Finasteride: BPH and Male Pattern Baldness

Finasteride: BPH and Male Pattern Baldness 645d532304cd6.png

Finasteride: BPH and Male Pattern Baldness

Though originally used to treat benign prostate hyperplasia,  5-alpha-reductase inhibitors are now widely prescribed to combat hair loss.

In fact, in 2020 around 2.4 million prescriptions were written for the 5-alpha reductase inhibitor finasteride, in order to treat male pattern baldness.

So what is a 5-alpha reductase?

5-alpha reductase is an enzyme that is present in the liver, skin, and prostate.

The role of this enzyme is to convert some of the testosterone, which is an androgenic steroid that is responsible for the growth seen during puberty, into dihydrotestosterone.

Dihydrotestosterone, also known as DHT, plays a significant role in male pattern baldness, the growth of facial hair, acne, and prostate growth. When the body is producing excessive DHT, this can lead to benign prostate hyperplasia, prostate cancer, and hair loss.

The 5-alpha reductase inhibitor finasteride is FDA approved for the treatment of male pattern baldness, whereas the 5- alpha-reductase inhibitor dutasteride, also known by its brand name Avodart is FDA approved for the treatment of an enlarged prostate.

Both of these medications work by inhibiting the production of the enzyme 5-alpha reductase which thereby reduces the production of dihydrotestosterone. However, they each affect different smaller enzymes called type 1 and type 2 isoenzymes.

The isoenzyme type 1 is found mainly in the liver and skin, and in smaller amounts in the prostate. Isoenzyme type 1 is inhibited by the 5-alpha reductase inhibitor finasteride. This particular medication, also known by its brand name Propecia, has been found to reduce DHT production by 70% and has resulted in a prostate size decrease of 18%. When taken to treat hair loss, finasteride takes at least 3 months to take effect, and up to sick months to effects the prostate size.

The isoenzyme type 2 is found mainly in the prostate, with small amounts found in the skin and liver. Both the 5-alpha reductase isoenzymes type 1 and type 2 are inhibited by the medication dutasteride. Dutasteride, also known by its brand name Avodart, has been found to reduce dihydrotestosterone production by a whopping 93%, and in clinical trials decreased prostate size by 25.7%.

Though both dutasteride and finasteride are effective in both treating male pattern baldness and decreasing prostate size, finasteride does not stay in the system as long as dutasteride. Thus making dutasteride a better choice for benign prostate hyperplasia.

Finasteride and dutasteride are both taken as daily oral medication. Finasteride is available in 1 mg and 5 mg tablets, with the usual dose for male hair loss being 1 mg once daily, and 5mg daily for an enlarged prostate. Dutasteride is available as a 0.5 mg capsule and the usual dose for treating an enlarged prostate is 0.5 mg once daily.

Though 5-alpha reductase inhibitors are effective at shrinking the prostate and reducing benign prostate hyperplasia symptoms, they are not without their own set of side effects and risks.

In our next article, we will take a look at the side effects and potential risks involved in taking these medications.

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