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.
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
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
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
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.
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.