Controversies in the treatment of androgenetic alopecia: The history of finasteride

Dermatol Ther. 2019 Mar;32(2):e12647. doi: 10.1111/dth.12647. Epub 2018 Sep 25.


Male androgenetic alopecia (AGA) affects up to 60% of men by the age of 50. Currently, there are only two approved drugs for the treatment of male AGA: topical minoxidil and oral finasteride. Topical minoxidil is readily available over the counter and has a well-established safety record. However, following 24 weeks of treatment, less than 40% of men respond to the drug. Additionally, due to the topical route of administration, compliance with minoxidil remains low. In contrast, oral finasteride, a 5-alpha reductase inhibitor, demonstrated efficacy in arresting hair loss in more than 80% of patients following 12 months of treatment. However, controversy surrounding potential adverse sexual side effects has negatively affected public perception of the drug and may significantly reduce the number of patients that can benefit from the drug.

Keywords: androgenetic alopecia; finasteride; sexual dysfunction.

Publication types

  • Comparative Study

MeSH terms

  • 5-alpha Reductase Inhibitors / administration & dosage*
  • 5-alpha Reductase Inhibitors / adverse effects
  • Administration, Oral
  • Administration, Topical
  • Alopecia / drug therapy*
  • Finasteride / administration & dosage*
  • Finasteride / adverse effects
  • Hair / drug effects
  • Humans
  • Male
  • Middle Aged
  • Minoxidil / administration & dosage*
  • Minoxidil / adverse effects
  • Treatment Outcome
  • Vasodilator Agents / administration & dosage
  • Vasodilator Agents / adverse effects


  • 5-alpha Reductase Inhibitors
  • Vasodilator Agents
  • Finasteride
  • Minoxidil