Our outlets will be closed from 26 Mar (Tue) to 27 Mar (Wed) for our annual team bonding event. We will resume operations on 28 Mar (Thu).
Our outlets will be closed from 26 Mar (Tue) to 27 Mar (Wed) for our annual team bonding event. We will resume operations on 28 Mar (Thu).

Dr Akira Tan: Why Finasteride is Not Recommended as First Line Therapy for Female Pattern Hair Loss

Finasteride Drug In Prescription Medication Pills Bottle

Hair loss can be an emotionally distressing experience for women, impacting not only their physical appearance but also their self-esteem and overall well-being. Hair is often seen as an important aspect of femininity, and its loss can bring about feelings of insecurity, anxiety and embarrassment. 

In the quest to regain control and address hair loss, many women embark on a wild journey in search for effective treatments that promise to restore their hair’s former glory. This journey is often overwhelming, as the market is flooded with a wide array of products, procedures, and remedies, each claiming to be the ultimate solution for their hair restoration.

Some patients in the clinic have asked about Oral Finasteride for treatment of their hair loss after seeing its effects on their male family and friends. Although it is commonly prescribed for male pattern hair loss, in this article, we will discuss why it is not considered first line therapy for female pattern hair loss (FPHL).

What is Finasteride?

Finasteride is a medication commonly used to treat both male pattern hair loss and prostate enlargement. It is a 5-alpha-reductase inhibitor, which inhibits the conversion of testosterone to dihydrotestosterone (DHT) in the body and scalp. High levels of DHT in the scalp will shrink hair follicles over time, leading to thinner hairs and hair loss.

By lowering DHT levels, Finasteride can slow down or even reverse this process, promoting hair regrowth and preventing further hair loss in especially male patients. 

General Side Effect Profile 

Finasteride’s mechanism of action involves interfering with androgen hormones, which play a vital role in male physiology and hair growth. For women, this hormonal interference can lead to more adverse effects.

Common Side Effects for both Genders

  • Deleterious effects on sexual function such as reduced libido and erectile dysfunction
  • Headaches
  • Postural Dizziness 


Other side effects for males include 

  • Breast enlargement 
  • Testicular Pain 


Females are physiologically different and thus have  other considerations 

  • Pregnancy Risk 
  • Changes to Menstrual Periods 
  • Breast Tenderness/Swelling


Finasteride, even in minute amounts, can cause feminisation of a male infant during pregnancy. It is therefore strongly contraindicated in pregnant and expecting women. 

Are there Other Alternatives for Finasteride?  

Finasteride side effect profile aside, we have medications with better safety profiles and data, such as topical minoxidil and oral spironolactone. 

Topical Minoxidil is the initial drug of choice for women with female pattern hair loss. It does not interfere with hormones and works directly on hair follicles by lengthening the growing phase of the hair cycle and improving blood flow to the scalp.

Topical Minoxidil has a good efficacy profile[1], with multiple studies[2]showing both increased patient reported clinically significant hair growth and an increase in hair counts within treatment areas. It also has a good safety profile[3] as it is not systemically absorbed to a significant degree, with most side effects being related to skin irritation. As such, it is the initial drug of choice for FPHL.

However, there are instances where female patients desire more results – in such cases, we can introduce oral anti-androgenic (anti-male hormone) medications. Some examples of these medications  include Spironolactone and Finasteride. 

Similar to Finasteride, Spironolactone’s list of side effects include teratogenicity, postural giddiness, headaches and decreased libido. Due to these side effects, we look at their efficacy to decide if it’s worth prescribing them. 

Let’s look at them separately. 

Spironolactone and Finasteride – Worth It?  

Spironolactone is clinically[4] the  first choice for FPHL add on therapy. This is because it has strong clinical data that suggests benefit for female pattern hair loss. It also has a myriad of other uses including indications such as Polycystic Ovarian Syndrome, Hirsutism and Acne amongst many others. It does however have some unique side effects to monitor for, including electrolyte and creatinine changes which do have to be monitored upon treatment initiation for those at risk.

Finasteride’s side effect profile is roughly similar to spironolactone, without the risk of electrolyte or creatinine changes. However, there are only a few studies which evaluate the efficacy of finasteride in patients with FPHL. As such it is generally recommended to start on Finasteride only if a patient is unable to tolerate oral spironolactone first. 

Other Hair Loss Treatments for FPHL 

If your hair loss is severe, you can also consider other hair treatments, including hair transplants, hair growth lasers and hair micrograft transfers. These treatments should be done together with prescribed medicine. A doctor can assess your hair health and recommend what combination of treatment works best.

Consult a Professional at SL Aesthetic Clinic

To address your hair loss concerns, you should consult with a qualified professional who specialises in hair restoration and understands the unique needs of women. 

At SL Aesthetic Clinic, our team of experienced doctors and hair specialists can provide personalised solutions based on a thorough evaluation of your condition. We will consider factors such as hormonal balance, underlying medical conditions, and individual preferences to recommend the most suitable hair loss treatment options for you.

You don’t have to face hair loss alone – effective hair loss treatments and medications are available, and with the proper guidance, you can regain your hair and confidence. Contact us today.

Like what you read? Share them!