Finasteride

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Finasteride on Prescriptsy

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Finasteride 1 mg is a prescription-only medicine used to treat male pattern hair loss (androgenetic alopecia) in men.

It belongs to a class of medicines known as 5-alpha reductase inhibitors and works by reducing levels of dihydrotestosterone (DHT), the hormone primarily responsible for the progressive thinning and loss of hair on the scalp in genetically susceptible men.

Finasteride 1 mg is taken once daily by mouth and is available as a generic tablet or under the brand name Propecia.

It is not available on the NHS for hair loss and requires a private prescription.

Male pattern hair loss is the most common type of hair loss in men, affecting approximately 50% of men by the age of 50 in the United Kingdom.

It follows a characteristic pattern, typically beginning with recession at the temples and thinning at the crown, and may progress to extensive baldness over years or decades.

The condition is driven by a combination of genetic predisposition and the effects of androgens (male hormones) on hair follicles.

While hair loss is not a medical condition in the traditional sense, its psychological impact can be substantial, affecting self-confidence, body image, social interactions, and mental health.

This page provides a comprehensive clinical overview of finasteride 1 mg for hair loss, including how it works, the evidence for its effectiveness, dosing guidance, potential side effects (including important safety information about sexual and mood-related effects), warnings, and how to obtain a prescription in the United Kingdom.

Important safety information about finasteride 1 mg

• Finasteride 1 mg is for men only. Women must not take finasteride.
• Women who are or may become pregnant must not handle crushed or broken tablets.
• Discuss the potential for sexual side effects with your prescriber before starting treatment.
• Report any persistent sexual dysfunction, mood changes, or depression to your prescriber.
• Tell your doctor you are taking finasteride if you have a PSA blood test for prostate cancer screening.

Understanding male pattern hair loss

Hair grows in cycles.

Each hair follicle on the scalp passes through an active growth phase (anagen, lasting 2 to 7 years), a transitional phase (catagen, lasting 2 to 3 weeks), and a resting phase (telogen, lasting approximately 3 months), after which the hair is shed and a new anagen phase begins.

In male pattern hair loss, dihydrotestosterone (DHT) binds to androgen receptors in genetically susceptible scalp follicles, triggering a progressive shortening of the anagen phase and a reduction in follicle diameter.

Over successive hair cycles, thick terminal hairs are gradually replaced by fine, short, barely visible vellus hairs. Eventually, the follicle may cease to produce visible hair entirely.

DHT is formed from testosterone by the action of the enzyme 5-alpha reductase.

There are two main isoforms: type I (found in the skin, liver, and sebaceous glands) and type II (found predominantly in the prostate, seminal vesicles, hair follicles, and liver).

Type II 5-alpha reductase is the principal isoform responsible for DHT production in the scalp.

Male pattern hair loss is classified using the Hamilton-Norwood scale, which grades the extent of hair loss from minimal (type I/II, receding hairline) through to extensive (type VI/VII, near-complete baldness of the crown and frontal regions).

Finasteride is most effective in the early to moderate stages (Norwood types II to V) and is less likely to produce meaningful regrowth in advanced baldness where follicles have been dormant for many years.

How finasteride works: mechanism of action

Finasteride 1 mg is a competitive and specific inhibitor of type II 5-alpha reductase.

By binding to the enzyme, it prevents the conversion of testosterone to DHT in the scalp, prostate, and other tissues.

At the 1 mg dose, finasteride reduces serum DHT levels by approximately 60 to 70%, which is sufficient to slow or halt follicular miniaturisation in the scalp in most men.

Scalp DHT levels are reduced to an even greater degree, as the drug concentrates in hair follicle tissue.

By lowering DHT levels, finasteride allows affected follicles to recover. The anagen phase lengthens, follicle diameter increases, and fine vellus hairs may transform back into thicker terminal hairs.

This process is gradual: visible improvement typically requires 3 to 6 months of continuous treatment, with maximum benefit observed at 12 to 24 months.

Importantly, finasteride does not affect testosterone levels or the hypothalamic-pituitary-gonadal axis to a clinically significant degree at the 1 mg dose.

Testosterone levels may rise slightly (by approximately 10 to 15%) as a compensatory response to reduced DHT formation, but this change is within the normal physiological range and does not produce clinical effects in most men.

Clinical evidence for finasteride in hair loss

The efficacy of finasteride 1 mg for male pattern hair loss was established in two pivotal phase III randomised, double-blind, placebo-controlled trials involving over 1,500 men aged 18 to 41 with mild to moderate hair loss.

In these trials, finasteride was assessed using three objective measures: hair count in a defined target area of the scalp, patient self-assessment, and investigator assessment based on standardised photography.

After 12 months of treatment, men taking finasteride 1 mg demonstrated a mean increase in hair count of approximately 107 hairs in the target area, compared with a mean decrease of 101 hairs in the placebo group, representing a net difference of approximately 208 hairs.

After 24 months, the treatment effect was maintained, with finasteride-treated men continuing to show increased hair counts while placebo-treated men continued to lose hair.

At 5 years, 90% of men taking finasteride showed visible improvement or no further hair loss, compared with 25% of men on placebo.

These results demonstrate that finasteride is effective at slowing hair loss and promoting regrowth in the majority of men with early to moderate male pattern baldness.

However, results vary between individuals, and finasteride is less effective for hair loss at the temporal hairline than at the vertex (crown).

It does not regrow hair in areas where follicles have been completely dormant for many years.

Finasteride compared with other hair loss treatments

The two evidence-based medical treatments for male pattern hair loss are finasteride 1 mg (oral) and minoxidil (topical).

Minoxidil is available over the counter as a 5% foam or solution (Regaine for Men) and works by a different mechanism, believed to involve prolongation of the anagen phase and improved blood flow to the follicle.

It is applied directly to the scalp twice daily.

Both treatments have been shown to slow hair loss and promote regrowth in clinical trials, and they work by complementary mechanisms.

Many men use both together for enhanced effect.

Key differences include the route of administration (oral versus topical), the side effect profile (finasteride carries a risk of sexual side effects; minoxidil may cause local scalp irritation and, uncommonly, unwanted facial hair growth), and the need for a prescription (finasteride requires a prescription; minoxidil does not).

Neither treatment is a permanent cure; both must be used continuously to maintain benefit, and hair loss resumes when treatment is stopped.

Hair transplant surgery is an option for men with established baldness who wish to restore hair density.

It can be combined with finasteride to protect remaining native hair from further loss.

Low-level laser therapy (LLLT) devices are marketed for hair loss but have a weaker evidence base.

Dosage and administration

Take one 1 mg finasteride tablet once daily with water. It can be taken with or without food. Swallow the tablet whole. Treatment should be taken at roughly the same time each day for consistency.

Continue treatment daily for at least 3 to 6 months before expecting visible results.

A full 12 months of treatment is recommended before deciding whether finasteride is effective for you.

If you stop taking it, hair loss will resume within 6 to 12 months.

Side effects of finasteride 1 mg

Sexual side effects

The most commonly reported side effects in clinical trials are sexual in nature: decreased libido (approximately 1.8% vs 1.3% placebo), erectile dysfunction (approximately 1.3% vs 0.7% placebo), and decreased ejaculate volume.

In the majority of affected men, these effects resolved during continued treatment or within weeks to months of stopping.

However, the MHRA has updated finasteride product information to warn that in rare cases, sexual dysfunction (including erectile dysfunction, decreased libido, and ejaculation disorders) may persist after discontinuation of the drug.

Mood-related effects

Depression, anxiety, and cognitive complaints have been reported in post-marketing surveillance.

A causal relationship has not been established in randomised trials, but patients should be aware of this association.

If you experience significant mood changes while taking finasteride, speak to your prescriber promptly.

Other side effects

Breast tenderness or enlargement (gynaecomastia) has been reported uncommonly. Hypersensitivity reactions including rash, pruritus, and urticaria are rare. Finasteride reduces PSA levels by approximately 50%, which must be considered during prostate cancer screening.

When to seek medical advice

Contact your GP or call NHS 111 if you develop persistent sexual side effects, breast changes, or mood changes.

Seek emergency help (call 999) if you experience suicidal thoughts. Report any suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Not for use in women

Finasteride 1 mg is licensed for men only and must not be taken by women.

Finasteride is a teratogen: it can cause abnormalities of the external genitalia of a developing male foetus.

Women who are or may become pregnant must not handle crushed or broken finasteride tablets, as the drug may be absorbed through the skin.

Intact coated tablets may be handled safely as the coating prevents contact with the active ingredient.

Informed consent

Before prescribing finasteride, healthcare professionals should ensure the patient is fully informed about the potential risks of sexual side effects, mood changes, and the possibility (however rare) that these may persist after stopping the drug.

The MHRA recommends that prescribers discuss these risks clearly and document the discussion.

Blood donation

Men taking finasteride should not donate blood until at least one month after their last dose, to avoid the possibility of finasteride reaching a pregnant woman through blood transfusion.

PSA and prostate cancer screening

Finasteride reduces PSA by approximately 50%. If you undergo PSA testing, inform your healthcare provider that you take finasteride so that the result can be doubled for accurate interpretation. Any confirmed rise in PSA during finasteride treatment warrants further investigation.

How to get finasteride 1 mg in the UK

Finasteride 1 mg for hair loss is a prescription-only medicine.

It is not routinely available on the NHS because hair loss is classified as a cosmetic concern rather than a medical condition.

A private prescription is required, which can be obtained from your GP (though some may decline to prescribe for this indication) or from an authorised online prescriber registered with the General Pharmaceutical Council (GPhC).

Some high-street pharmacies also offer hair loss consultation services with prescribing. Generic finasteride 1 mg tablets are widely available and significantly less expensive than the branded product (Propecia).

Living with hair loss: practical advice

Hair loss is a common condition and there is no reason to feel embarrassed about seeking treatment.

If hair loss is affecting your confidence or mental health, speak to your GP, who can offer support and referral if needed.

Organisations such as Alopecia UK provide information and peer support. If you choose not to take medication, cosmetic options including hair fibres, concealers, micropigmentation, and hairpieces are available.

Hair transplant surgery can produce natural-looking results in suitable candidates. Above all, remember that treatment is more effective when started early, before significant follicle miniaturisation has occurred.

Sources

• Finasteride 1 mg Film-Coated Tablets, Summary of Product Characteristics (EMC)
• Finasteride, British National Formulary (BNF)
• NICE CKS: Alopecia, androgenetic
• Hair loss, NHS
• British Association of Dermatologists: Male pattern hair loss
• MHRA Yellow Card Scheme