Finasteride

Generic finasteride 1mg and Propecia

The UK patent for Propecia expired in 2014. ‘Generic Propecia’ or more accurately ‘generic finasteride’ became available from other pharmaceutical companies. A generic medicine is a medicine which is the same as a branded original, but is prescribed and supplied by its medical name, rather than its brand name.

Propecia is a brand name. The active ingredient of Propecia tablets is finasteride 1mg. Propecia tablets and finasteride 1mg tablets are medically the same. Dr Fox may supply any UK licensed generic version (Accord, Amarox, Bristol, Mylan, Milpharm/Aurobindo, Relonchem).

How long does it take to work?

Clinical studies show improved hair growth usually noticeable after 4-6 months of taking finasteride 1mg daily. Maximum benefit is seen at 1-2 years. At 2 years 66% of men had improved hair growth counts compared to 7% of those taking no drug.

The studies were conducted on men aged 18 to 41 years of age with mild to moderate hair loss, but not complete hair loss.

How does finasteride work?

Hair grows in hair follicles normally for about three years. The hair then falls out and a new hair grows from the follicle. For men affected by male pattern hair loss, as they age, hair follicles gradually become smaller. New hair becomes thinner and falls out more quickly, eventually not growing enough to break the surface of the scalp (balding).

Male hormones cause these changes. Hair follicles convert the male hormone testosterone into another hormone called dihydrotestosterone (DHT). Hair follicles become more sensitive to dihydrotestosterone and this causes the hair follicles to shrink.

Finasteride 1mg blocks testosterone conversion to DHT which results in hair regrowth and improved hair thickness in most men.

Who benefits

Men at any stage of male pattern hair loss are likely to benefit. Finasteride 1mg is most effective for hair loss over the top of the scalp (vertex). It has NOT been proven to reverse receding frontal hairline, hair loss which is ONLY in the temple regions, nor restore hair to entirely bald areas.

Cautions

• If hair loss has been rapid and recent, or where there are symptoms of serious illness, such as unexplained weight loss, fevers, persistent diarrhoea, or excessive fatigue, you should see your GP.
• If hair loss is patchy or irregular, or comes out in clumps, or there is scalp inflammation, the scalp should be examined by a GP or dermatologist.
• Blood tests carried out to detect prostate cancer (PSA) can give misleading results when finasteride 1mg is being taken. Tell your doctor that you are taking finasteride, if you are having a PSA test.
• If treatment is stopped, the beneficial effects begin to reverse by six months and return to baseline by 9 to 12 months.
• Pregnant women should not come into contact with finasteride. It may affect the baby’s sex organ development. For this reason tablets are film-coated and women should not handle crushed or broken tablets.

What are the possible side effects of finasteride?

Finasteride 1mg is usually well tolerated by most men and side effects are uncommon. Men taking finasteride are at increased risk for erectile dysfunction, decreased libido, or other ejaculation disorder with up to 1 in 27 reporting changes in the first year. This is not generally severe enough to prevent continued use (1% mention it as a reason for stopping).

There are some case reports of diminished libido or erectile dysfunction persisting after stopping the drug and the patient leaflet has been updated to reflect this.

In 2017 the NHS reviewed new research and concluded that If sexual problems do occur, the drug can be stopped and the problem will resolve in nearly all cases. An editorial in the British Medical Journal in 2019 supported this position, but suggested a need for further research.

Other side effects can include breast tenderness, gynaecomastia (enlarged breast tissue in men), and anxiety or depression.

Important: if you develop any lumps or experience pain in your breast area, or discharge from your nipples, please consult your GP. There have been rare reports of breast cancer in men who have taken finasteride.

Some men have reported episodes of depressive illness in association with the use of finasteride 1mg for male pattern hair loss. There are some reports of men having suicidal thoughts. If low mood or depression develops stop treatment immediately and consult your GP straight away.

See patient leaflet for full list of side effects.

Alternative hair loss treatment

Regaine Extra Strength (minoxidil 5%) foam or lotion applied to the scalp twice daily is the only other proven effective hair loss treatment. Regaine and finasteride 1mg can be used at the same time.