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Hair Loss Medication

In this page: Aldactone, Androcur, Propecia/Proscar

Spironolactone (Aldactone)

For unknown reasons, androgens cause scalp hairs to miniaturize (alopecia) and body hair to grow or enlarge (hirsutism). In the treatment of hair loss, spironolactone acts by blocking the effects of androgens (male hormones) on scalp hair follicles. At the same time, it can also reduce the amount of body hair that you have.

Due to the feminisation effects of spironolactone, this drug is only used to treat female pattern hair loss and is not used in males.

What should I expect to see with spironolactone (Aldactone) treatment?
Many women affected by FPHL experience an increase in hair shedding or a reduction in hair volume, or both. You may start to notice a reduction in hair shedding within 4 months of commencing treatment with spironolactone.

It is important to note that the hairs you shed now actually died 3 months ago and had been sitting dormant in the follicle until new hairs grow to replace them. As such, there would be a delay of about 3 months before the effects of spironolactone are seen after commencing treatment.

By about 8 months, there may be a reduction in the amount of body hair. By about 12 months, some women may experience a slight increase in their hair density on the scalp. It is important to manage expectations with spironolactone treatment as the main aim is to slow or stop the progression of hair loss rather than expecting hair regrowth. Any regrowth is considered a bonus.

What are the side effects of spironolactone (Aldactone) and what should I do before commencing treatment?

This is a relatively safe medicine that has been around for 30 years and was originally developed to treat high blood pressure. Only in the last 10 years has it been used regularly to treat female pattern hair loss.

Common side effects are dizziness and tiredness, which may disappear in the first few days of treatment. Due to their effects on altering potassium levels in the blood, it is important to have blood tests before you commence treatment and during treatment.

Some women may have breast tenderness and menstrual irregularities that usually settle within the first 3-4 months of treatment.

Allergic skin rashes are rare with spironolactone but if you develop a new rash and you suspect that this is related to spironolactone, see your doctor immediately.

It is highly recommended to use an oral contraceptive pill so you do not get pregnant while on spironolactone treatment as it is harmful to the unborn baby.

What if I stop taking spironolactone (Aldactone)?
The effects of spironolactone will only be seen with continued medication and will wear off quickly once it is stopped. It is recommended that treatment should continue for at least 12 months before assessing any benefit from it.

Many thanks to the Autralasian Hair and Wool Research Society “Using spironolactone” patient information handout.

Cyproterone Acetate (Androcur)

For unknown reasons, androgens cause scalp hairs to miniaturize (alopecia) and body hair to grow or enlarge (hirsutism). In the treatment of hair loss, spironolactone acts by blocking the effects of androgens (male hormones) on scalp hair follicles. At the same time, it can also reduce the amount of body hair that you have.

Due to the feminisation effects of spironolactone, this drug is only used to treat female pattern hair loss and is not used in males.

How is cyproterone acetate (Androcur) taken?
Post-menopausal women or those who have had a hysterectomy (removal of the uterus) can take 1 or 2 tablets of Androcur daily (please follow your doctor’s advice). In women who are still having regular periods, Androcur is generally taken for only 10 days each month to prevent any irregularities of periods. If you are on the contraceptive pill, it is recommended that you take 1 or 2 tablets of Androcur (as advised by your doctor) with the first active pill of the month.

Androcur is stored in the fat and slowly released into the bloodstream. Therefore, it continues to work for the entire month even if it’s only taken for part of the month. Sometimes, the release can be slower than usual and cause your period to be delayed or absent. This is not a cause for concern.

What should I expect to see with cyproterone acetate (Androcur) treatment?
Many women affected by FPHL experience an increase in hair shedding or a reduction in hair volume, or both. You may start to notice a reduction in hair shedding within 4 months of commencing treatment with spironolactone.

It is important to note that the hairs you shed now actually died 3 months ago and had been sitting dormant in the follicle until new hairs grow to replace them. As such, there would be a delay of about 3 months before the effects of spironolactone are seen after commencing treatment.

By about 8 months, there may be a reduction in the amount of body hair. By about 12 months, some women may experience a slight increase in their hair density on the scalp. It is important to manage expectations with spironolactone treatment as the main aim is to slow or stop the progression of hair loss rather than expecting hair regrowth. Any regrowth is considered a bonus.

What are the side effects of cyproterone and what should I do before commencing treatment?
This is a relatively safe medicine that has been around for 15 years and was originally developed to treat high blood pressure. Only in the last 10 years has it been used regularly to treat female pattern hair loss.

Some women may have breast tenderness and menstrual irregularities that usually settle within the first 3-4 months of treatment. If your periods become highly irregular, it is recommended to take the oral contraceptive pill to help regulate your periods. It is highly recommended that you do not get pregnant while on cyproterone acetate (Androcur) treatment as it is harmful to the unborn baby.

Depression or low mood may be seen in susceptible people.

What if I stop taking cyproterone acetate (Androcur)?
The effects of Androcur will only be seen with continued medication and will wear off quickly once it is stopped. It is recommended that treatment should continue for at least 12 months before assessing any benefit from it.

Many thanks to the Autralasian Hair and Wool Research Society “Using cyproterone acetate” patient information handout.

Finasteride (Propecia/Proscar)

Finasteride is a medication that prevents the conversion of testosterone to its more active form, DHT (dihydrotestosterone) by inhibiting an enzyme called 5-alpha reductase type II in the scalp hair follicles. Lower levels of DHT in the scalp can slow down or prevent hair loss. However, because finasteride does not completely block this conversion, it will not complete arrest hair loss.

What evidence do we have that finasteride (Propecia/Proscar) works?
Finasteride has been tested extensively all around the world by scientists and doctors in large clinical trials and was found to be very effective in treating male pattern baldness (androgenetic alopecia). At the end of 2 years after commencing finasteride, it was found that 99% of men retained all the hair they had when they first started treatment, while those on placebo (sugar tablets) lost their hair with the balding process. Moreover, 48% of men who was on finasteride actually had more hair at the end of the first year after commencing treatment. At the end of 2 years, 66% had more hair than when they first commenced treatment.

What should I expect to see while on finasteride (Propecia/Proscar) treatment?
The main aim of treatment is to stop you becoming bald. Finasteride arrests hair loss and helps you keep the hair that you have left. In other words, if you do not take finasteride, you would expect to lose more hair over the years. Some men have reduced body hair growth while on higher doses of finasteride.

It is important to manage expectations with finasteride treatment as the main aim is to slow or stop the progression of hair loss rather than expecting hair regrowth. Any regrowth is considered a bonus. Some men actually experience some hair regrowth as early as 4 months after commencing treatment but it usually takes up to 2 years before any regrowth is noticed. Even so, only a third of men on finasteride will actually grow enough hair for their family and friends to notice the difference.

For men who start to go bald in their late teens and early twenties, finasteride is a desirable treatment for many to delay the process as long as possible until their thirties or fourties when they do not mind the prospect of becoming bald after establishing their careers and family lives.

Why am I losing more hair now when I have just started finasteride (Propecia/Proscar)?
On the balding scalp, there are many hairs sitting in the dormant or resting phase on the scalp. Sometimes, finasteride can cause rapid reactivation of the hair follicles to produce new hairs causing the old hairs to be pushed out all at once, so you notice more hair shedding. This is not a serious cause for concern if it happens, and should settle within 6 months. This is an indication that finasteride is having an effect on your hair follicles and “reawakening” them.

What happens if I stop taking finasteride (Propecia/Proscar)?
Once you stop the medication, you will continue to lose your hair and the balding process will take over once again at the same rate had you never have taken finasteride. Finasteride helps to delay this outcome as long as you continue taking this medication.

Many thanks to the Autralasian Hair and Wool Research Society “Using finasteride” patient information handout.

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