Question of the Month
I am a 35 year old female with diagnosed
AGA (biopsy). All hormone tests are normal -- my androgens are normal. I am now
considering propecia. In your practice how effective is this medication for hair
regrowth in women? Why do published results (postmenopausal women) indicate this
medication does not work if DHT is the cause? Thank you for your time.
Propecia (also available as Proscar; the
generic name is finasteride) is not officially recommended for women for two
reasons. First, the enzyme it inhibits, 5 alpha reductase, is needed for normal
development of a male fetus. Hence there is concern that birth defects could
result if a woman takes it when she is pregnant. This is a serious concern but
it obviously does not apply to women who have had their tubes tied, whose
husband has had a vasectomy or who are postmenopausal.
Second, the manufacturer's studies did not show it to be effective for women. My
interpretation is that they did not understand that postmenopausal alopecia in
women is most often due to lack of estrogen and not to testosterone. So they
were treating the wrong form of female alopecia.
In my experience, finasteride can be effective. It only to be considered for
women who will not become pregnant. By itself, in my experience it is less
effective than spironolactone (Aldactone).
Given that finasteride is not labeled for use in women, the decision to take it
is a serious one and should be made with the advice experienced in use of such
medications in women.
Hope this is helpful.
Geoffrey Redmond, MD
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