Oral finasteride increases hair count but may increase sexual dysfunction

January 01, 0001

Oral finasteride increases hair count but may increase sexual dysfunction

Androgenetic alopecia is the most common form of alopecia in men. The aim of this study was to determine the efficacy and safety of finasteride therapy for patients with androgenetic alopecia. Data Sources  MEDLINE, EMBASE, CINAHL, Cochrane Registers, and LILACS were searched for randomized controlled trials reported in any language that evaluated the efficacy and safety of finasteride therapy in comparison to treatment with placebo in adults with androgenetic alopecia. Twelve studies fulfilled the eligibility criteria (3927 male patients).

The proportion of patients reporting an improvement in scalp hair was greater with finasteride therapy than with placebo treatment in the short term (RR, 1.81) and in the long term (RR, 1.71), both results were considered to have moderate- quality evidence. The number needed to treat for 1 patient to perceive himself as improved was 5.6 in the short term and 3.4 in the long term. Moderate-quality evidence suggested that finasteride therapy increased the mean hair count from baseline in comparison to placebo treatment, expressed as a percentage of the initial count in each individual, at short term (mean difference, MD, 9.42%) and at long term (MD, 24.3%). Also, the proportion of patients reported as improved by investigator assessment was greater in the short term (RR, 1.80, number needed to treat, 3.7) (moderate-quality evidence). Moderate- quality evidence suggested an increase in erectile dysfunction (RR, 2.22, number needed to harm, 82.1) and a possible increase in the risk of any sexual disturbances (RR, 1.39). The risk of discontinuing treatment because of sexual adverse effects was similar to that of placebo (RR, 0.88) (moderate-quality evidence).

The researchers concluded: "Moderate-quality evidence suggests that daily use of oral finasteride increases hair count and improves patient and investigator assessment of hair appearance, while increasing the risk of sexual dysfunction."

Prescribing information mentions this, but no explanation. Further information on the effect on prostate cancer would be helpful, as well.

For the full abstract, click here.

Arch Dermatol 146(10):1141-1150, October 2010 © 2010 American Medical Association
Efficacy and Safety of Finasteride Therapy for Androgenetic Alopecia: A Systematic Review. José Manuel Mella, María Clara Perret, Matías Manzotti, Hugo Norberto Catalano and Gordon Guyatt.

Category: S. Skin Keywords: androgenic, alopecia, finasteride, efficacy, safety, systematic review, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 5 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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