Why Can’t Pregnant Women Take Finasteride?

For years, finasteride has been a popular treatment for male pattern baldness. It works by blocking the conversion of testosterone into dihydrotestosterone (DHT), the hormone that damages hair follicles. But finasteride for women isn't FDA-approved due to potential risks during pregnancy. ¹

However, some dermatologists have started prescribing finasteride off-label to women struggling with thinning hair. And new research indicates that may be safe and effective when taken with proper precautions.

So, can women take finasteride? And can this med be taken during pregnancy?

In this article, we'll take a closer look at how finasteride works, review clinical studies on using this medication to treat hair loss in women, and discuss whether it's possible to take finasteride safely during pregnancy.

How Does Finasteride Work?

Finasteride blocks an enzyme called Type II 5α-reductase. This enzyme normally converts testosterone into dihydrotestosterone (DHT). While DHT plays an important role early in male development, it can drive hair loss in adulthood. ¹

Here's how it happens - DHT shrinks and weakens hair follicles over time, especially follicles genetically prone to DHT sensitivity. The result? Thinning hair and bald patches on the scalp. What's more, balding regions tend to have higher DHT levels than hairy scalp areas. ¹

Can Women Take Finasteride?

When it comes to hair loss treatments, finasteride is one of the big guns. By reducing DHT, finasteride can slow down hair loss and even regrow new strands. But there's a catch - finasteride for women is not FDA-approved. ¹ So, what gives?

As it turns out, there's a very good reason for all the warnings around finasteride for women. You see, DHT plays different roles throughout a man’s life:

• Early development: DHT is critical for the formation of male genitalia.

• Later in life: DHT spurs prostate growth, male pattern baldness, and growth of body and facial hair. ²

During the early stages of pregnancy, DHT is essential for the proper formation of a male fetus. Without enough DHT, a male fetus runs the risk of being born with abnormal genitalia. ¹

This risk was confirmed in studies on pregnant rats and monkeys given finasteride. The male offspring were born with varying degrees of genital abnormalities due to the lack of DHT. ¹

Because of this risk, the FDA strongly advises against finasteride for women who are planning on becoming pregnant. In fact, the FDA gave finasteride a Pregnancy Category X rating. ¹

And it's not just about taking finasteride tablets yourself. The risks can come from simply handling broken finasteride tablets or even from exposure to a partner's semen if he is taking finasteride. ¹

The risks during pregnancy are clear, but can women take finasteride if they are not planning on becoming pregnant?

The bottom line is this: If you want to start finasteride for hair loss, have a conversation with your doctor. Together, you can weigh the pros and cons and determine if this medication is right for you. While finasteride for women is risky during pregnancy, it may be a viable option for women who are not considering pregnancy.

Finasteride for Women: Off-Label Use

While finasteride for women has shown promise in early studies, the jury's still out on whether it's truly effective and safe.

You see, finasteride is FDA-approved to treat hair loss in men - not women. ¹ So, when doctors prescribe finasteride for women, it's considered "off-label." Now, off-label doesn't always mean bad. But it does mean there's limited research on safety and effectiveness for that particular use.

Research on finasteride for women is limited due to the risks of taking it during pregnancy. In fact, current research on finasteride for women only includes participants taking oral contraceptives to prevent accidental pregnancy.

In one study involving 37 women with female pattern baldness, researchers gave the participants 2.5 mg of finasteride daily along with an oral contraceptive. After a year, 23 women experienced improved hair density. More importantly, no side effects were reported by the women. However, researchers were unsure whether the improved hair was due to the high dose of finasteride, or the birth control pills as both have antiandrogenic effects. ³

Antiandrogens are drugs that block androgens, which are sex hormones that can damage or destroy hair follicles. By blocking androgens, antiandrogens may stop hair loss from female pattern baldness, also known as androgenetic alopecia. However, antiandrogens can cause side effects in women, like irregular periods and drowsiness. ⁴

So, based on the findings, can women take finasteride for female pattern baldness?

Well, at the conclusion of the study, the researchers expressed that more data is needed to understand which female hair loss patterns respond best to finasteride. ⁴ Until then, have an open conversation with your doctor if you're considering this off-label treatment. Discuss your goals, pregnancy plans, and whether the potential side effects make sense for you.

Side Effects of Finasteride in Women: Beyond the Pregnancy Risks

So, other than finasteride's risks during pregnancy, are there any other side effects women should know about?

A three-year study aimed to find out. Researchers looked at 256 premenopausal women taking 5 mg of finasteride daily along with birth control pills. ⁵ They checked in on the women's side effects throughout the study and discovered some interesting results.

After three months, one in five women had at least one side effect. These included:

• Decrease in libido
• Breast pain
• Increased hair growth in unwanted areas (face, arms, legs)
• Irregular periods
• Increased liver enzymes
• Dizziness
• Edema
• Urinary retention
• Urinary incontinence
• Discharge ⁵

But over time, most women said the side effects had faded or gone away completely. By the end of the study, only one in 30 still had issues. ⁵ These lingering side effects were:

• Decreased libido
• Increased hair growth in unwanted areas
• Breast pain ⁵

Researchers aren't sure why the side effects decreased. They speculated it could be from hormonal changes in the body adapting or the brain’s perception shifting. ⁵

The researchers concluded that 5 mg of finasteride seems to be a safe treatment for hair loss in premenopausal women who do not plan to become pregnant. However, the long-term effects are still unknown since the study only lasted 36 months. Due to this, the researchers stated that additional long-term studies need to be conducted to fully evaluate the safety of finasteride for women. ⁵

Conclusion

Current research on finasteride for women shows promise in improving hair density in cases of female pattern baldness. The women in these studies have experienced thicker, fuller hair with temporary side effects. Moreover, some doctors are increasingly prescribing finasteride off-label to women who do not plan to become pregnant.

Based on these encouraging early findings, can women take finasteride safely? The jury is still out. While current data on efficacy and safety is promising, it is still quite limited, largely stemming from concerns about potential dangers during pregnancy. More research is needed to definitively determine the risk profile.

If you are a woman considering finasteride for hair loss, have a frank conversation with your doctor about whether it may be appropriate for your situation. They can review your medical history, plans for pregnancy, and tolerance for potential side effects.

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