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Paper Chase #2 - Finasteride vs Minoxidil in Male Alopecia

Tom Robertson, MD and Steve Biederman, MD
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To compare the efficacy of oral finasteride and topical minoxidil for males with androgenetic alopecia.

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Kapil S. -

Can you comment on the rate of post-finasteride syndrome described in the literature? In addition, can you comment on the combined efficacy of finasteride vs minoxidil vs either alone?

Neda F., MD -

Hi Kapil. Here's Steve's response: "Thanks for listening and for your questions! Post-finasteride syndrome is not well-characterized in the literature. There was a 2010 trial "Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review" by Mella et al. that describes increased incidence of sexual adverse effects of 1.5% with finasteride. These typically stop with cessation of the medicine. Persistence of symptoms of sexual dysfunction described as the post-finasteride syndrome itself really haven't been well characterized or defined. This is actually somewhat controversial - there is a nice BMJ summary at this link: https://www.bmj.com/content/366/bmj.l5047 .

In all of the literature, finasteride plus minoxidil has been demonstrated to be more efficacious than either agent alone. Given their different mechanisms of action and safety to be taken simultaneously, for maximum efficacy both could be prescribed to a patient."

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Primary Care RAP January 2020 Written Summary.pdf 1 MB - PDF

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