You’ve no doubt heard for years that Propecia is either ineffective or “dangerous” for women to use, and is therefore exclusively for men. This seemed puzzling to us as the mechanisms underlying men and women’s hair loss are almost identical, with a small hormonal variation that implicates DHEA a slightly more than DHT. DHT is howeve,r is a significant factor in women’s hair loss.

      The reason that Propecia use was actively discouraged in women was that there was a purely theoretical concern that the penile (penis) development in the male fetus could be compromised during pregnancy, possibly resulting in the birth of boys with inadequate or ambiguous male genitalia. The 5 alpha reductase enzyme, which Propecia and Avodart so efficiently inhibit, is critical in this developmental role. The company which produces Propecia was so terrified of the possible litigation surrounding even one incident that it even warned women away from handling “crushed Propecia tablets”, as though even a one time contact with a miniscule amount of active ingredient was enough to cause a birth defect.

      Propecia has been on the market since 1998 and Proscar since 1992 and there has yet to be a single documented incident of a finasteride induced birth defect. Moreover, thousands of men have fathered children while using Propecia (finasteride) and Avodart (dutasteride) with again, no documented incidents of birth defects.

      Most significantly, subsequent studies have been published showing Propecia, and one showing Avodart, to be as about effective in women as it is in men. The evidence uniformly suggests, despite what they have been told by doctors and drug companies for years women can take advantage of Propecia and Avodart.

Here are some study abstracts on finasteride usage in women for hair growth.
Effect of finasteride 5 mg (Proscar) on acne and alopecia in female patients with normal serum levels of free testosterone.
Kohler C, Tschumi K, Bodmer C, Schneiter M, Birkhaeuser M
Division of Gynaecological Endocrinology and Reproductive Medicine, Department OB/GYN, University of Berne, Berne, Switzerland.
      BACKGROUND: In some women with acne or alopecia who have normal serum levels of free testosterone, no clinical improvement can be reached by the classical treatment with antiandrogens, isotretinoids or corticosteroids. Our hypothesis is that some of these women have an excessive activity of the enzyme 5alpha-reductase. OBJECTIVE: To evaluate the subjective benefit of the treatment with finasteride (5 mg/day) in women with normal serum levels of free testosterone suffering from acne or alopecia. DESIGN: This was a retrospective study evaluating a questionnaire filled out by 12 patients, six of whom had acne and six of whom had alopecia. RESULTS: Nine of the 12 patients benefited from the treatment, their symptoms decreased significantly and they felt better psychologically than before the administration of finasteride. The other three patients did not benefit at all from finasteride and reported no change in the extent of the acne/alopecia. Treatment was generally well tolerated, only a few adverse effects were noted. CONCLUSIONS: Nine of the 12 patients benefited from the treatment. This supports our hypothesis of an excessive activity of 5alpha-reductase enzyme in peripheral tissue in these patients. The fact that three of the patients did not realize any change in their symptom severity implies that there must also be other pathways in the genesis of acne and alopecia in women with normal levels of free testosterone. Further evaluation is needed to elucidate more precise indications for the administration of finasteride in women with acne and alopecia.

Arch Dermatol. 2006 Mar;142(3):362-4.
Finasteride treatment of female pattern hair loss.
Iorizzo M, Vincenzi C, Voudouris S, Piraccini BM, Tosti A.
Department of Dermatology, University of Bologna, Via Massarenti, I-40138 Bologna, Italy.
      OBJECTIVE: To evaluate the efficacy of oral finasteride therapy associated with an oral contraceptive containing drospirenone and ethinyl estradiol in premenopausal women with female pattern hair loss. SETTING: Outpatient consultation for hair disorders at the Department of Dermatology, University of Bologna. PATIENTS AND INTERVENTION: Thirty-seven women with female pattern hair loss were treated with oral finasteride, 2.5 mg/d, while taking an oral contraceptive containing drospirenone and ethinyl estradiol. Treatment efficacy was evaluated using global photography and the hair density score from videodermoscopy. A self-administered questionnaire was used to assess patient evaluation of treatment effectiveness. RESULTS: At 12-month follow-up, 23 of the 37 patients were rated as improved using global photography (12 were slightly improved, 8 were moderately improved, and 3 were greatly improved). No improvement was recorded in 13 patients. One patient experienced worsening of the condition. There was a statistically significant (P = .002) increase in the hair density score in 12 patients. No adverse reactions to the drug were reported. CONCLUSIONS: Sixty-two percent of the patients demonstrated some improvement of their hair loss with the use of finasteride, 2.5 mg/d, while taking the oral contraceptive. It is unclear whether the success was due to a higher dosage of finasteride (2.5 mg instead of 1 mg) or to its association with the oral contraceptive containing drospirenone, which has an antiandrogenic effect. Further studies are necessary to understand which patterns of female pattern hair loss respond better to this treatment.

Effective treatment of female androgenic alopecia with dutasteride.
Olszewska M, Rudnicka L.
Department of Dermatology, Warsaw Medical School, Warsaw, Poland.
      Dihydrotestosterone is the main molecule responsible for androgenic alopecia. Finasteride, which reduces transformation of testosterone into dihydrotestosterone and decreases dihydrotestosterone activity, is approved for treatment of androgenic alopecia in men. We describe the case of a 46-year-old woman with androgenic alopecia, non-responsive to minoxidil, who initially benefited from finasteride. Due to only limited improvement after finasteride and persisting profound psychological distress resulting from androgenic alopecia, another 5-reductase inhibitor, dutasteride, was introduced. Clinical evaluation and trichogram were applied for assessment of dutasteride efficacy in this patient. Additionally, mean hair diameter was monitored by means of computer dermoscopy. After 6 months of therapy, significant improvement was observed and after 9 months the clinical diagnosis of androgenic alopecia could no longer be made in this patient. No side effects were observed. In conclusion, theoretical data and our experience in this case show that dutasteride might develop into a true alternative in treatment of androgenic alopecia.

Finasteride treatment of patterned hair loss in normoandrogenic postmenopausal women.
Trüeb RM; Swiss Trichology Study Group.
Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
      BACKGROUND: Finasteride, an inhibitor of type 2 5alpha-reductase, inhibits conversion of testosterone to dihydrotestosterone, resulting in a decrease in serum and scalp dihydrotestosterone levels believed to be pathogenic in androgenetic alopecia. Oral finasteride has been shown to be effective in the treatment of hair loss in men, while its efficacy in women has remained controversial. METHODS: 5 postmenopausal women without clinical or laboratory signs of hyperandrogenism were given 2.5 or 5 mg/day oral finasteride for the treatment of pattern hair loss. Efficacy was evaluated by patient and investigator assessments, and review of photographs taken at baseline and at months 6, 12 and 18 by an expert panel. RESULTS: Finasteride treatment improved scalp hair by all evaluation techniques. The patients’ self-assessment demonstrated that finasteride treatment decreased hair loss, increased hair growth and improved appearance of hair. These improvements were confirmed by investigator assessment and assessments of photographs. No adverse effects were noted. CONCLUSIONS: Oral finasteride in a dosage of 2.5 mg/day or more may be effective for the treatment of pattern hair loss in postmenopausal women in the absence of clinical or laboratory signs of hyperandrogenism.

      Having said that, we strongly warn against any women, for the same theoretical reasons mentioned above, using Propecia and/or Avodart while pregnant or at the risk of becoming pregnant.

      Another concern for women of any age, is that using Propecia and/or Avodart will likely increase the risk for breast cancer. Propecia has breast enlargement in men as a well documented side effect, likely due to an increase in estrogen. If you are at risk for breast cancer and still elect to use Propecia, you can significantly reduce that risks by concurrently using several health and hair growth promoting phyto-estrogenic compounds such as Natural Estrogen with Pomegranate Extract, Super Absorbable Soy Isoflavones, Mega Green Tea Extract, and Resveratrol among others.

      As with men, don’t expect a lot in the way of hair growth from either Avodart or Propecia alone.