The Mechanism of Finasteride: Halting DHT's Effect
Finasteride is an FDA-approved oral medication (often known by the brand name Propecia) that treats male pattern baldness. Its mechanism targets the root cause of this type of hair loss: the hormone dihydrotestosterone (DHT). Specifically, finasteride works by inhibiting the type II 5-alpha reductase enzyme, which is responsible for converting testosterone into DHT. By reducing DHT levels in the scalp by up to 70%, finasteride protects susceptible hair follicles from the damaging effects of this hormone.
Over time, high DHT levels can cause hair follicles to shrink, a process known as miniaturization. This leads to the production of shorter, finer, and weaker hairs until the follicles eventually become dormant. By blocking DHT, finasteride can halt this process, allowing miniaturized follicles to recover and begin producing thicker, healthier hair again.
The Crucial Distinction: Thinning vs. Complete Baldness
The effectiveness of finasteride hinges on the state of the hair follicles. For the medication to work, there must be living hair follicles present, even if they are miniaturized or dormant. Clinical studies have consistently shown finasteride to be highly effective at slowing hair loss and promoting regrowth in areas of mild to moderate hair thinning, particularly on the crown (vertex) of the scalp. For example, studies have shown that after two years, 83% of men with crown hair loss who took finasteride experienced no further hair loss, with 61% seeing mild to moderate regrowth.
However, in areas that are completely bald, the hair follicles have been permanently destroyed or scarred. In these cases, since there are no active or dormant follicles left to revive, finasteride will not be able to stimulate new hair growth. This is the hard truth for those with advanced hair loss: finasteride cannot reverse complete baldness. For these individuals, hair transplantation is the only option for restoring hair to the completely bald areas.
Timeline and Expectations for Results
For those with existing hair follicles, patience is key. The effects of finasteride are not immediate and require consistent, long-term use. The timeline for results typically looks like this:
- Months 1-3: Initial shedding, known as finasteride shedding, can occur as weakened hairs fall out to make way for new growth. This is a normal part of the process and a sign that the medication is working.
- Months 3-6: This is often when users start to notice a reduction in hair loss and some early signs of regrowth or thickening.
- Months 6-12: More significant improvements, including increased hair density and thickness, become visible.
- Years 1-2: The maximum benefits of finasteride are typically achieved during this period.
- Long-Term: Continued daily use is necessary to maintain results. Stopping the medication will cause DHT levels to rise again, and any gains will be lost, with hair loss resuming within 6-12 months.
Combining Treatments: Finasteride and Minoxidil
For many men, combining finasteride with other hair loss treatments can produce superior results compared to using either medication alone. The most common combination is with minoxidil (brand name Rogaine).
Comparison of Finasteride vs. Minoxidil
| Feature | Finasteride | Minoxidil | Combination (Finasteride + Minoxidil) |
|---|---|---|---|
| Mechanism | Blocks DHT production, preventing follicle miniaturization. | Stimulates blood flow to hair follicles, promoting growth. | Addresses hair loss from two different angles. |
| Availability | Prescription-only oral tablet. | Over-the-counter topical foam or solution. | Requires prescription for oral Finasteride, OTC for topical Minoxidil. |
| Target | The hormonal cause of male pattern baldness. | Growth stimulation for existing follicles. | Combines hormonal blocking and growth stimulation for enhanced results. |
| Best Used | For early to moderate hair loss to preserve existing hair. | For stimulating growth, particularly in the early stages. | For comprehensive treatment and optimized hair regrowth, especially in moderate cases. |
Combining these two treatments can be particularly beneficial for individuals with moderate balding, as finasteride works to stop the progression of hair loss while minoxidil encourages new growth and thickens existing hair.
The Importance of Early Intervention
Starting finasteride in the earlier stages of male pattern baldness, when hair follicles are still miniaturizing, offers the best chance of success. The earlier the intervention, the more hair can be salvaged and potentially regrown. Waiting until bald spots are completely smooth and shiny, indicating the follicles are dead, means the opportunity for regrowth with finasteride has passed. In such advanced cases, the medication can still be useful for preserving the remaining hair in other areas of the scalp and preventing further balding.
Conclusion
In summary, the answer to does finasteride work if you're already bald depends on the degree of baldness. It is highly effective at preventing further hair loss and promoting regrowth in areas with active, but miniaturized, hair follicles. However, it is powerless to revive follicles in completely bald areas where they have died. For those with extensive baldness, finasteride can still help preserve remaining hair, but hair transplants remain the only option for restoring hair to completely bald patches. The most successful treatment approach for male pattern baldness often involves early intervention and, in many cases, a combination of finasteride and other therapies like minoxidil, under the guidance of a healthcare professional. For more in-depth information, you can explore resources from reputable medical sources.(https://www.hims.com/blog/are-finasteride-results-legit-what-the-average-man-can-expect)
