My Experience and Thoughts on Finasteride (Propecia)
by: Good Looking Pharmacist (w/ Good Looking Loser)
Although Good Looking Pharmacist is a licensed pharmacist in the country in which he resides, this article and all other discussions on hair loss prevention are not medical advice nor a suitable substitute for advice from a physician. If you feel you are experiencing male pattern baldness or any sort of accelerated hair loss - please see a doctor. This is subject to our Medical Disclaimer.
Lets talk Finasteride, the only FDA-approved prescription medication to prevent Androgenic Alopecia in males, also called 'Male Pattern Baldness'.
If you are interested in Propecia (or generic Finasteride), speak to your doctor.
Virtually every general practioner is willing to prescribe it for you.
Forward by Good Looking Loser
I have used Finasteride on-and-off since 2001.
I know all about the compound - from reading the clinical studies to personal use for over a decade.
I've used it to combat my natural DHT levels, DHT from super-physiological doses of anabolic steroids and DHT from hormone replacement therapy. I've used it in more dosages than I can remember.
I know this compound inside and out.
In a nutshell, as reiterated by Dr. Paul J. McAndrews and the American Hair Loss Association, Finasteride is your "first line of attack" against the progression of male pattern baldness.
My experience with the compound has been largely a positive one - a noticeable decrease in hair loss and no sexual side effects.
Throughout my 20's I used high doses of anabolic steroids - most of which Finasteride is not (and is not supposed to be) effective against.
I feel Finasteride is absolutely mandatory if you are prone to male pattern baldness and want to keep your hair.
Like ANY compound, prescription or otherwise, a minority of users will experience side effects. Finasteride is no better or worse in my opinion.
While the plight of the anti-Finasteride crowd is absolutely a justified (and noble) one, the fact of the matter is - the vast majority of guys do quite well with Finasteride.
I have been one.
(sorry - that is the reality)
The horror stories are nothing to disregard, but like all medications - the side effects are almost always temporary and can be stopped by simply discontinuing the medication. It is highly unlikely that you will have lasting 'long-term' side effects unless you choose to completely ignore the 'short-term' side effects for a significant period of time.
In the very worst case scenario in which your body no longer produces adequate amounts of testosterone (and DHT) you can see an endocrinologist who will restore your testosterone levels with basic hormone replacement therapy (HRT). You will never be stuck with brain fog and a penis that doesn't work. But again, this will only be a concern for less than .01% of guys.
That is my opinion of Finasteride.
It has worked pretty well for me and everyone I know.
I feel that every guy concerned about hair loss should speak to their doctor about Finasteride - you have a lot to gain and very little to lose.
If you get side effects (we will discuss this later) - tell your doctor and discontinue the medication and things will almost certainly return to normal.
If they don't, we have a foolproof solution for you.
Lets give you the basics on this compound so you understand what it is, how it works, why it works and what to expect.
And of course, we'll discuss some other topics that you absolutely won't hear elsewhere.
All About Finasteride
What is Finasteride?
Finasteride is the "stop hair loss" drug.
It is the only prescription medication approved by the FDA for such.
Finasteride belongs to a class of compounds known as 5-alpha-reductase inhibitors.
More particularly, it is a type 2, 5-alpha-reductase inhibitor, meaning that it should ideally not have an impact on muscle growth, as muscle cells do not have receptors of this type within them.
It is available as "Propecia (1mg Finasteride)" and "Proscar (5mg Finasteride)".
Propecia is generally prescribed for hair loss and Proscar is usually prescribed for Benign Prostate Hyperplasia (BPH).
What Does Finasteride Do?
Finasteride has a few unique functions, important especially for steroid users who may experience a myriad of adverse effects while on a cycle. Its important uses can be summed up as;
- Alopecia Androgenetica - better known simply as male pattern baldness (or MPB), Finasteride was shown to be effective in more than 2 out of every 3 men using it. In fact, the other “non-responders” were shown to not have further hair loss, although they may not have had any regrowth. However, the main downside appears to be the fact that upon cessation of treatment, the hair loss may resume.
- BPH - Benign Prostatic Hypertrophy, better known as an enlarged prostate, is becoming a major public health concern, particularly because of its propensity of developing into prostate cancer. Bodybuilders who use highly androgenic steroids; such as testosterone, are at particular risk for developing BPH, be it transient or permanent.
How Does Finasteride Work?
In certain tissues in the body; particularly the prostate, skin and the scalp, testosterone converts to a much more potent androgen, known as DHT (or dihydrotestosterone). At these sites, it stimulates the cells, for example, in the skin it increases production of sebum, while in the prostate its influence leads to enlarging of the cells. The enzyme responsible for converting testosterone into this more potent form is a 5-alpha reductase, with the type 2 isozyme found predominantly in the areas mentioned above. Administration of Finasteride competitively inhibits the effect of 5-A-R, preventing testosterone from being metabolized. The effect of Finasteride is somewhat residual; with a protective effect on the prostate and scalp lasting up to 10 months after stopping therapy.
How Should Finasteride Be Used?
Use as directed by your doctor.
Depending on the goal of using it, the dosage my vary significantly;
- For Hair Loss - generally, a dose of 1mg daily is very effective; however a dose of up to 2 mg is proven to be effective for its effect on the scalp. Doses above that have no real value or effect, as saturation of the receptors occurs at that dose.
- For BPH/ Enlarged Prostate - doses of 5mg daily, taken either as a single dose or in 2 split doses, have proven the best. As with the use for hair loss, doses above this are not effective.
I am prescribed both Proscar and Propecia.
I personally take 2.5mg of generic Proscar, every other day.
Is Finasteride Proven Effective for Male Pattern Baldness?
Yes, according to multiple studies conducted on the drug.
The American Hair Loss Association reports that 1mg of Finasteride can reduce DHT up to 60% - a decrease that significantly slows or even prevents further hair loss in most guys.
Researchers found and published in the "Journal of the American Academy of Dermatology" that at a dose of 1mg/ day for a year the vast majority of men had marked improvement of hair loss symptoms, especially in the frontal area.
The study concluded -
In men with hair loss in the anterior/mid area of the scalp, Finasteride 1 mg/day slowed hair loss and increased hair growth.
The conclusions in the 2004 Swiss "Journal of Dermatology" were nearly identical and Finasteride was even more effective when paired with 5% Minoxidil.
A study in the scholarly journal "Drugs" found that Finasteride can prevent hair loss and help regrow hair as well -
Oral finasteride promotes scalp hair growth and prevents further hair loss in a significant proportion of men with male pattern hair loss. With its generally good tolerability profile, finasteride is a new approach to the management of this condition, for which treatment options are few. Its role relative to topical minoxidil has yet to be determined.
So yes, it is clinically proven.
Not just by it's manufacturer (Merck).
Is it Approved for Treatment of Male Pattern Baldness?
Initially, Finasteride was used to prevent BPH by keeping DHT off the male prostate to prevent it from enlarging.
Turns out, DHT attacks hair follicles as well as the prostate.
Finasteride Side Effects
The possible side effects of Finasteride are a big sticking point when it comes to choosing whether to use it or not, owing largely to its sexual side effects. There have been reports of men experiencing disturbed libido long after discontinuing treatment, and this could be a big thing for you as well. The most commonly experienced effects of Finasteride use include;
- Development of male breasts (gynecomastia) - this is a catch-22, since inhibiting your natural DHT level allows estrogen to manifest unabated. DHT has a suppressive effect on estrogen, with DHT being a purported natural anti-estrogen
- Erectile Dysfunction - few men (less than 2%) may experience ED, since DHT plays a role on virility as well. The PDE-5 inhibitors may help (Cialis, Viagra, and Levitra) but are not guaranteed to do so.
The good news?
Any permanent effects can be reversed, normally with supervised HRT administration.
Common sense and science tells us - if you start experiencing side effects - STOP TAKING IT [and call your doctor].
Chris' Non-Medical Opinion on Finasteride and the Potential For Side Effects
0:00 My experience, history with Finasteride
1:10 I used Proscar 2.5mg every other day, as prescribed by my doctor.
2:35 My view of the potential "side effects", why it can happen to a minority of guys and how to fix it.
4:20 The "permanent' side effects and why they won't be permanent, even worst case scenario.
9:00 Finasteride works quite well for most guys, conclusion for reversing side effects.
Miscellaneous/Advanced Finasteride Topics
Is Finasteride Effective For Preventing Hair Loss From Steroids?
Yes, Finasteride is very effective for treating hair loss related to steroid usage, but only if the steroid is a testosterone based one that converts to DHT via the 5-A-R enzyme. And while it is a common belief that DHT based steroids can have their androgenic effect inhibited as well, this is wrong since the action of 5-A-R is not called into play (and Finasteride is a 5-A-R inhibitor).
Again, Finasteride is a type 2 DHT inhibitor.
It will likely not prevent hair loss from compound other than testosterone and it's derivatives.
Unfortunately, it will absolutely not be effective against DHT created by Dianabol, trenabolone, anadrol, winstrol, masteron, equipoise, etc.
Theoretically (and usually in practice - for most guys) Dutasteride is effective against DHT produced by nearly all steroids. Dutasteride, unlike Finasteride, inhibits both types of DHT. Type-2 produced from analogues of testosterone and also Type-1 from all the other various steroids.
In my non-medical opinion - you will want to start Finasteride at least 3 or 4 weeks before your cycle and remain on during PCT.
Can Finasteride Be Used With Deca-Durabolin or NPP?
There has been a decade old debate of whether Finasteride caused accelerated hair loss when paired with Deca-Durabolin (or the shorter ester, NPP).
For the longest time, people said to never pair the two because it would result in a ridiculous amount of hair loss that would continue for up to 16 months.
Sometime later, people claimed that this was simply an "old wives tale" and the combination wouldn't cause increase hair loss.
LETS CLEAR THIS UP.
Here's the answer -
NEVER PAIR FINASTERIDE WITH DECA.
When they are used concurrently, an interesting scenario unfolds; Finasteride is reduced via the 5AR enzyme to a metabolite, which is not as androgenic as DHT. In addition, the metabolite of Deca-Durabolin is less androgenic than the parent compound, which means that if your Finasteride is pre-occupied with the metabolite, Deca-Durabolin is more able to wreak havoc on the hairline.
So in short, the potential of Nandrolone for hair loss is much more than the less androgenic metabolite (DHN- dihydronandrolone), so it’s a safe bet to stay away from it completely.
I have experienced this personally, don't pair the two if you care about your hair.
Where can I get Finasteride?
Speak to your doctor about Finasteride.
What About Liquid Finsteride from "Research" Sites?
Some research chemical sites sell the compound for laboratory use.
Many thrifty guys ignore the disclaimer and consume the product orally.
I highly suggest against doing that.
Here's the reason -
The usual dose of Finasteride is 1mg a day.
Even with a VERY PRECISE liquid dropper, it is almost impossible to measure such a small dose from liquid suspension that was likely made in a random basement.
Many research companies are known to exceed their own label claims (especially with inexpensive compounds such as Finasteride) so it wouldn't surprise me if some guys were taking a dose two or three times higher than the one their doctor suggests.
Get it from your doctor.
What About Dutasteride (Avodart)? Is That Better?
In layman's terms, Dutasteride is a stronger version of Finasteride.
As mentioned, it inhibits Type 1 and Type 2 DHT.
Dutasteride is only approved for BPH (Benign Prostate Hyperplasia) but some hair restoration doctors are prescribing it to their patients to stop hair loss.
In my personal experience, I didn't find a lot of difference between Dutasteride and Finasteride.
A clinical study published in "Reviews of Urology" (2006) found that .5mg of Dutasteride was not significantly different than taking 1mg of Finasteride.
Yet another different clinical trial in the "Journal of American Dermatology" from the same year found that 2.5mg of Dutasteride was significantly more effective than Finasteride - at any dose.
As Dr. Robert Berstein summarizes - Dutasteride (2.5mg) stopped hair loss and regrew an average of 109.4 hairs while Finasteride (5mg) regrew an average of 75.6 hairs in men that participated in the 24 week study. I mention this study in the video below.
It is probably fair to make the assumption that Dutasteride will be as good, if not better for combating Androgenic Alopecia.
I recommend you speak to your doctor about it.
In my personal opinion however -
Unless you are on hormone replacement therapy and can dictate your testosterone levels or using super-physiological doses of steroids (juicing), I think you should avoid Dutasteride unless Finasteride absolutely does not work for you or you have excessive Type 1 DHT (the kind that Finasteride does not inhibit) in your body.
Here is why -
The half-life of Dutasteride is over 4 weeks, compared to Finasteride which has 12-18 hour half-life.
If you experience side effects, it could be several months until they go away.
While Dutasteride can inhibit a higher percentage of DHT than Finasteride, you need to remember - you don't want to TOTALLY DESTROY your DHT levels.
I have before and trust me - it ain't fun.
(horrendous fatigue, bloat, rapid fat storage, depression, erectile dysfunction, etc)
Overall, however, Dutasteride will work very well for some guys. There's a plenty of stories out there. I just don't recommend it as the FIRST option.
Here is a video discussing Dutasteride -
My Non-Medical Opinion of Dutasteride
What About RU58841? Can't I Just Take That Instead?
While I have over a decade of experience with all the compounds that I've mentioned, as of August 2014 - I've only used RU58841 for research for about 7 months.
The entire time my research subject was using Finasteride as well.
I cannot comment with any certainty if it's a total replacement for Finasteride or how much better it is or isn't.
I will say though, combined with Finasteride, RU58841 (at a moderate dose) seems to be really good.
I'm very sensitive to male pattern baldness and I have very high testosterone levels - so you certainly shouldn't assume that you will have the exact same result.
The combination might lower your DHT levels too much (in which case, stop taking one or both) or it might be the ultimate solution to your Androgenic Alopecia fight.
You will have to conduct your own laboratory research.
Finasteride has been pretty good to me and just about every guy I know.
After multiple years of use, it seems to lose some (but certainly not all) of it's effectiveness.
Still, the alternative of not taking it if it works for you is a very poor decision.
I don't see any evidence that the side effects of Finasteride are any more or less frequent than any other prescription compound.
If you experience side effects, tell your doctor and he will almost always tell you to - STOP TAKING IT.
Everything will go back to normal (including your rate of hair loss unfortunately).
If it doesn't, HRT will fix you. (see our series on Hormone Replacement Therapy)
In my opinion - you have a lot to gain (keep) and little to lose so long as you stop taking it if you get side effects.
Speak to your doctor about Finasteride if you are interested in using it or you think you are seeing side effects.
This discussion is a supplement to our guide to hair loss prevention that should be published pretty soon.
Until then, you can find further information and my list of what works to prevent hair loss on Hair Loss From Steroids.
For questions or comments on this post - I won't be able to tackle them below, so I will direct you to the Good Looking Loser Hair Loss Prevention Forum.