What Propecia Is and How It Works
Propecia is the brand name of a prescription medication, finasteride, designed to treat men’s hair loss.
It is FDA-approved for use in men only and is intended for those suffering from male pattern hair loss.
This article will cover the facets of finasteride, from its different forms to its strengths and side effects.
Propecia is an androgen hormone inhibitor treatment, and available by prescription only.
Androgens are the most common form of balding is known as male pattern hair loss, representing close to 95% of all hair loss cases.
Mild to moderate male pattern hair loss affects about half of men by the time they reach age 50.
This type of hair loss is characterized by a receding hairline and/or balding at the crown.
Male pattern hair loss tends to be heredity, from either the mother or father’s side of the family, and is also attributed to certain hormonal characteristics.
Doctors commonly believe that excess DHT is one apparent cause of hair loss.
Human hair normally follows a cycle of growth, falling out, and then new growth.
However, increased levels of DHT are believed to contribute to the shortening of the growth phase and a reduction in the time it takes for the hair to fall out.
This results in the thinning of the hair on the scalp.
FDA Approval and Indications
Finasteride received FDA approval for hair loss treatment in 1997 under the brand name Propecia (1mg dose).
The medication is indicated specifically for androgenetic alopecia (male pattern baldness) in men only.
It is approved for use in men ages 18-60 experiencing mild to moderate hair loss at the vertex and anterior mid-scalp.
The FDA has not approved finasteride for hair loss treatment in women due to lack of efficacy data and potential risks during pregnancy.
Off-label use in post-menopausal women occurs but remains controversial and unsupported by large-scale studies.
Treatment Protocol and Dosing
Standard Dosing Regimen
The FDA-approved dose for hair loss is 1mg taken orally once daily.
Taking the medication at the same time each day helps maintain consistent blood levels.
No food restrictions apply; finasteride can be taken with or without meals.
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose.
You should then skip the missed dose and resume your regular schedule. Do not take double doses of this medication.
Timeline for Results
Most men see initial stabilization of hair loss within 3-4 months of starting treatment.
Visible hair regrowth typically becomes apparent between months 6-12 of consistent use.
Peak results occur at 12-24 months, after which hair density plateaus.
Discontinuing finasteride results in gradual loss of any gained hair over 6-12 months as DHT levels return to baseline.
The following patient is 25 years old with advanced hair loss for his age.
We recommended topical finasteride before considering a transplant. The reason: a transplant without stabilizing future loss sets him up for disappointment later.
He used topical finasteride daily for 116 days without missing applications.
The topical finasteride result below shows measurable improvement in hair density counts and visible thickening, which you can see in the photos.
This case demonstrates why medical therapy matters, especially for younger patients facing aggressive hair loss. Surgery alone won’t solve the underlying problem. You need to address the cause first.
Long-Term Use Requirements
Finasteride is a chronic treatment, not a cure; benefits persist only while taking the medication.
Studies demonstrate maintained efficacy for at least 10 years of continuous use in responders.
Annual reassessment with a physician helps monitor response and adjust treatment if needed.
Combining finasteride with other treatments (minoxidil, low-level laser therapy) may enhance results.
Clinical Evidence and Effectiveness
Published Trial Data
The pivotal FDA approval trials included 1,879 men ages 18-41 with mild to moderate vertex hair loss.
After 12 months, 48% of finasteride users showed increased hair count versus 7% on placebo.
At 24 months, 66% of finasteride users showed improvement compared to 7% of placebo users.
Average hair count increases ranged from 86-107 additional hairs per 5.1cm² target area at 2 years.
Real-World Effectiveness
In clinical practice, approximately 65-70% of men experience stabilization or improvement of hair loss.
About 30-35% of users show visible regrowth that would be noticeable to others.
Younger men (under 40) and those with recent-onset hair loss tend to respond better than older men with longstanding baldness.
Finasteride does not regrow hair in completely bald areas where follicles have been dormant for years.
Limitations of Evidence
Most published studies focus on vertex (crown) balding rather than frontal hairline recession.
Long-term data beyond 10 years remains limited to smaller observational studies.
No head-to-head trials directly compare finasteride to hair transplant surgery or other interventions.
Effectiveness in men over 60 has not been systematically studied.
Side Effects and Safety Profile
Common Side Effects
Like all prescription products, Propecia may cause side effects.
In clinical studies, side effects from PROPECIA were uncommon and did not affect most men.
However, a small number of men experienced certain sexual side effects.
These men reported one or more of the following: less desire for sex, difficulty in achieving an erection, and a decrease in the amount of semen.
Each of these side effects occurred in less than 2% of men and went away in men who stopped taking Propecia.
They also disappeared, in time, in most men who continued taking Propecia.
Post-Marketing Reports
With general use, the following side effects have been reported: allergic reactions, including rash, itching, hives, and swelling of the lips and face; problems with ejaculation; breast tenderness and enlargement; and testicular pain.
Some men have reported persistent sexual dysfunction after discontinuing finasteride, though causality remains debated.
Depression and mood changes have been reported, but occur at rates similar to placebo in controlled trials.
Contraindications and Warnings
Finasteride is contraindicated in women who are or may become pregnant due to risk of birth defects in male fetuses.
Pregnant women should not handle crushed or broken finasteride tablets due to potential absorption through the skin.
Men with known hypersensitivity to finasteride or any component should avoid use.
Finasteride can affect PSA (prostate-specific antigen) levels, reducing them by approximately 50%; inform your doctor before prostate screening.
Patients with liver disease may require dose adjustment or closer monitoring.
Managing Side Effects
Sexual side effects that develop should be discussed with your physician; many resolve with continued use.
Discontinuing the medication typically results in resolution of side effects within weeks to months.
Some practitioners recommend temporary breaks or dose reduction if side effects occur, though this reduces efficacy.
No established treatments exist for persistent sexual dysfunction after finasteride discontinuation.
Available Formulations and Dosages
Finasteride is available in the following dosages:
Propecia: 1mg tablets (FDA-approved for hair loss)
Proscar: 5mg tablets (FDA-approved for benign prostatic hyperplasia)
Generic finasteride: 1mg and 5mg tablets available from multiple manufacturers
Some patients attempt to save money by cutting 5mg tablets into quarters, though this is off-label and results in inconsistent dosing.
Generic 1mg finasteride costs approximately $10-30 per month, while brand-name Propecia costs $70-80 per month.
Topical finasteride formulations exist but lack FDA approval and have limited safety/efficacy data.
Storage and Handling
Store Propecia away from direct light and heat.
Store in a dry location; avoid storing it in the bathroom, near sinks, or other areas where it may become damp.
Do not use Propecia after the expiration date.
Keep Propecia away from children; both when storing it and when discarding any unused medication.
Propecia tablets may be crushed for easier swallowing, though this is rarely necessary.
Women of childbearing age, or women who are pregnant, should not handle crushed tablets due to absorption risk.
Cost and Insurance Coverage
Typical Out-of-Pocket Costs
Generic finasteride 1mg: $10-30 for 30-day supply (common at discount pharmacies)
Brand Propecia: $70-80 for 30-day supply
Annual cost range: $120-960, depending on generic vs brand
Insurance Considerations
Most insurance plans do not cover finasteride for hair loss as it’s considered cosmetic.
Some plans may cover finasteride if prescribed for benign prostatic hyperplasia at 5mg dose.
FSA/HSA accounts may reimburse finasteride if documented as medically necessary.
Discount pharmacy programs (GoodRx, RxSaver) can reduce generic costs to $10-15 per month.
Frequently Asked Questions
How long do I need to take finasteride to see results?
Most men notice hair loss stabilization within 3-4 months. Visible regrowth typically appears between months 6-12. Peak results occur at 12-24 months. Remember that finasteride works by slowing or stopping hair loss; it’s not a rapid hair growth serum. Patience matters.
What happens if I stop taking finasteride?
You’ll gradually lose any hair you gained, typically over 6-12 months, as DHT levels return to pre-treatment baseline. Hair loss will resume at the rate it would have progressed without treatment. This is why finasteride is considered a chronic therapy rather than a cure.
Can I take finasteride before a hair transplant?
Yes, and many surgeons recommend it. Finasteride can help preserve native hair and potentially improve transplant results. Some surgeons prescribe it 3-6 months before surgery and continue it indefinitely after. Discuss timing with your hair restoration surgeon during consultation.
Does finasteride work for receding hairlines?
Results are less predictable for frontal hairline recession compared to vertex (crown) thinning. Most clinical trials focused on crown hair loss. Some men see frontal stabilization or modest improvement, but expectations should be tempered. Hair transplant surgery often works better for hairline restoration.
Are the sexual side effects permanent?
For most men who experience sexual side effects (less than 2% in trials), symptoms resolve after stopping the medication. A small subset of men report persistent symptoms, though the actual incidence and causality remain debated in medical literature. If you develop concerning side effects, discuss them with your physician rather than abruptly stopping.
Can women take finasteride for hair loss?
Finasteride is not FDA-approved for women and is absolutely contraindicated in pregnant or potentially pregnant women due to birth defect risks. Some post-menopausal women use it off-label with mixed results. This decision requires careful discussion with a dermatologist specializing in hair loss.
Will finasteride prevent me from needing a hair transplant?
Not necessarily. Finasteride slows progression but doesn’t always prevent all hair loss. Many men eventually pursue transplant surgery despite taking finasteride, then continue the medication to protect remaining native hair. Think of finasteride as loss prevention, not full restoration.
How does finasteride compare to minoxidil?
Both are FDA-approved but work differently. Minoxidil is topical, works through different mechanisms, and helps with vertex thinning. Finasteride is oral, blocks DHT conversion, and works throughout the scalp. Many dermatologists recommend using both together for synergistic effects. Minoxidil requires twice-daily application indefinitely; finasteride is once daily oral.
Prescription Requirements
You can only purchase Propecia with a doctor’s prescription.
Many dermatologists, primary care physicians, and hair restoration specialists can prescribe finasteride.
Telehealth platforms now offer finasteride prescriptions after online consultation, though quality varies.
Annual follow-up visits help monitor response, assess side effects, and discuss alternative options if needed.
Some prescribers recommend baseline bloodwork (hormone levels, liver function) though this isn’t universally required.
Medical Disclaimer
This article provides educational information about finasteride (Propecia) and should not replace consultation with a qualified physician.
Individual results vary based on age, extent of hair loss, genetic factors, and overall health.
Side effects discussed represent reported experiences but may not reflect individual risk.
Finasteride is a prescription medication; only a licensed physician can determine if it’s appropriate for your specific situation.
Off-label uses (women, topical formulations) lack FDA approval and comprehensive safety data.
The information presented reflects medical knowledge as of the publication date; newer research may update recommendations.
Patients experiencing side effects should consult their prescribing physician rather than discontinuing medication without guidance.
Related Reading
For comprehensive information on hair loss treatment options:
Ultimate Guide to Hair Loss Treatment and Prevention
