How to reduce the side effects of finasteride

The technical term for balding in men is androgenetic alopecia (AGA), also known as male pattern baldness. If you are unfortunate enough to have the genes that make hair follicles more vulnerable to thinning, typically on the top of the head, then there is one medicine you need to know about. It’s finasteride and blocks an enzyme called 5-alpha reductase, which converts testosterone into dihydrotestosterone (DHT). But how do you reduce the side effects of finasteride?

At Medical Mojo, we have developed a way to get finasteride’s benefits with a reduced side effects profile. Read on to learn more, but let’s break down the whole blog before we do.

What is DHT?

DHT—these three letters are the bane of many middle-aged men experiencing male pattern baldness. But what is dihydrotestosterone, or DHT, and what is its association with androgenetic alopecia or male pattern baldness?

Why does DHT cause hair loss?

DHT  is a more potent form of testosterone that, unfortunately, in predisposed men, has a fondness for hair follicles on the scalp. But this attraction is not reciprocated, and the hair follicles in genetically primed men take flight, leaving a bald patch. That’s the short version; let’s explore this in more detail.

5-alpha reductase and DHT

Androgenetic alopecia (AGA) happens mainly because an enzyme called 5?-reductase converts testosterone into dihydrotestosterone (DHT). DHT then binds to specific receptors in hair follicles, interfering with essential signals needed for hair growth. This causes the hair growth cells to stop functioning correctly, resulting in thinner hair or hair loss[1].

Over time, hair follicles genetically prone to hair loss begin to shrink, causing the thick, healthy hair they typically produce to be replaced by much finer, thinner strands [2]. As this continues, the hair growth cycle changes, too: the growth phase (anagen) gets shorter, and the resting phase (telogen) becomes longer. Since the growth phase determines how long hair grows, the hair ends up shorter. Over time, this leads to shorter hair and a more noticeable bald spot [3].

Blocking 5-alpha reductase reduces hair loss

So, if we block the 5 alpha reductase enzyme by using finasteride to decrease the amount of DHT, we stop hair loss and encourage growth. That’s the good news, but as with everything in life, there is no such thing as a free ride. Unfortunately, finasteride comes with a whole host of side effects, including erectile dysfunction, which explains why many men are hesitant to take it.

What is androgenetic alopecia?

So, now we can return to our definition of androgenetic alopecia (AGA) or male pattern baldness. We now know this is a largely genetic condition where hair follicles shrink due to hormonal effects, typically at the top of the head [4]. It impacts over half of men under 50 [5]. Even minor hair loss that might not be easily noticed can negatively affect one’s quality of life [6].

Men genetically prone to male pattern baldness tend to convert testosterone into a more potent form, dihydrotestosterone (DHT), at a higher rate within their hair follicles due to the action of 5?-reductase [7]. Finasteride, a drug that blocks this enzyme, was initially approved in pill form to treat this type of hair loss in men [8]. Unfortunately, many men experience significant side effects, such as erectile dysfunction and loss of libido, that deter them from using it.

How effective is oral finasteride for hair loss?

The effectiveness of oral finasteride in treating androgenetic alopecia (AGA) is well-proven. Long-term studies show that taking 1 mg of finasteride daily can slow down hair loss or even improve hair growth in men with male pattern hair loss. These benefits can start to be seen as early as three months after beginning treatment and can last for 5 to 10 years [9].

What are the side effects of finasteride?

While oral finasteride is usually well tolerated, as with all medicines, it can cause some side effects in some patients due to its mechanism of inhibiting 5?-reductase. These side effects can include sexual issues such as erectile dysfunction, problems with ejaculation, and decreased sexual desire [10]. Additionally, there is an increased risk of depression [11], which has led health authorities in some countries to require warnings on the product’s label.

How can the side effects of oral finasteride be reduced?

Applying finasteride directly to the scalp has shown the potential to reduce the systemic side effects typically associated with its oral use by targeting the 5-? reductase enzyme in the scalp. This approach has gained attention in recent years. However, the topical form of finasteride is not widely available and has to be specially compounded by specialised pharmacies.

Medical Mojo has teamed up with such a pharmacy and is now able to offer a range of compounded finasteride-based hair loss liquids and foams, including:

• Finasteride 0.1% minoxidil 5% hair loss liquid
• Finasteride 0.1% minoxidil 5% hair loss foam
• Finasteride 0.1% minoxidil 10% hair loss liquid
• Finasteride 0.1% minoxidil 10% hair loss foam

Is the topical finasteride as effective as the oral tablets?

Early results from topical finasteride in treating male pattern baldness have been encouraging in studies involving a mouse model with testosterone-induced alopecia. A group treated with a 2% topical finasteride solution displayed increased hair follicle density and better growth-to-resting hair ratios [12].

In human studies, a trial conducted by Mazarella and colleagues, which included 52 patients (28 males) with androgenetic alopecia, showed promising outcomes when using topical finasteride. Starting from six months of treatment, those using topical finasteride observed a significant and continual reduction in hair loss compared to those using a placebo [13]. Additionally, there were no significant differences in the levels of total testosterone, free testosterone, and DHT in the blood between the two groups.

Does topical finasteride reduce serum DHT levels?

Early studies on a 0.25% finasteride solution applied to the scalp showed that using four sprays once a day, with each spray delivering a small amount of the medication to different areas, was the most effective way to reduce levels of DHT directly on the scalp. Importantly, this approach caused less decrease in DHT levels in the blood compared to higher doses of the medication, suggesting it could have fewer side effects [14].

So, topical finasteride reduced the DHT concentrations in the scalp, where we want this effect, sparing the DHT circulating in the plasma. These results suggest a localised effect with reduced systemic involvement.

Large-scale study into efficacy and safety of topical finasteride

 A 24-week, randomised, double-blind study involving 458 male patients across 45 European sites compared the efficacy and safety of topical finasteride to a placebo and evaluated its systemic absorption relative to oral finasteride.

Results showed that topical finasteride significantly improved hair counts at 24 weeks, with effects comparable to oral finasteride but substantially lower levels of the drug detected in the blood. This suggests a reduced risk of sexual side effects due to lower changes in hormone levels. This indicates that topical application might reduce the risk of side effects associated with higher systemic finasteride levels.

Overall, topical finasteride was found to be well tolerated. It offers an effective alternative to oral finasteride with fewer systemic effects, potentially making it a preferred option for those concerned about the side effects associated with oral medications [15].

The side effects of topical finasteride

Skin reactions like itching and redness were slightly more common with topical finasteride compared to placebo or oral forms, but these were generally mild. Notably, the large-scale study highlighted a significant reduction in serum DHT levels with both forms of finasteride. Still, reductions were more pronounced with the oral form, suggesting a lower risk of systemic side effects with the topical form. This was particularly relevant to sexual side effects, which were less frequent with topical applications.

European Guideline recommendations for hair loss

Current European guidelines recommend topical minoxidil and oral finasteride as primary treatments for androgenetic alopecia and suggest additional therapies like low-level laser light[16]. Although surgical and non-surgical methods like follicular unit transplantation and microneedling with PRP are available, they are typically recommended in conjunction with medical treatments.

Watch this video for the effects of combining PRF (platelet-rich fibrin) and six weeks of compounded finasteride 0.1% minoxidil 10% hair loss liquid. Based on these impressive results, Medical Mojo has teamed up with Rockhealth to provide a more effective hair loss treatment strategy. Book your PRP (Platelet Rich Plasma) or PRF (Platelet Rich Fibrin) with Rockhealth today.

In conclusion, the large-scale study supports topical finasteride as an effective, well-tolerated alternative to oral finasteride for treating male pattern baldness. It offers lower systemic exposure and a comparable safety profile to placebo. Further long-term studies are needed to confirm these findings.

Summary

In this blog, we examined the safety and efficacy of topical finasteride compared to the oral version, both of which are used to treat hair loss. We discussed how topical finasteride works by directly targeting the scalp, potentially reducing the risk of systemic side effects associated with the oral form. Research shows that topical finasteride is similar in its effectiveness in promoting hair growth while minimising hormonal side effects.

To try the compounded finasteride hair loss liquid or foam, you will first need to complete a health questionnaire. If you have any concerns about starting a hair loss therapy based on either finasteride or dutasteride, please do not hesitate to contact us.

At Medical Mojo we aim to give you the knowledge you need to make informed health choices. Feel free to reach out if you have any questions or suggestions for future topics.

References:

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