Finasteride Uses, Efficacy Examined in Female Patients

Off-label use has become more common in women for treatment of alopecia and hirsutism.

The use of finasteride in the treatment of female patients was evaluated in a systematic review published in the International Journal of Dermatology.

Finasteride, a competitive and specific inhibitor of Type II 5α-reductase, is currently approved by the Food and Drug Administration for the treatment of benign prostatic hyperplasia and androgenetic alopecia in men. However, off-label use has become more common in women for treatment of alopecia and hirsutism. To better understand the use and efficacy of this treatment in a female patient population, study authors conducted a literature search of studies involving finasteride use in women. 

Sixty-five studies with a total of 2683 female patients were included in the analysis. Results showed most of the randomized controlled trials (RCTs) involved women being treated with finasteride for hirsutism (49.7%) or female pattern hair loss (34.7%). Recommendations from RCTs indicated that treatment may be effective in female patients with hirsutism or polycystic ovarian syndrome, while the evidence for use in female pattern hair loss was mixed.

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In addition, case reports showed that finasteride could potentially be beneficial in patients with hidradenitis suppurativa and chronic migraines. Finasteride was also evaluated in the treatment of alopecia, lichen planopilaris, and frontal fibrosing alopecia, however none of these were RCTs. 

Among these studies, the dosing of oral finasteride ranged from 0.5mg to 5mg per day in patients 6 to 88 years old. Treatment duration ranged from 6–12 months (57.6%); monotherapy (88.9%) and continuous use (96.4%) were the most common treatment characteristics.

“The studies reviewed here provide a good starting point for assessing finasteride dosage and length of treatment in the management of candidate conditions that may benefit from finasteride therapy,” the authors concluded, adding that, “Due to finasteride’s potential teratogenicity, it is important to not only caution finasteride use in women who are considering pregnancy but also administer a contraceptive to women of reproductive age throughout the duration of finasteride use.”

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