Finasteride is used to treat benign prostatic hyperplasia (BPH) and androgenetic alopecia. It’s effective for these conditions because of its ability to lower concentrations of a hormone called dihydrotestosterone (DHT). However, for nearly as long as finasteride has been approved by the regulatory agencies to treat these health problems, there have been questions raised about its effects on male reproductive and prostate health. Let’s take a closer look at the relationship between finasteride use and its potential effects on prostate health.
What is finasteride?
Finasteride, sold under the trade names Proscar (for BPH) and Propecia (for androgenetic hair loss), is a type of medication called a 5-alpha reductase inhibitor. These medications work by preventing testosterone from being converted into a related molecule, dihydrotestosterone (DHT). Why is this significant? Elevated levels of DHT can trigger hair follicle shrinkage and excessive prostate tissue growth in men with a genetic predisposition to pattern hair loss and BPH, respectively. By lowering concentrations of DHT, you can potentially slow down the progression of these conditions and improve quality of life.
Can finasteride cause prostate problems?
The consensus within the medical community is that finasteride can help with symptomatic BPH, rather than worsening prostate problems. Because one of the effects of finasteride is to reduce prostate volume (i.e., shrink prostate cells), patients typically find that the medication helps with symptoms like increased urinary frequency and reduced urinary flow (urinary retention).
Does finasteride affect prostate volume?
Yes, one of the main effects of finasteride is a reduction in DHT levels within the prostate gland, which has been associated with decreased prostate gland size over time. One of the earliest studies on the effects of finasteride on BPH showed that the maximum reduction in prostate volume occurs approximately 6 months after beginning treatment with finasteride. Additionally, both 1mg and 5mg doses of finasteride were found to be capable of reducing the size of the prostate gland by at least 20% by the end of the first year of treatment (Gormley et al., 1992).
Does finasteride cause prostate cancer?
Based on currently available studies and data, finasteride is not believed to directly cause prostate cancer, but let’s spend some time unpacking the connection between the two. Finasteride has been shown to be capable of dramatically reducing the size of the prostate gland. While this can be helpful in alleviating symptoms of BPH, it can complicate the diagnosis of certain types of prostate cancers.
Prostate cancers are defined by their Gleason Score. A Gleason Score describes how abnormal cancer cells are compared to normal cells and the likelihood of the cancer spreading. The higher the Gleason Score, the more aggressive the prostate cancer is.
In 1993, a study was launched to determine whether using finasteride could help prevent the development of prostate cancer in aging men. Initial examination of study results showed that there was a small but statistically significant increase in the risk of developing high-grade prostate cancers (high Gleason Score) in a subset of study participants (Thompson et al., 2013). However, in the same study, there was also a 43% reduction in the risk of low Gleason Score prostate cancers and an overall reduction in prostate cancer risk of 25% after seven years of treatment.
To make sense of these findings, investigators theorized that because finasteride helps reduce prostate gland size, it might also increase the likelihood of detecting high-grade cancers on biopsy. These improved detection rates are a positive thing because they enable more timely treatment and improved clinical outcomes. They may also help patients and their healthcare providers avoid unnecessary diagnostic testing and treatment.
Should you take finasteride if you have prostate cancer?
If you’ve had prostate cancer in the past or have a family history of prostate cancer, you’ll need to consult with your doctor or another trusted healthcare provider before taking finasteride. While finasteride does not directly cause prostate cancer, it can alter prostate-specific-antigen (PSA) levels which could impact prostate cancer detection. Because of this, men taking finasteride for hair loss or BPH may want to consider regular PSA monitoring with their doctors.
Finasteride and prostate health: Takeaway
Finasteride’s dual role in treating pattern hair loss and BPH makes it an important medication in the maintenance of optimal male health and wellness. But given its possible impacts on prostate health and the potential for side effects, the decision to take finasteride may not be a straightforward one.
If you’re considering using finasteride, start by consulting with your doctor or other healthcare provider. They’ll consider your medical history and help you determine whether finasteride is the safest and most effective option to manage your symptoms and help you reach your health goals.
