5-alpha WHAT? 5-alpha reductase inhibitors are a group of medicines used to treat male pattern hair loss.
5ARIs, as they are often abbreviated, are also used to manage and treat prostate enlargement.
5-alpha reductase inhibitors include finasteride and dutasteride, more commonly known as Proscar® and Avodart®, respectively.
5ARIs were first released in the market in 1992, after the United States Food and Drug Administration approved the use of finasteride as a hair loss and prostate enlargement treatment.
However, 5-alpha reductase inhibitors may also be used to treat 1) an excess of testosterone, 2) hirsutism (excessive hair growth, particularly in women), and 3) hormonal imbalances in transgender individuals.
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5-Alpha Reductase Inhibitors: How Do They Work?
5-alpha reductase inhibitors are primarily used to stop the hair loss and treat benign prostatic hyperplasia (BPH), which is just another fancy medical term for an enlarged prostate gland.
As their name implies, 5-alpha reductase inhibitors work by inhibiting the 5-alpha reductase enzyme, which is responsible for converting testosterone into dihydrotestosterone (DHT) in places like the hair follicles, prostate, skin, and liver.
Testosterone and DHT are both androgens or male sex hormones that bind to receptors throughout the body, but they are responsible for producing different effects.
For instance, testosterone is responsible for physical growth, bone and muscle mass development in men. On the other hand, DHT is associated with the development of male sex characteristics, particularly during antenatal development, hair growth patterns, and prostate growth, which includes male pattern hair loss.
For individuals with genetic factors predisposing them to male pattern hair loss, DHT binds to receptors located in the scalp. This causes the hair follicles in the scalp to gradually stop producing new hair over time.
DHT is also one of the leading causes of prostate enlargement, which affects as much as 1 in 2 men by age 60, and increases in prevalence with age.
Individuals with benign prostatic hyperplasia (prostate enlargement) may have DHT accumulate in their prostate and bind to androgen receptors located therein, leading to the gland’s eventual enlargement.
5ARIs prevent the 5-alpha reductase enzyme from converting testosterone to DHT, which may lead to a reduction in prostate size.
Two Types of 5-Alpha Reductase Inhibitor Drugs: Finasteride and Dutasteride
The United States FDA has approved the use of 5ARIs for treating male pattern baldness and benign prostatic hyperplasia: finasteride and dutasteride.
However, 5-alpha reductase inhibitors may be prescribed “off the label” to treat excessive hair growth in women, a condition referred to as hirsutism.
Finasteride (brand name Proscar®/Propecia®)
Finasteride, a drug first developed in the 70s and first approved by the FDA in 1992 as a treatment for benign prostatic hyperplasia under the brand name Proscar®.
Meanwhile, in 1997, the FDA approved finasteride as a treatment for male pattern baldness under the brand name Propecia®.
Both medicines are used to treat benign prostatic hyperplasia and its related symptoms, such as frequent urination. They may also reduce the likelihood of individuals having to get prostate surgery.
Finasteride has also been used to treat male pattern baldness or general hair loss due to its effectiveness as a treatment for such.
Finasteride dosages depend largely on the condition being treated. For instance, 1 mg of Propecia® may be prescribed for treating male pattern baldness, while a 5 mg dose of Proscar® may be prescribed for treating benign prostatic hyperplasia.
Dutasteride (brand name Avodart®)
Dutasteride was first patented in 1996 and approved by the FDA in 2001 as Avodart® as a treatment for benign prostatic hyperplasia and its symptoms. While some studies support the claim that dutasteride may be effective as a hair loss treatment, it has yet only been approved by the FDA for prostate enlargement.
Dutasteride is available as an oral capsule containing 0.5 mg of the substance taken once daily.
Dutasteride may be prescribed as a medicine combining it with tamsulosin – a drug that promotes the relaxation of prostate muscles and dilation of the bladder to help improve BPH symptoms. This combination is available as a prescription medicine called Jalyn®.
5ARI Side Effects
There is no medication without any potential side effects, and 5ARIs are no different.
Finasteride and dutasteride share similar potential side effects, such as:
- Erectile dysfunction (ED)
- Reduced sex drive
- Gynecomastia (the development of breast tissue or “man-boobs” in men)
- Anxiety and depression
- Increased high-severity prostate cancer risk
On the other hand, Jalyn®, which combines dutasteride with tamsulosin, may cause low blood pressure, dizziness, and malaise/general weakness.
5ARI Interactions and Potential Risks
5-alpha reductase inhibitors may also cause potentially detrimental interactions and risks worth noting.
For instance, using 5-alpha reductase inhibitors may increase the risk of developing high-severity prostate cancer.
Some individuals may note a marked increase or reduction in their prostate-specific antigen (PSA) levels when taking 5ARI medications. That corresponding increase in PSA levels may be an indication of prostate cancer.
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That said, before going on a treatment involving the use of 5-alpha reductase inhibitors, individuals need to get their PSA levels measured and monitored throughout the duration of the treatment to keep an eye on the drug’s effects.
Moreover, finasteride may interact with herbal supplements, most notably St. John’s Wort, a supplement used to treat ADHD, depression, and anxiety, among others.
Consult your healthcare provider immediately upon noticing any signs or symptoms of adverse drug interactions.
The Final Word on Using 5-Alpha Reductase Inhibitors
Hair loss is quite a prevalent condition for many men. However, the good news is that treatment is entirely possible through 5-alpha reductase inhibitors like dutasteride and finasteride.
Both medications work by blocking the 5-alpha reductase enzyme responsible for converting testosterone into DHT, which is linked to male pattern baldness and prostate enlargement.
The reduction of DHT levels has been demonstrated in studies to slow down, stop, or reverse the course of male pattern hair loss that may stop men from a good quality of life.
The 5-alpha reductase inhibitor category of drugs is also used to treat prostate enlargement and manage its symptoms such as uncontrollable or frequent urination, or difficulties controlling urine flow.
Worried about male pattern hair loss or prostate enlargement and want to see if a 5-alpha reductase inhibitor is suitable for you? Consult your healthcare provider to determine the best treatment option based on your medical history and current health situation.
