Oral finasteride for male androgenetic alopecia

Oral finasteride can be used as monotherapy for mild to moderate male androgenetic alopecia. It can also be used in combination with topical minoxidil for more severe male androgenetic alopecia, or in mild to moderate cases if the patient requests initial combination therapy.

Psychological adverse events and suicidality have been reported with finasteride for male androgenetic alopecia, especially in younger malesNguyen, 2021. It is unclear whether this is due to increasing rates of mental health disorders in the younger population, a nocebo effect, or a true causal effect. Before starting oral finasteride, screen patients for underlying psychological and mood disorders to ensure suitability for treatment.

Also discuss with the patient the low risk of sexual dysfunction (eg erectile dysfunction, reduced libido), and gynaecomastia (rare). The incidence of sexual dysfunction related to finasteride for androgenetic alopecia is unclear as it has not been well studiedBelknap, 2015. Adverse effects tend to resolve with time or when treatment is stopped. Persistent sexual dysfunction after stopping finasteride has been reported, but has not been demonstrated in randomised controlled trials.

No adverse effects on pregnancy (eg teratogenicity, premature termination, premature birth) have been reported when the father is taking finasteride. Finasteride therapy in androgenetic alopecia is unlikely to increase the risk of prostate cancer, because higher doses are used for long-term management of benign prostate hyperplasia (BPH) without increasing the overall risk of prostate cancer.

For androgenetic alopecia in a male who requests treatment, use:

Only the finasteride 1 mg tablet is approved by the Therapeutic Goods Administration for the treatment of androgenetic alopecia. Dose regimens using the finasteride 5 mg tablet are common practice because they are more cost-effective for the patient.

Review finasteride treatment annually for efficacy and adverse effects.