible side effects of Finasteride?
Like all prescription products, finasteride may cause side effects. In clinical studies, side effects from finasteride were uncommon and did not affect most men. A small number of men experienced certain sexual side effects.
These men reported one or more of the following: less desire for sex; difficulty in achieving an erection; and, a decrease in the amount of semen. Each of these side effects occurred in less than 2% of men. These side effects went away in men who stopped taking finasteride. They also disappeared in most men who continued taking finasteride. |
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GOOD NEWS!
Recent studies have also shown that finasteride may also reduce the risk of prostate enlargement and cancer. In addition to enhancing or maintaining thinning scalp hair in males, finasteride can shrink the prostate gland and reduce the risk of enlargement. Recent medical studies are showing that the risk of prostate cancer drops by about 25% among men taking finasteride.
Finasteride is available from a dispensing physician or pharmacy by prescription only.
Finasteride can be taken only by men, and is of no benefit to women, and could be harmful to a developing male fetus if consumed by a pregnant woman. The most common side effect Dr. Cole sees with this medication is decreased sex drive or difficulty maintaining an erection in about 1 in 100 males over 40. When the medication is stopped this goes away. But half of his patients will have the symptom go away if they stay on it for two months. He also encourages men to try it more than once to make sure it was not some life stressors that were happening simultaneously.
Results of clinical studies:
For 12 months, doctors studied over 1800 men aged 18 to 41 with mild to moderate amounts of ongoing hair loss. Of these men, approximately 1200 with hair loss at the top of the head participated in additional extension studies, resulting in a total study time of up to five years. In general, men who took finasteride maintained or increased the number of visible scalp hairs and noticed improvement in their hair in the first year. Improvement, compared to the start of the study, was maintained through the remaining years of treatment. Hair counts in men who did not take finasteride continued to decrease.
In one study, patients were questioned on the growth of body hair. Finasteride did not appear to affect hair in places other than the scalp. |
Minoxidil (brand name Rogaine™)
 Minoxidil 2% is the only re-growth medication that is indicated for women (but not during pregnancy or lactation), and is also recommended for men over 18. Taken twice daily as a topical solution, minoxidil is used on the scalp, especially for crown baldness, to assist in the re-growth and maintenance of existing balding hair. For men, minoxidil 5% can be twice as effective, but may also have more side effects.
While this medication can be very effective. the original research on minoxidil reported that after 12 months, 8% of males had dense re-growth, 40 % moderate re-growth, 36 % minimal re-growth, with 16% showing no benefit. It must be applied to the thinning scalp twice daily. This treatment requires a highly motivated patient. Dr. Cole is less enthusiastic about recommending this approach because patients often don’t use it regularly enough for it to be effective. It also hasn’t been shown to improve growth in thinning areas at the front of the scalp, which is of concern to most of his patients.
More common side effects of topical minoxidil include scalp flaking (dandruff), itching, redness and irritation in about 15% of patients. This often leads to discontinuation of the product.
Minoxidil does not work for everyone, and a trial of 6 months to 1 year is recommended to see if it is beneficial for you.
Minoxidil is available over the counter in Canada in a 2% formulation. It is available in the US in a 2% formulation and a 5% foam. The 5% foam while more effective may also have more side effects.
Both men and women can use minoxidil, but women should begin with the 2% formulation, and discontinue its use when pregnant or breast feeding.
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