Objective: To review available evidence on the safety and efficacy of finasteride in the treatment of alopecia in women.

Data sources: A literature search was conducted through PubMed (1948-March 2010) and MEDLINE (1950-March 2010) using the search terms finasteride and alopecia. References cited in relevant publications were reviewed.

Study selection and data extraction: All data sources identified were reviewed for inclusion. Reports of finasteride treatment of female alopecia were included in the review. This included prospective and retrospective trials, case series, and case reports. Studies in men were not included.

Data synthesis: Few pharmacologic options exist for women with alopecia who do not achieve satisfactory responses to topical minoxidil solution. Treatment successes with finasteride in women with female pattern hair loss, although an off-label indication, have been primarily described in uncontrolled studies and anecdotal reports. In 2 controlled clinical studies, finasteride showed no benefit over placebo or no treatment in female pattern hair loss. A finasteride regimen of 1 mg orally daily, as indicated in male pattern hair loss, may be recommended for those who fail or cannot tolerate minoxidil therapy. A 12-month trial is needed to assess stabilization of hair loss, and hair regrowth may take 2 years or longer. Although data are sparse, menopausal status, circulating androgen concentrations, and concomitant symptoms of hyperandrogenism do not appear to predict response to finasteride. Overall, finasteride is well tolerated; however, women of childbearing potential must adhere to reliable contraception while receiving finasteride, and treatment is contraindicated in pregnancy, due to known teratogenicity.

Conclusions: Although objective evidence of efficacy is limited, finasteride may be considered for treatment of female pattern hair loss in patients who fail topical minoxidil treatment.