Can Women Take Finasteride? Exploring Treatment Options for Female Hair Loss

Finasteride is a medication used to treat male pattern baldness (also known as androgenetic alopecia). It works by reducing the levels of dihydrotestosterone (DHT), a hormone that plays a big role in male pattern baldness.

In the UK, finasteride is not licensed for use in women with hair loss as it's known to cause birth defects during pregnancy.

In this article, we'll explore the evidence for finasteride treatment in women with female pattern baldness, including the benefits, risks and alternate options which may benefit women experiencing hair loss.

What is Finasteride?

Finasteride is a medication originally developed to treat benign prostatic hyperplasia (BPH), a condition that causes an enlarged prostate gland in men.

It is known as a 5-alpha reductase inhibitor, inhibiting the enzyme which converts the hormone testosterone to dihydrotestosterone (DHT). DHT is a hormone that's involved in both BPH and male pattern baldness.

DHT binds to hair follicles, causing miniaturisation, and shortening the hair growth cycle therefore leading to hair thinning and loss. A person's genetics can make them more vulnerable to these effects.

The medication is usually taken as one tablet taken once a day. Finasteride can cause side effects including a decreased sex drive, difficulty achieving an erection and decreased semen production. These side effects are usually mild and temporary but if they persist, it's important to seek medical attention.

Hair Loss in Women: Understanding the Basics

Different types of hair loss can affect men and women. Here, we'll focus on female pattern hair loss.

Female pattern hair loss shares similarities with male androgenic alopecia and is also related to increasing age, genetic factors and hormones. High androgen levels (testosterone) in women can lead to acne, irregular periods and excessive facial hair but it is unclear whether this also contributes to hair loss.

In male pattern hair loss, the loss starts with thinning on the crown, and temples and a receding hairline. In women, hair thinning is usually seen over the whole scalp with the hairline generally remaining unchanged.

The psychological impact of hair loss in women can be significant. Women often place a greater emphasis than men on physical appearance and attractiveness and hair loss can generate feelings of low self-esteem.

Finasteride for Women: The Debate

Can Women Take Finasteride?

Generally, UK guidelines and official advice from the NHS suggest women should not take finasteride. The National Institute of Care Excellence advises that women of childbearing potential should not handle crushed or broken tablets. This is due to the risk of birth defects in children of pregnant women.

While there are some studies suggesting finasteride may be effective, the case is not clear. It is important to consider the potential side effects and risk-to-benefit ratio.

The Concerns with Finasteride Use in Women

Various side effects have been observed in women taking finasteride. Some of the most common include headaches, menstrual irregularities, dizziness and increased body hair growth. Reduced libido and abnormal liver function have also been reported.

Most of the side effects are mild and resolve on their own. Perhaps the most concerning is the effect finasteride can have on an unborn baby. Oral finasteride is linked to an increased risk of birth defects in monkeys, especially in the male fetus. We know finasteride breaks down testosterone into another hormone. Finasteride therefore directly impacts testosterone levels which is important in the development of male offspring.

There are limited studies on whether finasteride can increase the risk of miscarriage or giving birth early, but a few animal studies suggest it might.

All women experiencing hair loss considering finasteride treatment that are of childbearing age must use a reliable form of contraception and not just rely on condoms. If you do fall pregnant whilst on treatment, you should stop taking finasteride and inform your doctor straight away.

Topical finasteride applied directly to the scalp, may be a good alternative for women as the effects of the medication are localised. This can reduce the risk of side effects, but should still be avoided in pregnant women.

Efficacy of Finasteride in Women

Studies on finasteride use in women are generally either in post-menopausal women or reproductive-aged women using an effective contraceptive method.

There is some evidence that finasteride is effective for normoandrogenic postmenopausal women with hair loss. This is when women who have gone through menopause, have normal testosterone levels yet still experience hair loss. Despite being called female androgenetic alopecia, androgen hormones like testosterone are less important in female pattern hair loss than in the male type.

A small study found improved hair appearance and growth, and decreased hair loss when taking a 2.5mg dose of finasteride. Pre and post-menopausal women taking 5mg of finasteride daily for 12 months experienced increased hair density and hair thickness in another trial. However, another study found that lower doses of finasteride (1.25mg) weren't effective.

A high dose of finasteride (5mg) was found to be effective in pre-menopausal women with high androgen hormone levels.

While there is evidence that finasteride can help both pre and post-menopausal women suffering from hair loss, it seems to be more effective in reproductive-aged women. This group is also more likely to suffer from side effects.

Comparing Finasteride to Other Treatments

Finasteride and minoxidil are the two most common hair loss treatments. Minoxidil is a topical solution applied directly to the scalp and works by dilating the small blood vessels, leading to increased blood flow to the area, which stimulates hair growth. It's also possible to take minoxidil as an oral medication.

Topical minoxidil is available in different concentrations. It may take 4 to 6 months to see any positive effects, and after stopping treatment, hair loss may resume. Similarly, it can take up to 6 months to see any changes to your hair density when taking finasteride, and the positive effects stop when you stop treatment.

Minoxidil can cause side effects such as scalp irritation, itching, and dryness. However, there are generally fewer side effects affecting other parts of your body, like the nausea and headaches you may get with finasteride.

Minoxidil is approved to treat female pattern baldness, whilst finasteride is not. Both medications are only really useful at treating this type of hair loss (in men and women), and may not be effective against other types like alopecia areata.

While these are the two most common hair loss treatments, there are other non-medication-based hair loss treatments that we'll talk about later.

Safe Usage of Finasteride in Women

Finasteride is not recommended as a hair loss treatment in women. A doctor must prescribe the medication off-label, and this is only done in certain cases. Usually, only where other treatments have failed and the hair loss is significantly affecting your life.

Before approving a prescription, a healthcare professional will discuss the medication with you in detail, and review your medical history. They may also discuss alternative treatment options to ensure finasteride is the best choice for you.

If you're of reproductive age, the doctor will likely discuss contraception with you. They may also want to do some tests and organise follow-up appointments to check how you're doing.

There are plenty of alternative treatments available, including laser therapy, hair transplantation, and wigs. Nutritional supplements and lifestyle changes may also be helpful in cases where hair loss is caused by a nutritional deficiency or stress.

Low-level laser therapy is a non-invasive treatment that uses low-energy lasers to stimulate hair growth. This treatment works by increasing blood flow to the scalp, promoting the growth of new hair follicles. It's generally considered safe, but not everyone can agree as to how effective it is.

Hair transplantation is a surgical procedure that involves transplanting hair follicles from one part of the scalp to another. It's more invasive, expensive and is usually reserved for severe cases.

Wigs are a great non-surgical option for addressing hair loss. They can be made from natural or synthetic hair and can be customised to match the individual's hair colour and style.

Generally, hair loss treatments aren't funded by the NHS, so it's worth weighing up the costs involved before deciding.

New hair loss treatment therapies and procedures that are available, include; Stem cell therapy, platelet-rich plasma therapy and gene therapy. These are just some of the treatments currently in development. They aim to address the underlying cause of hair loss and promote the growth of new hair follicles, but more research is needed into their safety and effectiveness.

Summary and Conclusion

Despite several studies suggesting finasteride can help hair growth in women with female pattern baldness, it is important to note finasteride is not licensed for this in the UK. This is largely due to the risk of side effects, particularly in pregnant women.

However, some healthcare professionals may still prescribe finasteride for women in certain circumstances. It is important to weigh the benefits against the risks, and for reproductive-aged women to use effective contraception if they decide to take finasteride.