My Dermatologist Prescribed 2.5mg Finasteride Daily and Said She’d See Me in a Year

Hi There Doctor!

Im a 22 year old guy with a pretty good head of thick hair currently. No one currently would ever know I am thinning. Recently I went to get my haircut and my stylist told me i may have some “thinning issues” as she noticed short hairs near the front of my hairline. Crown is very thick at the moment.

I made an appointment with a dermatologist and she said that right now is a great time to catch it and potentially preserve everything I have and started me on Finasteride 5mg cut in half once per day. (2.5mg daily) and she said “see ya in a year!” I have been on it for two and a half weeks with no side effects yet.

My question is if it takes a year for Finasteride to show any results, isnt a year a VERY LONG time to lose hair? Couldn’t I lose A LOT of Hair in that period of time? I hate this feeling that I’m on the best medication for hair loss, but at the same time I’m gonna be losing hair at the same rate for a year before it even starts working?! Am I understanding how Finasteride works correctly Or does it immediately start to “help” but will just take a year to see any major preservation or potential regrowth?

Thanks!

It may take up to a year before you notice the effects of finasteride on treating androgenic alopecia. Maybe some will see signs in 6 months, but I generally inform my patients that they should be prepared for a 6 to 12 month time span before they can see results. That being said, Propecia (finasteride 1mg) is for the treatment of androgenic alopecia on the crown and top of your scalp. Some patients and doctors use it for frontal hairline thinning, but it is generally not effective.

As for the dosage you were given, the recommended dose is 1mg taken daily. Many patients and doctors, in the interest of cost saving, choose the generic 5mg which they break into quarters (1/4) to make 1.25mg of finasteride. There is no generic finasteride in 1mg dose legally available in the US yet due to patent laws. While breaking up a small 5mg tablet in to four small semi-equal pieces may be annoying, it saves hundreds of dollars a year. For example, a one year supply of finasteride 5mg taken 1/4 pill a day will cost you under $30 per YEAR. The brand name will cost you close to $800 a year depending on where you buy it. There is no difference in efficacy in taking the generic drug. Taking 1.25mg a day as opposed to 1mg should not have any significant difference. Ideally you should be cutting the pill in to five equal pieces, but this is not practical.

Taking 2.5 mg daily is more than doubling the dose and it would not have any beneficial impact in treating your hair loss. Taking more does not mean it will work better. Rather, it will give you more side effects. But some doctors have their own opinions and they’re in their right to practice medicine and prescribe medications as they see fit. If you do not agree with your doctor and have concerns, you should seek a second opinion. After all it is called a “practice” of medicine. Just to be clear, I am not your doctor and this is not a second opinion.

There is a rising body of evidence that less finasteride may work. So for those of you who may be experiencing any side effects, a half dose may be just as effective as a full dose. This is presently an unofficial comment as this is not yet what the majority of doctors believe is the recommended dose for finasteride.

Finally, what troubles me most from your question is that you state that you never considered yourself as someone who is losing hair. You set off on this medical endeavor because your hair stylist mentioned something that got you worried. And now you are second guessing your dermatologist’s recommendations and treatment plan. From what I am reading, you need to speak with your dermatologist regarding your concern and if you are still not satisfied you need to seek a second opinion.

What I do with everyone who sees me is to perform bulk measurements on the hair in different parts of the scalp. This is a very accurate way to make the diagnosis if hair loss is occurring before you can see it with your naked eye and it brings scientific measurements to the diagnostic process.