Finasteride: Oral prescription medication used for male-pattern hair loss (commonly known as Propecia)

ByDr. Celestine (Certified Trichologist)

What is Finasteride?

Finasteride is a prescription medication that helps stop hair loss by blocking a hormone that shrinks hair follicles. It works by slowing down the process that causes male pattern baldness, allowing your existing hair to stay in its growth phase longer. Most people don’t realize this pill was originally developed for a completely different medical condition before its hair-growing benefits were discovered.

I often explain to my patients that it’s one of the few FDA-approved treatments that actually tackles the root cause of genetic hair loss. The surprising part is that it doesn’t create new follicles, but rather protects the ones you still have from further miniaturization. Many of my clients see their hair loss stabilize within the first six months of consistent use.

How Finasteride Fights Hair Loss

Finasteride targets an enzyme called 5-alpha reductase that converts testosterone into DHT (dihydrotestosterone). Think of DHT like a fertilizer that’s too strong for your hair follicles – it actually shrinks them over time until they can’t produce visible hair anymore. By blocking this conversion process, finasteride lowers the amount of DHT attacking your scalp.

Your hair follicles respond by staying healthier and producing thicker, more terminal hairs instead of the fine, miniaturized hairs common in pattern baldness. I’ve observed that patients who start early, when thinning first appears, typically get the best long-term results from this mechanism.

The reduction in scalp DHT happens surprisingly fast, usually within weeks of starting treatment. However, it takes longer for your hair cycles to reset and show visible improvement.

The Finasteride Commitment Timeline

Finasteride requires patience and consistency to deliver results. Think of it like growing a tree – you need to water it regularly before you see new branches. Most people don’t notice any change until at least three to six months into daily use. The full benefits typically appear around the one-year mark.

In my clinic, I see about 80% of men experience either regrowth or significant slowing of their hair loss after twelve months. The remaining 20% primarily achieve stabilization, which is still a major victory against progressive baldness. I always warn patients that stopping the medication will reverse all gains within six to twelve months.

This isn’t a quick fix but rather a long-term maintenance strategy. The men who get the best outcomes are those who incorporate it into their daily routine without expecting overnight miracles.

Finasteride’s Unexpected Side Effects

While generally well-tolerated, finasteride can cause sexual side effects in a small percentage of users. These might include decreased libido or erectile dysfunction, particularly during the first few months of treatment. Think of your body adjusting to new hormone levels like a thermostat recalibrating to a new temperature setting.

In my practice, I’ve found these effects occur in about 2-3% of patients and are usually temporary. They typically resolve either with continued use or after discontinuing the medication. I always discuss this possibility during consultations because informed patients make better treatment decisions.

What surprises many is that these side effects are dose-dependent. The 1mg dose for hair loss has significantly fewer reported issues than the 5mg dose used for prostate conditions.

When Finasteride Falls Short

Finasteride works best for male pattern baldness at the crown and mid-scalp, but it’s less effective for receding hairlines. The medication can’t revive completely dead follicles that have been inactive for years. Think of it as protecting the territory you still hold rather than reclaiming lost land.

I often see disappointed patients who expected regrowth in areas that were already smooth and shiny. Once the follicles have miniaturized completely and the scalp shows through clearly, even finasteride can’t bring them back to life. This is why early intervention is so crucial for optimal results.

It also doesn’t work for hair loss caused by factors like nutritional deficiencies, thyroid issues, or autoimmune conditions. Proper diagnosis is essential before starting treatment.

Finasteride Versus Other Hair Loss Treatments

Finasteride works differently than topical treatments like minoxidil. While minoxidil stimulates blood flow to follicles, finasteride addresses the hormonal cause of pattern baldness. Using them together often provides better results than either treatment alone through complementary mechanisms.

In my clinical experience, the combination approach typically yields the highest patient satisfaction rates. I’ve noticed that finasteride does the heavy lifting of stopping further loss, while minoxidil helps stimulate regrowth of weakened hairs. This one-two punch approach is particularly effective for men in their late 20s to early 40s.

Unlike surgical options, finasteride is a medical treatment that preserves your existing hair. Many transplant surgeons actually recommend starting finasteride before considering surgery to stabilize loss.

Will It Work For You?

Yes

  • If you have early to moderate male pattern baldness
  • When you’re committed to taking a daily pill long-term
  • If your main concern is thinning at the crown rather than the hairline

No

  • If you’re a woman of childbearing age (it’s not approved for women)
  • When your hair loss is from non-hormonal causes like stress or illness
  • If you have advanced baldness with completely smooth areas

From My Experience

Through years of practice, I’ve developed what I call the “18-month rule” for finasteride. Patients who stick with it for at least this duration are overwhelmingly glad they did. The first year stabilizes loss, while the next six months often show gradual improvement in hair density and quality.

I always perform a baseline hair analysis and photograph new patients before they start. This objective documentation prevents the common frustration of not noticing gradual changes that are actually occurring. Our eyes adjust slowly to progressive improvement, making photos essential for tracking real progress.

The most successful patients are those who view finasteride as part of their overall health routine, like brushing teeth or exercising. Integration beats motivation when it comes to long-term hair preservation.

Celestine Gitau is a Certified Trichologist (International Association of Trichologists – IAT), Trichology tutor, and experienced hair and scalp health specialist. She has extensive expertise in diagnosing, treating, and managing hair loss across all hair types, with a focus on afro-textured hair. Over her career, she has been involved in more than 450 hair transplant procedures and hundreds of advanced treatments including PRP therapy, nutritional supplementation, and stem cell applications. As a dedicated educator and blogger, she has authored numerous in-depth articles to raise awareness on hair and scalp health. Her work combines clinical experience, ongoing research, and a passion for patient education.
Note: The information shared is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for personalized guidance.