A Complete Guide to 5-Alpha Reductase Inhibitors: Treatments, Benefits, and Managing Hair Loss

Hair loss affects 85% of men at some point in their lives, but that doesn’t make it any easier to deal with [1]. Knowing you aren’t alone might make you feel slightly better, but coping with the impact of hair loss on self-confidence can be difficult, especially if you’re only in your 20s or 30s and none of your friends have started to lose their hair. While there’s nothing wrong with being bald, there’s also nothing wrong with wanting to keep your hair full, which is why there are so many treatment options available to help treat male hair loss.

It’s best to treat hair loss in the early stages, but treatments have shown promise for men with more moderate thinning and balding as well. 5-alpha reductase inhibitors are an alternative to prescription hair loss medications that may be able to help inhibit hair loss and improve hair volume.

In this guide, we’ll explore how 5ARIs work and what you should know before considering them.

What Conditions Do 5-Alpha Reductase Inhibitors Treat?

5-alpha reductase inhibitors can treat male pattern baldness (androgenetic alopecia) and benign prostatic hyperplasia (BPH). BPH is a prostate condition that causes the prostate to enlarge, and it can lead to issues like erectile dysfunction and urinary problems.

5ARIs are a class of drugs that include finasteride (Proscar® and Propecia®) and dutasteride (Avodart®). Finasteride has been available in Canada since 1992 under the name Proscar.

How 5-Alpha Reductase Inhibitors Work

5-alpha reductase inhibitors treat hair loss by blocking the production of the 5-alpha reductase enzyme, which converts testosterone into dihydrotestosterone (DHT). DHT is important in prenatal development, but it can build up later in life and cause prostate enlargement. Up to 50% of men experience BPH by age 60, and the risk increases with age [2].

DHT can cause hair loss by binding to androgen receptors in the scalp. These receptors can regulate processes related to hair growth. However, DHT can cause too much stimulation of follicle dermal papilla cells, which leads to hair loss [3].

Men who are genetically predisposed to develop male pattern baldness may find that 5-alpha reductase inhibitors help prevent balding during the early stages of alopecia. Noticeable thinning is the first sign, and it can happen in your late teens or early 20s. Whenever you notice changes to your hair, speaking with a doctor can help you intervene early and hopefully prevent further loss.

The Difference Between Finasteride and Dutasteride

Finasteride is most commonly prescribed for hair loss while dutasteride is more frequently used to treat an enlarged prostate. Finasteride is sold as Propecia and Proscar and a generic medication. In Canada, 1mg doses of finasteride are permitted to treat male pattern baldness [4].

Health Canada does not approve dutasteride, sold as Avodart, as a treatment for hair loss in men or women. It is strictly used for treating an enlarged prostate. Sometimes, it is used in combination with an alpha-blocker called tamsulosin to treat benign prostatic hyperplasia [5].

The Phoenix 2-in-1 pill offers men an easier way to combat hair loss by combining two of the most popular prescription medications for male pattern baldness: minoxidil and finasteride. Minoxidil increases blood flow to the scalp, which can promote healthy, strong hair follicles and enhanced growth. Meanwhile, finasteride works as an enzyme inhibitor to prevent DHT from causing more hair loss.

Click here for a free screening to find out if you would be a good candidate for our 2-in-1 hair loss pill.

Alternative Hair Loss Treatments

There are two main alternatives for men who don’t take 5ARIs: minoxidil and hair transplants. Minoxidil, sold as Rogaine, is a topical medication that you apply directly to your scalp to promote blood flow. It acts as a vasodilator, which expands your blood vessels, and allows more nutrient-rich blood to reach your hair follicles. This can promote healthier hair growth and prevent future hair loss for some patients.

Hair transplants are a surgical procedure that directly transplants hair follicles from one part of your scalp onto the balding areas. It can use the hair follicular unit strip surgery (FUSS) and follicular unit extraction (FUE) method — both can achieve the same results, but the difference lies in how they extract hair from the donor site [6].

FUSS removes a strip of hair from the scalp, then transplants it to another portion. FUE takes individual hair follicles, meaning it is less invasive, produces less scarring, and is generally more preferred by most patients and practitioners today.

However, FUSS, also called FUT, has its own benefits, which include shorter operative time, less bleeding at the donor site, and a denser packing of follicular units that can lead to fuller looking results.

Ultimately, a hair transplant can restore lost hair, but it doesn’t offer any physiological treatment to prevent future hair loss. This is why some men like to combine their hair transplant with prescription drugs; a dual approach helps restore the appearance of their hair while preventing future loss.

How Long Does It Take to See Results?

Allow at least 3 months of consistent treatment to start seeing finasteride results. The exact timeline can vary, but 90 days is the average time it takes to begin noticing benefits in terms of reduced hair loss. To track your progress, take monthly photos of your scalp so you can easily compare them. Checking the photos every 3-6 months will ultimately help you gain a clearer perspective on how the medications are impacting your hair growth.

Side Effects of 5-Alpha Reductase Inhibitors

Finasteride and dutasteride may cause erectile dysfunction, enlarged male breast tissue (gynecomastia), lower libido, depression and increase the risk of prostate cancer in some men. For this reason, it is important to have prostate-specific antigen monitoring to notice any changes that indicate the presence of cancer growth.

Finasteride can negatively interact with St. John’s Wort, an herbal supplement. It is also contraindicated for anyone who has sensitivities to any of the ingredients in its formula. If you are taking any prescription medications or herbal supplements, talk to a doctor about whether it’s safe for you to take finasteride or any other medication for hair loss.

Some men who have taken finasteride have also become infertile. If you are planning to have biological children, this could be a risk. Speak to your doctor about the chances of finasteride impacting your fertility rates before trying a prescription [7].

Who Should Avoid 5-Alpha Reductase Inhibitors?

Men with lower urinary tract symptoms (LUTS) may want to avoid finasteride or 5ARTs to prevent complications. The medications are also contraindicated for women who are pregnant or may be pregnant, as well as children.

The Psychological Impact of Hair Loss

Living with hair loss can take a toll on your self-esteem. It can contribute to depression, social anxiety and negative self-image that ultimately hinders your ability to live life to the fullest. You deserve to feel confident in your own skin, and if hair loss is hindering your ability to feel confident or attractive, then it’s important to look for treatment options that may help improve your hair growth.

Additionally, speaking with a therapist can be helpful in allowing you to process the mental health impacts of your hair loss. While it’s often written off as “just a part of life” for men, the reality is that alopecia can have devastating impacts on your self-esteem, and whether you’re experiencing frustration, depression, anxiety, or a combination of them all, you deserve support and acknowledgement for your feelings.

Talk to a Doctor Today

Phoenix Health in Canada helps men virtually connect with physicians who can help them treat hair loss, erectile dysfunction, weight loss, and other issues. Start our free screening process to get started.

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