Finasteride 5 mg/day treatment of patterned hair loss in normo-androgenetic postmenopausal women

Abstract

Background:There is no consensus on the standard treatment options for female pattern androgenetic alopecia (AGA). Efficacy of finasteride in women is controversial. The purpose of this study was to evaluate the clinical efficacy and safety of 5 mg/day oral finasteride in normoandrogenic postmenopausal woman.Materials and Methods:A total of 40 normoandrogenic postmenopausal women with AGA was enrolled in this study. They were treated with oral finasteride 5 mg/day for 18 months. Efficacy was evaluated by patient's satisfaction and global photograph assessment. All the 40 patients completed 18 months of finasteride treatment schedule.Results:After 6 months, 22 patients referred significant improvement, 12 moderate improvement, and 6 no improvement. Regarding to global photo assessment, 8 patients showed no improvement, 16 showed moderate improvement and 16 showed significant improvements at the 6th month. A slight improvement was observed over time from 6 to 12 and 18 months observation. Maintained libido reduction was referred by four patients and liver enzymes increase was observed in one patient. Older patients were more prone to worse response.Discussion:Finasteride 5 mg/day is effective and safe for the treatment of female AGA in postmenopausal women in the absence of clinical or laboratory signs of hyper-androgenism.

The efficacy and use of finasteride in women: a systematic review

“…Finasteride dosage for treatment of FPHL varied widely (1–5 mg/day). Four studies suggested that high‐dose (5 mg/day) finasteride use in postmenopausal patients with FPHL could effectively improve hair loss in 6–12 months . One of the studies further demonstrated no significant difference between premenopausal and postmenopausal groups in the percentage of improvement in scalp hair appearance and changes in hair thickness .…”

“…Current research on finasteride in premenopausal and postmenopausal women with FPHL has highlighted its use in high (5 mg/day), medium (2.5 mg/day), low (1.25 mg/day), and lower (1 mg/day) doses. This range has predominantly improved hair loss in women with FPHL, but evidence from RCTs suggests otherwise for high and low doses, and high‐powered studies are lacking for medium and low doses in the past 20 years (Table ). Interestingly, the high finasteride doses that did demonstrate improvement were only studied in postmenopausal women, and none were RCTs .…”

“…This range has predominantly improved hair loss in women with FPHL, but evidence from RCTs suggests otherwise for high and low doses, and high‐powered studies are lacking for medium and low doses in the past 20 years (Table ). Interestingly, the high finasteride doses that did demonstrate improvement were only studied in postmenopausal women, and none were RCTs . Of note, one of these therapeutically successful studies compared finasteride use in premenopausal and postmenopausal women in the absence of oral contraceptives in order to assess the pure effects of finasteride without confounding the antiandrogenic effects .…”

“…While there are multiple 5‐alpha‐reductase isotypes in the body, finasteride specifically acts on isoenzyme II, which is found in the uterus, endometrium, fallopian tube, prostate, male genitalia, hair follicle root sheath, and liver . Because finasteride neither directly inhibits testosterone synthesis nor interacts with the androgen receptor, its physiologic actions are restricted to DHT‐dependent tissues . However, since finasteride inhibits the conversion of testosterone to DHT, the mean circulating levels of testosterone are concomitantly increased following use.…”

“…Despite its potential teratogenicity, finasteride is prescribed to women for off‐label use in treatment of alopecia and hirsutism . Women are usually informed about the teratogenic risks with finasteride and are often administered a contraceptive to reduce pregnancy potential.…”