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Question of the Month

Q:  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.

A: 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.

Sincerely,

Geoffrey Redmond, MD


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