Does Finasteride Actually Regrow Hair? Real Response Rates
What percentage of men respond to finasteride?
The Propecia studies measured both hair counts and photographic improvement. The table separates those outcomes. [1]
| Outcome | Finasteride | Placebo | Assessment |
|---|---|---|---|
| Visible increase at one year | 48% | 7% | Independent photographic panel |
| Visible increase at two years | 66% | 7% | Independent photographic panel |
| No hair-count decline at two years | 83% | 28% | Calculated from the reported proportions with declining counts |
Source: Propecia prescribing information, clinical studies. [1]
The two-year 83% figure is not an 83% visible-regrowth rate. Likewise, a person whose hair looks stable has not necessarily failed treatment. With progressive hair loss, maintaining the starting appearance can be an important result.
What the original trials actually measured
Kaufman and colleagues studied 1,553 men aged 18 to 41 in two randomized trials, with 1,215 continuing into second-year blinded extensions. The researchers used hair counts, participant assessments, investigator assessments and standardized photographs. [2]
The counted vertex area was a circle one inch in diameter, approximately 5.1 cm². The difference between finasteride and placebo was 107 hairs at one year and 138 hairs at two years in that target area. These were differences between groups, not a claim that every participant grew that many hairs. [2]
This matters when comparing before-and-after pictures with a scientific result. Hair counts can detect a change that is difficult to see in casual photographs. Lighting, length, styling and wetness can also alter the apparent density without changing the actual number of hairs.
The five-year report described continued placebo-controlled extensions, not simply an open-label follow-up of early responders. It found sustained treatment benefits while the placebo group experienced progressive loss. [3] Longer follow-up also needs to be read in light of who remained in the study, rather than treating every later percentage as the outcome of all original participants.
What clinical practice studies show
A Japanese clinic study enrolled 3,177 men receiving finasteride 1 mg daily and evaluated photographic efficacy in 2,561. Improvement was recorded in 2,230 of those assessed, or 87.1%. The reported grades were:
- Slight increase: 39.5%.
- Moderate increase: 36.5%.
- Great increase: 11.1%.
Those categories show why the headline percentage should not be interpreted as dramatic regrowth for nearly nine out of ten men. The denominator also matters: the efficacy result concerned 2,561 evaluated patients, not all 3,177 originally treated. The authors noted missing follow-up and that the data came from one institution. [4]
This study provides real-world clinical evidence. It is different from a forum poll because the clinic used a photographic grading method. It is also different from a randomized trial because there was no concurrent placebo comparison.
How to read online finasteride reviews
A patient review can describe useful details: how treatment fits a routine, how long someone stayed on it and what changes they noticed. It usually cannot establish a population response rate.
Before using a review as a comparison, check:
- Diagnosis: Was the person treating male pattern hair loss or another cause of shedding?
- Treatment: Was finasteride used alone, or together with minoxidil or another intervention?
- Duration: How long was the treatment actually taken?
- Outcome: Did the person mean less shedding, stable appearance or new visible growth?
- Photos: Were lighting, hairstyle and angles comparable?
Without that information, differences between two reviews may reflect different situations. It is not possible to calculate a reliable gap between trial results and forum results from selected posts, or to assume that everyone reporting no benefit stopped too early.
A practical assessment at three, six and twelve months
Take baseline photographs before treatment when possible. Use a front view, a top view and a crown view, keeping the lighting, camera distance and hair condition as consistent as practical. Save dates rather than relying on memory.
Three months
Review tolerability, actual use and any early change. Clinical improvement was detected as early as three months. [1]
Six months
Compare the same views with baseline. Separate visible density from day-to-day shedding. If another treatment was started during the same period, record its start date so that the overall response is not automatically attributed to finasteride alone.
Twelve months
Review the direction of change with the prescriber: better density, stable appearance or continued progression. A year is a useful comparison interval, but it is not a requirement to remain on treatment through troublesome symptoms. If results are disappointing, check the diagnosis, consistency of use and other contributors to shedding before selecting another treatment.
A hair-pull test by itself does not establish whether finasteride has succeeded or failed. It addresses active shedding at an examination, while treatment response also involves the longer-term pattern and density.
Crown thinning, the hairline and advanced loss
The anterior mid-scalp study excluded the front hairline and bitemporal recession. Its results are not a temple-regrowth rate. [1]
A trial average also cannot predict restoration of a long-standing bare area. The more useful discussion is what improvement is realistic for the current pattern and whether maintaining existing hair would meet the person's goal. No routine clinical response percentage can guarantee the result before treatment begins.
Does adding minoxidil improve results?
A randomized Chinese study assigned 450 men to finasteride 1 mg, topical 5% minoxidil or the combination for 12 months. Among 428 assessed at the end, improvement was reported in 80.5%, 59% and 94.1%, respectively. The combination had the highest improvement rate in that study. [5]
These figures support discussing an additional treatment when the response to one medicine is incomplete. They are not directly interchangeable with the Propecia photographic percentages because study populations, assessment methods and follow-up differ. A combination result also cannot be used as a finasteride-only response rate.
Dutasteride and topical finasteride
In a 24-week trial of 917 men with androgenetic alopecia, dutasteride 0.5 mg improved hair-count and width outcomes more than finasteride 1 mg. The number and severity of adverse events were similar across groups during that trial. It would be inaccurate to cite this study as proving a higher side-effect burden with dutasteride. [6]
A separate 24-week phase III trial randomized 458 men to a topical finasteride study, with an oral comparison arm. The topical treatment increased target-area hair counts more than placebo, with lower systemic exposure than oral treatment. [7] These findings concern the tested spray formulation; they should not be assumed to apply equally to every compounded concentration or combination.
Treatment choices should be compared using hair-loss studies. A study of enlarged-prostate treatment does not establish comparative scalp-hair response.
Tolerability is part of the result
In the first-year Propecia trials, at least one drug-related sexual adverse effect was reported by 3.8% of treated men and 2.1% receiving placebo. Persistent sexual symptoms and depression have also been reported after marketing; spontaneous reports do not establish their frequency. [1]
New sexual or mood symptoms deserve a direct conversation with the prescriber, including when they started and whether they persisted after stopping. A treatment that improves hair but is not acceptable to the person taking it needs reassessment. That practical decision is distinct from the photographic definition of response used in a trial.
Do the men's response rates apply to women?
No. A randomized study of 137 postmenopausal women found that finasteride 1 mg daily for 12 months did not improve hair growth or slow thinning compared with placebo. [8] Results from men should not be transferred to women or used to claim that this dose showed a modest benefit in that trial. Finasteride is contraindicated during pregnancy because of risk to a male fetus. [1]
Frequently asked questions
Can finasteride work without obvious regrowth?
Why do finasteride success rates differ between studies?
Does no change in my photos mean finasteride failed?
Does finasteride work better with minoxidil?
Can shedding predict my final result?
What happens to results after stopping?
References
- Organon. Propecia prescribing information: clinical studies and adverse reactions. Prescribing information.
- Kaufman KD, et al. Finasteride in the treatment of men with androgenetic alopecia. Journal of the American Academy of Dermatology. 1998. PubMed.
- Finasteride Male Pattern Hair Loss Study Group. Long-term five-year multinational experience with finasteride 1 mg in men with androgenetic alopecia. European Journal of Dermatology. 2002. PubMed.
- Sato A, Takeda A. Evaluation of efficacy and safety of finasteride 1 mg in 3177 Japanese men with androgenetic alopecia. Journal of Dermatology. 2012. PubMed.
- Hu R, et al. Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized comparative study in Chinese patients. Dermatologic Therapy. 2015. PubMed.
- Gubelin Harcha W, et al. A randomized study of different doses of dutasteride versus placebo and finasteride in male androgenetic alopecia. Journal of the American Academy of Dermatology. 2014. PubMed.
- Piraccini BM, et al. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III randomized controlled trial. Journal of the European Academy of Dermatology and Venereology. 2022. PubMed.
- Price VH, et al. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. Journal of the American Academy of Dermatology. 2000. PubMed.