Finasteride is an FDA-approved pharmacologic pill for treating androgenic alopecia (male pattern hair loss) in men. It was first used in 1992 to treat noncancerous enlarged prostates at a 5mg dose, and in 1997 it was approved to treat male pattern hair loss at a lower 1mg dose. Dermatologists have commonly prescribed 1mg finasteride for androgenic alopecia over the past 25 years. Tens of millions of men have taken it since, and its prescriptions to treat hair loss averaged 175,000 a month in the U.S. during 2024. It has a proven track record of efficacy with patients slowing down their hair loss and having a reversal of hair count density within 12 months.
Propecia (finasteride) 1mg tablet is an oral medication approved by the FDA for the treatment of hair loss in men. Propecia’s label states 3.8% of patients experience one or more sexual side effects, compared with 2.1% who took a placebo. There is no medical evidence-based data substantiating the link between finasteride and sexual side effects after discontinuation of the drug in numerous, double-blind, placebo-controlled studies conducted evaluating the use of Propecia 1mg for hair loss. Since sexual dysfunction is a complex disorder, it can be difficult to pinpoint the exact cause when multiple factors such as nicotine, alcohol, prescription medications, stress, anxiety, fatigue, and depression can contribute to erectile dysfunction (ED).
Topical finasteride and minoxidil solutions are other options to the oral 1mg daily dose. The topical formulation can also improve hair count, but the daily long-term use is not always appealing to patients. Its overall effect is similar to that of oral finasteride, but with lower systemic exposure and less impact on serum DHT concentrations.
Recently, telehealth companies and social media sites have started selling finasteride, without a medical exam from a doctor to discuss the possible side effects, nor a prescription from an actual pharmacist who may be aware of possible side effects from other patient medications. The telehealth companies are creating their own personalized treatments, using drug ingredients and formulations laid out by their clinicians, to create their custom version of the drug. The recent social media and internet forum reports of sexual dysfunction by men who have used drugs from telehealth companies to treat hair loss should not define the safety and effectiveness of the finasteride drug when properly prescribed by a Dermatologist specializing in hair loss.
As of today, there are only 2 medications that are FDA-approved for male pattern hair loss: finasteride (Propecia) and minoxidil (Rogaine). There are no other medications on the market that can legally and ethically claim that their product causes clinically significant hair growth. There are products from Glaxo-Wellcome and Upjohn that are presently in clinical trials and are showing significant promise, but they are not currently available. Unfortunately, there are numerous unethical companies, telemarketers, and doctors who claim that their products “may cause fuller and thicker looking hair” and hope that you interpret that as actually “causing clinically significant hair growth”.
