A diffuse reduction in the hair density on the crown and frontal scalp is a common female pattern hair loss characteristic. The frontal hairline in the frontal scalp is retained in women affected with pattern baldness. The older the women get, the more prevalent the pattern baldness is on them. Social anxiety and embarrassment (which worsens if not attended to) are common complains heard from women affected with pattern baldness.

Finasteride is used in men with pattern baldness because it reduces DHT production, which in turn limits the action of DHT in the scalp hair follicles. In women, Finasteride and other 5 -reductase inhibitors have remarkable effects on hirsutism. Theoretically, if the hair loss in women is androgen-dependent as in the case of male pattern baldness, then Finasteride would have almost the same effect on both male and female pattern baldness.

It was initially thought that the mechanism triggering the hair loss on both men and women were the same. However, subsequent studies shows that the role of androgens in the baldness of women, and consequently the efficacy of Finasteride treatment for female pattern baldness, is yet unclear.

Clinical trials

The restriction of Finasteride in treating women is bounded by the fact that it interacts with the placenta of the fetus, causing malformations in male fetuses. With this, Finasteride could only be used on post-menopausal women with pattern baldness. A large-scale research was done on women with pattern baldness at their post-menopausal stage in life. The mean age of the participants is 53 years old and the mean onset of hair loss was at 43.5 (+/-) 10 years of age. Those women below 59 years old with Ludwig I or II frontal hair thinning and hair density of 3 to 5in the Savin scale were chosen to be subjected with the placebo-controlled trial of 1 mg Finasteride a day. After one year, it was found out that there was no remarkable difference in the hair counts of the target area between the results found in those using Finasteride and the placebo group, patient or investigator assessment, global panel review, or representative biopsy-related changes.

The results of the research, when compared to those in studies on male pattern baldness, were curiously different. However, many other variables in the study foreshadow the inactivity of Finasteride in the female pattern hair loss, indicating the need for further studies to be able to establish the efficiency or the non-efficiency of this drug.

All the studies on women neither evaluated pre-menopausal women with pattern baldness, nor were they conducted specifically on women with early onset of female pattern baldness. This study did not put exclusion to women with chronic telogen effluvium who have so far discovered clinical signs and symptoms are quite similar with that of early female pattern hair loss.

Higher doses of Finasteride (5mg per day) were able to show significant re-growth after one year of treatment in a postmenopausal, non-hyperandrogenic woman with FPHL, despite it being an isolated case report. There are conflicts with the result of the treatment done on women with androgen excess using different dosing regimens. To determine whether a 5 -reductase inhibitor has any role in the treatment of women with female pattern hair loss, Finasteride should be administered to women with FPHL having hyperandrogenemia.

Side effects and Precautions

Being a teratogen, Finasteride causes malformation of the fetus. Studies on animals (rats) exposed to Finasteride during the utero-develop hypospadias (a developmental anomaly of the urethra) with cleft prepuce, decreased anogenital distance, reduced prostate weight and also altered the formation of nipple.

Finasteride tablets are coated to prevent contact with the active ingredients during use. Finasteride is not advisable for women with high possibility of pregnancy, to the extent of preventing them from handling crushed or broken tablets. Although there have been no studies yet that would assert the risk of teratogenicity of Finasteride in women, it has been known that the drug can cause hypospadias in the developing male fetus. Also, being exposed to the semen of men who had taken Finasteride showed no risk at all.

Conclusion

To conclude, Finasteride has no proven effectivity on postmenopausal women and in as much as the FDA is concerned; Finasteride is approved for use by men. Use of Finasteride in pregnant or may become pregnant women has neither been approved nor rejected.