Does finasteride work for women?

Losing your hair is difficult, no matter your sex. Most people think it’s more of an issue for men. It’s true, 42% of men between the ages of 18 and 49 experience hair loss. But female pattern hair loss occurs, too. As women age, they often experience hair thinning or even balding. This is called female pattern hair loss (FPHL), which is a common form of nonscarring hair loss. There is a progressive loss of terminal hairs located in the frontal and top of the scalp. Hair density is visibly reduced. Often when appearance is significantly impacted by a health condition, self-confidence is affected. Luckily, there are easy and accessible treatment options, such as Rogaine. You may have heard of Propecia (finasteride) for male pattern hair loss. Does Propecia for women work?

What is Propecia (finasteride)?

Propecia (finasteride) is an oral medication approved by the U.S. Food and Drug Administration (FDA) to treat a prostate gland enlargement (benign prostatic hyperplasia) and male pattern baldness (androgenic alopecia). 

Currently finasteride  is not approved to treat hair loss or thinning hair in women. However, providers sometimes use finasteride for women off-label, especially for post-menopausal women when topical minoxidil and oral spironolactone have been ineffective. 

How does finasteride work for hair loss?

The most common cause of baldness is androgenetic alopecia, a genetic condition affecting men and women. The exact cause is unknown, but it’s believed to involve a sensitivity to the male hormone dihydrotestosterone (DHT). For people affected, DHT causes hair follicles to shrink and weaken, eventually causing hair loss. Finasteride slows down your body’s conversion of testosterone to dihydrotestosterone. When less DHT is present, there will be less hair loss and increased hair density.

“Typically, it is believed that hair loss is due to anagen, the long growth phase of hair growth, is shortened, and with this medication finasteride, the very fine hairs revert back into a robust anagen growth phase,” says Beth Goldstein, MD, president at Central Dermatology in Chapel Hill, North Carolina.

Dr. Goldstein says that women in her practice are happy about the decreased hair loss after taking finasteride. She explains that most people prefer the tablet over the topical form of the medication, simply because it’s easier to remember each day.

Does finasteride work for hair loss in women?

There is limited research on use of finasteride in women. However, a review of the existing clinical trials found that it increased hair density and reduced hair shedding when compared to a placebo. The studies included pre-menopausal women and post-menopausal women with and without hyperandrogenism (too much testosterone).

Additionally, a study of 40 postmenopausal women found that after six months, 22 women had significant improvement in hair count and density, 12 women had moderate improvement while six women experienced no improvement. In another study, 81.7% of the women who took finasteride for three years found that their hair thickness increased, suggesting hair regrowth.

“Just like every drug, it may or may not work for patients. I think that finasteride is a great drug particularly for patients 50 years or older,” says Ben Behnam, MD, FAAD, board-certified dermatologist and medical director of Happy Head. But, you can still go bald when taking finasteride. Hair growth is a slow process. Women will often need follow up for treatment of hair loss after four to six months. Larger long-term research is needed to confirm the findings that finasteride helps more than minoxidil and spironolactone. 

Finasteride warnings for women

The reason finasteride has not been approved by the FDA for use in women who experience hair loss is because it may have a teratogenic effect. Half of pregnancies are unplanned. This means that women of childbearing age should not take any medication that can cause birth defects in the unborn child or feminization of male offspring. Research has only been done on rats. However, animal studies show that finasteride could cause issues with sexual development in males born to mothers treated with this medication.

“Finasteride should only be used in post-menopausal women or women without the ability to have children due to risks of male fetus developmental issues that a pregnant women could experience when taking the medication,” says Dr. Goldstein  

Additionally, finasteride is not recommended for breastfeeding mothers because the transmission through the breast milk to the infant is unstudied. If you are considering taking finasteride, consult your doctor first.

What medications may interact with finasteride?

Before taking finasteride, discuss all medications that you currently take with your provider or pharmacist, including supplements and vitamins. Finasteride might interact with the following medications and supplements:

• Aspirin
• Carbamazepine
• Cialis (tadalafil) 
• CoQ10 (ubiquinone) 
• Crestor (rosuvastatin)
• Diltiazem
• Eliquis (apixaban) 
• Erythromycin
• Fish oil 
• Flomax (tamsulosin) 
• Fluconazole
• Itraconazole
• Lasix (furosemide) 
• Lipitor (atorvastatin) 
• Metoprolol Succinate ER (metoprolol) 
• Metoprolol Tartrate (metoprolol) 
• MiraLAX (polyethylene glycol 3350) 
• Plavix (clopidogrel) 
• Tacrolimus
• Terazosin
• St. John’s Wort
• Synthroid (levothyroxine) 
• Tylenol (acetaminophen) 
• Vitamin B12 (cyanocobalamin) 
• Vitamin C (ascorbic acid) 
• Vitamin D3 (cholecalciferol) 
• Xarelto (rivaroxaban) 

This is not a complete list, so be sure to talk to your healthcare provider or pharmacist about interactions.

There aren’t any restrictions on food or drinks that you can consume when taking finasteride. There are no interactions of finasteride with alcohol consumption, but finasteride can affect your liver, so if you have hepatitis or excessive drinking discuss this with your provider. 

Finasteride side effects

As with any medication, there are possible adverse effects that women may experience when taking finasteride, though they are uncommon. The FDA classifies finasteride in the drug class called 5-alpha reductase inhibitors, which means that the medication affects the hormone testosterone. For women, this change is unlikely to cause decreased libido. “Women typically don’t experience sexual side effects. But anxiety or depression have been reported among women, so you do have to be careful of that and warn patients,” says Dr. Behnam.

The most common potential side effects of finasteride for women include:

• Headache
• Dizziness
• Abnormal menstrual periods 
• Breast tenderness 
• Changes in mood or depression
• Excess body hair growth 

There have not been any reports of overdoses on finasteride, but overdoses could happen if there is a side effect from a drug interaction causing the drug finasteride to be more potent.

Finasteride dosage for hair loss

Most people take one 1 mg tablet per day for hair loss. “In men, typically the recommended dose is one milligram,” Dr. Behnam says. “Women can be prescribed up to 2.5 milligrams because studies have shown that higher doses in females could be beneficial, whereas higher doses in males are not.”

In general, you will need to take the medication for many months before noticing a decrease in hair loss or thinning. “Results typically take about four to six months to be seen,” Dr. Behnam explains. “Once you are on it, you pretty much have to be on it forever.” If you stop the medication, hair loss or thinning will occur again.

If you miss a dose of finasteride, then take it when you remember—but don’t double up on the medication. “If you are a few hours near the time of the next dose, skip the forgotten dose,” Dr. Gibson advises.

How much does finasteride cost? 

On average, finasteride costs $171 for a one-month supply of 30, 1 mg tablets. If you use SingleCare’s finasteride coupon, you can pay around $2. 

Most insurance plans cover finasteride when it’s taken to treat prostate gland enlargement (benign prostatic hyperplasia), but insurance companies usually don’t provide coverage for finasteride when used to prevent hair loss or thinning. Medicare prescription drug plans don’t cover the cost of finasteride for hair loss.

RELATED: How to get finasteride without insurance

Alternatives to finasteride for hair loss in women

If you are unable to take finasteride or you are concerned about side effects, there are other effective treatments for hair loss.

Hair transplant surgery

Besides medications, one other option is hair transplantation surgery. During this procedure, a surgeon removes hair from the back of the scalp and grafts the hair to the front of the scalp to fill in bald patches. This procedure is usually extremely expensive—costing thousands of dollars—and is typically not covered by insurance.

Iron supplements

Another option is to try iron supplements since some women lose their hair or experience hair thinning due to an iron deficiency. If you are concerned about this, see your physician for testing. Iron deficiency is easily diagnosed with an inexpensive blood test. But do not add this supplement without it; taking iron supplements when not iron deficient can be harmful. 

Corticosteroids

Sometimes hair loss is caused by inflammation. If this is the cause, corticosteroid medications can help with hair loss. 

RELATED: Why is my hair falling out?

“Hair loss in women can be quite complicated and should be evaluated by a healthcare professional,” Dr. Goldstein says. “It can be a sign of underlying medical conditions, infections, or medications.” Work with your provider to explore hair loss treatments such as minoxidil or spironolactone or finasteride. He or she can help you find a treatment suited for you.