Dr. Ahmed Finasteride can be used for the treatment of PCOS as it works by reducing the levels of testosterone, a hormone that is generally found in increased concentrations among women with PCOS.
Finasteride is a medication that inhibits the activation of testosterone into its active form. It is commonly used to treat male pattern baldness and prostatic enlargement. Because of its anti-androgenic properties, it is also used to treat some of the symptoms of polycystic ovary syndrome (PCOS) in women.
PCOS is a hormonal disorder characterized by a hyper-androgenic state that can cause a range of symptoms, including irregular periods, excess hair growth, and acne.
In women with PCOS, testosterone production is increased. Finasteride inhibits the activation of testosterone and hence blocks its virilizing effects. It is especially helpful in relieving the symptoms of excess facial hair and acne. It is typically used in conjunction with other treatments, such as birth control pills and metformin.
How Finasteride helps women with PCOS?
Finasteride primarily helps women with an excess of facial hair and a male-like physique. Although, it is not approved to treat fertility in women, reducing high testosterone levels in women may help women achieve fertility.
Having said that, women who become pregnant should immediately stop Finasteride as it can severely affect the fetus. Importantly, it may change the physical appearance of the male baby resulting in a female-like newborn.
Role of finasteride in PCOS for different aspects:
Symptom | Role of finasteride in PCOS |
| Hirsutism (excess hair growth) | Finasteride can help to slow down the growth of facial and body hair in women with PCOS. |
| Irregular menstrual cycles | Finasteride may help regulate menstrual cycles when given in combination with birth control pills and metformin. |
| Fertility | Finasteride is not recommended for the treatment of fertility in women with PCOS. However, if a woman has very high levels of testosterone, reducing their levels can increase her chances of a woman getting pregnant. It is very important to stop Finasteride as testosterone levels normalize and before planning to get pregnant. |
| Female physique | Finasteride can reduce male-pattern baldness and facial hair in women with PCOS. In addition, it may normalize the balance between estradiol and testosterone and may cause enlargement of breasts and improve the female physique. |
Finasteride Vs Metformin for Women with PCOS:
One of the most common drugs used to treat PCOS is metformin. Metformin improves insulin sensitivity and metabolic derangements in patients with PCOS.
In addition, it is associated with some degree of weight loss which is very helpful in women with PCOS.
The combination of metformin and Finasteride may improve most of the symptoms of women with PCOS.
Finasteride Vs Metformin in treating women with PCOS:
Treatment | Finasteride | Metformin |
| Mechanism of action | Inhibits the conversion of testosterone to dihydrotestosterone (DHT) by inhibiting the enzyme 5-alpha reductase | Reduces insulin resistance and lowers insulin levels |
| Symptoms treated | Hirsutism (excess hair growth) | Irregular menstrual cycles, insulin resistance, and high blood sugar levels |
| Effects on fertility | Not recommended but may be helpful if taken a few months before planning pregnancy. | May improve fertility by regulating menstrual cycles and improving ovulation |
| Side effects | Possible side effects include decreased libido, erectile dysfunction, and depression | Possible side effects include gastrointestinal upset, metallic taste, and vitamin B12 deficiency |
| Use in combination with other treatments | Often used in combination with birth control pills or other treatments for PCOS symptoms | Can be used in combination with other treatments for PCOS symptoms, such as clomiphene citrate for infertility |
| Precautions | Should not be used during pregnancy, as it may cause birth defects | Should be used with caution in patients with liver or kidney disease, as it can increase the risk of lactic acidosis |
Finasteride and metformin alone may be less effective compared to combination therapy as each drug targets a different aspect in the treatment of women with PCOS.
Finasteride Vs Spironolactone for PCOS:
Like Finasteride, Spironolactone is one of the drugs that is commonly used by women with PCOS. It is a potassium-sparing diuretic with anti-androgenic properties.
Both Finasteride and Spironolactone help women with PCOS and excess facial hair.
Finasteride and Spironolactone in the treatment of PCOS:
Treatment | Finasteride | Spironolactone |
| Mechanism of action | Inhibits the conversion of testosterone to dihydrotestosterone (DHT) by inhibiting the enzyme 5-alpha reductase | Blocks the action of androgens (male hormones) at the receptor level |
| Symptoms treated | Hirsutism (excess hair growth) | Hirsutism, acne, and hair loss |
| Effects on fertility | May increase the chances of women getting pregnant but should be used weeks to months before planning pregnancy. | Not recommended for the treatment of fertility. It can cause birth defects in babies and should be avoided. |
| Side effects | Possible side effects include decreased libido, erectile dysfunction, and depression | Possible side effects include breast tenderness, menstrual irregularities, and hyperkalemia. |
| Use in combination with other treatments | Often used in combination with birth control pills or other treatments for PCOS symptoms | Often used in combination with birth control pills or other treatments for PCOS symptoms |
| Precautions | Should not be used during pregnancy, as it may cause birth defects | Avoid in patients with kidney disease (causes hyperkalemia) |
It is important to note that finasteride and spironolactone have different mechanisms of action and are typically used to treat different symptoms of PCOS.
Both Finasteride and Spironolactone reduce androgen levels and may improve symptoms of virilization manifesting as excessive facial hair, male-pattern baldness, coarse features, acne, and irregular menstrual cycles.
If a woman with PCOS on either of the two drugs (Finasteride or Spironolactone) gets pregnant, she should immediately stop all the medications as they may harm the fetus.
Finasteride vs Flutamide for PCOS:
Flutamide is another hormone that blocks the effects of testosterone at receptor levels. Like Spironolactone and Finasteride, Flutamide may improve the symptoms of PCOS, particularly, acne, and excessive facial hair.
Finasteride and Flutamide in the treatment of PCOS:
Treatment | Finasteride | Flutamide |
| Mechanism of action | Inhibits the conversion of testosterone to dihydrotestosterone (DHT) by inhibiting the enzyme 5-alpha reductase | Blocks the action of androgens (male hormones) at the receptor level |
| Symptoms treated | Hirsutism (excess hair growth) | Hirsutism and acne |
| Effects on fertility | Not recommended for use in women who are trying to conceive, as it can harm the developing fetus | Not recommended for use in women who are trying to conceive, as it can cause birth defects |
| Side effects | Possible side effects include decreased libido, erectile dysfunction, and depression | Possible side effects include breast tenderness, menstrual irregularities, and liver toxicity |
| Use in combination with other treatments | Often used in combination with birth control pills or other treatments for PCOS symptoms | Often used in combination with birth control pills or other treatments for PCOS symptoms |
| Precautions | Should not be used during pregnancy, as it may cause birth defects | Should be used with caution in patients with liver disease or impaired liver function, as it can cause liver toxicity |
Flutamide is relatively costly but more potent than Finasteride. It is only indicated in women with PCOS who fail to respond adequately to Finasteride or Spironolactone or who are allergic to these first-line drugs.
Summary of different treatment options for PCOS:
Treatment of PCOS aims to target multiple problems at the same time. Lifestyle interventions to lose weight such as a low-calorie diet and exercise are recommended for all women with PCOS.
Metformin is recommended for most women with PCOS and especially those with underlying metabolic syndrome.
Other treatments depend on the underlying problem such as clomiphene to achieve fertility, and Finasteride to improve symptoms of virilization.
Different treatment options for PCOS:
Treatment | Fertility | Menstrual Cycles | Hirsutism | Insulin Resistance | Female Physique |
| Lifestyle changes (diet and exercise) | May improve fertility in some women with PCOS | Can improve menstrual regularity in some women with PCOS | Can reduce hirsutism in some women with PCOS | Can improve insulin resistance in some women with PCOS | This can result in weight loss and improved body composition in some women with PCOS |
| Metformin | May improve fertility in some women with PCOS | Can improve menstrual regularity in some women with PCOS | Can reduce hirsutism in some women with PCOS | Can improve insulin resistance in some women with PCOS | This can result in weight loss and improved body composition in some women with PCOS |
| Oral contraceptives | Not indicated for improving fertility | Can improve menstrual regularity in women with PCOS | Can reduce hirsutism in some women with PCOS | May improve insulin resistance in some women with PCOS | These might result in weight gain in some women with PCOS |
| Anti-androgens (such as spironolactone or finasteride) | Not indicated for improving fertility | May improve menstrual regularity | Can reduce hirsutism in some women with PCOS | Not indicated for improving insulin resistance | May improve the female physique |
| Gonadotropins (such as clomiphene citrate) | Can improve fertility in some women with PCOS | Can improve menstrual regularity in some women with PCOS | Not indicated for improving hirsutism | Not indicated for improving insulin resistance | Not indicated for improving female physique |
| Ovarian surgery (such as ovarian drilling) | Can improve fertility in some women with PCOS | Can improve menstrual regularity in some women with PCOS | Not indicated for improving hirsutism | Not indicated for improving insulin resistance | Not indicated for improving female physique |
Update: Novel drugs for the treatment of PCOS:
There have been several new drugs that have been approved or are under investigation for the treatment of PCOS. Here are a few examples:
Elagolix:
This drug was approved by the US Food and Drug Administration (FDA) in 2020 for the treatment of heavy menstrual bleeding associated with uterine fibroids and moderate to severe pain associated with endometriosis but it is also being investigated for the treatment of PCOS-related menstrual irregularities.
Relugolix:
Relugolix is an FDA-approved drug for the treatment of men with advanced prostatic cancer. It is also being investigated for the treatment of PCOS-related menstrual irregularities. It works by inhibiting the production of gonadotropin-releasing hormone (GnRH), which can help to reduce the levels of androgens in women with PCOS.
Egrifta (tesamorelin):
Egrifta is a growth hormone-releasing factor analog. This drug was approved by the FDA in 2010 for the treatment of excess abdominal fat in people with HIV, but it is also being investigated for the treatment of PCOS-related insulin resistance and metabolic dysfunction.
Raloxifene:
This drug is a selective estrogen receptor modulator (SERM) that is being investigated for the treatment of PCOS-related insulin resistance and metabolic dysfunction. It works by reducing inflammation and improving insulin sensitivity in women with PCOS.
Nolasiban:
This drug is being investigated for the treatment of infertility in women with PCOS. It works by blocking the action of the hormone oxytocin, which can help to improve embryo implantation rates in women undergoing in vitro fertilization (IVF).
Ozempic and Mounjaro:
Ozempic and Mounjaro are drugs used to treat diabetes type 2 and obesity. Both drugs are associated with significant weight loss and improve insulin resistance.
These drugs are being used off-label for the treatment of obese women with PCOS and underlying metabolic syndrome.
