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This study, titled "Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up," was conducted by Rossi et al at the Department of Dermatology and Plastic Surgery, University “Sapienza” of Rome, and CASPUR (Inter-University Consortium for Supercomputing), Rome, Italy. The research aimed to assess the long-term efficacy and safety of Finasteride, a 5-alpha reductase inhibitor, in treating male androgenetic alopecia (androgenetic alopecia) over a period of 10 years. The Rossi et al study was an uncontrolled, long-term trial involving 118 men aged between 20 and 61 years, diagnosed with mild to moderate androgenetic alopecia. These men were in good physical and mental health. The study excluded individuals with significant physical or laboratory abnormalities, those who had prior surgical hair loss correction, used topical minoxidil within the past year, consumed drugs with androgenic or antiandrogenic properties, or had hair loss causes other than androgenetic alopecia.
Each participant was administered 1 mg/day of Finasteride. The treatment's efficacy was gauged through standardized global photographs taken at the start (baseline) and then after 1, 2, 5, and 10 years of treatment. These photographs were evaluated by a panel of three experts, including two experienced dermatologists and one junior dermatologist, who compared the photographs and assigned a score from -3 (great decrease) to +3 (great increase) compared to baseline.
The results indicated that Finasteride is effective in treating male pattern hair loss. Notably, better improvements were observed in patients older than 30 years and those with higher androgenetic alopecia grades. About 42.8% of patients aged between 20 and 30 years showed no improvement even after 10 years. In contrast, patients with androgenetic alopecia grade 4 and 5 started showing improvements after just one year of treatment. Interestingly, the study found that continuing treatment beyond 5 years led to better results in 21% of cases.
The effectiveness of Finasteride seemed to vary with age and the initial grade of androgenetic alopecia. Older patients and those with more severe hair loss showed better responses. This could be due to the fact that there would be a significant improvement of hair that is to be gained once it is gained in those who have gone without it for an extended period of time.
The efficacy of Finasteride did not diminish over time. Many patients who did not show improvement in the first year experienced positive results later on.
A small percentage of patients experienced side effects related to sexual function, which in some cases led to discontinuation of the treatment.
The study highlighted that the majority of patients who saw improvements within the first five years continued to maintain or improve their hair growth in the following years.
The study provides detailed data on the progression of hair growth in patients treated with Finasteride over 10 years, particularly highlighting the differences observed at 1 year, 5 years, and 10 years. While the study does not explicitly provide numerical data in a tabular format in the provided excerpt, it does discuss trends and findings across these time points.
After the first year of treatment, there was a notable improvement in some patients. The study particularly emphasizes that the first year can be predictive of the treatment's overall effectiveness.
It was observed that older patients and those with higher androgenetic alopecia grades responded better in the first year compared to younger patients and those with lower androgenetic alopecia grades.
By the fifth year, there was a continuation and, in some cases, an improvement in hair growth for those who had shown positive results in the first year.
For those who did not observe improvement in the first year, about 25% showed improvements by the fifth year. The persistence of hair growth or further improvement in hair quality was significant among patients who initially responded well to the treatment.
At the 10-year mark, the study observed that patients who showed improvement in the first year had a high probability (68%) of further improvement or at least maintaining their hair growth.
However, there was a noted decline in the effectiveness for some patients between the fifth and tenth year. This decline was not predominant but was significant enough to be noted. Approximately 14% of the patients experienced a worsening of their condition by the tenth year.
Despite this decline for a subset of patients, the overall effectiveness of Finasteride at the 10-year mark was still higher compared to the first year. This suggests that while some patients may experience a decrease in the effectiveness of the treatment over time, the majority either maintained or improved their hair growth.
Now when looking at the tables you may notice that there is a decline in hair counts for between year 5 and 10. However, overall, year 10 is better than year one. There may be some Reasons for Decline Between Year 5 and Year 10:
The observed decline in hair growth effectiveness between the 5th and 10th years of Finasteride treatment, as reported in the study, could indeed be influenced by factors such as seasonal shedding or general aging. These considerations offer a more nuanced understanding of the long-term effects of Finasteride treatment:
Hair growth can naturally vary with seasons, a phenomenon known as seasonal shedding. This cyclic pattern might influence the perceived effectiveness of the treatment over time. During certain times of the year, patients might experience a natural increase in hair shedding, which could be misconstrued as a decline in the effectiveness of Finasteride.
As individuals age, various physiological changes can occur that might affect hair quality and growth. Aging can lead to a natural reduction in hair density and changes in hair texture, which might impact the perceived efficacy of Finasteride treatment in the long term. Additionally, the progression of androgenetic alopecia itself can continue despite treatment, although at a potentially slower rate due to Finasteride.
Despite these factors possibly contributing to a decline in effectiveness between years 5 and 10, it's important to highlight that the overall findings of the study were positive. Patients, on average, remained significantly above their baseline in terms of hair growth and quality even after 10 years of continuous Finasteride treatment. This underscores the long-term efficacy of Finasteride in managing male androgenetic alopecia, with most patients maintaining or improving their hair growth compared to their initial state before beginning the treatment
This heatmap shows the likelihood of a patient’s condition (worsening, staying the same, or improving) in the first year of treatment changing or staying the same by the fifth year. For example, if a patient's condition improved in the first year, there’s a 53% chance that this improvement will continue or even get better by the fifth year. It does not mean that 53% of all patients improved, but rather that among those who improved in the first year, 53% continued to see improvements over the next four years.
Similarly, this heat map indicates the probability of changes in a patient's condition over a longer period (from the first year to the tenth year). For instance, if someone's condition improved in the first year, there’s a 68% chance that they will either maintain or see further improvement in their condition by the tenth year.
This heat map focuses on changes (or stability) in the patient's condition from the fifth year to the tenth year. It shows that if a patient’s condition improves by the fifth year, there’s a 73% chance that this improvement will persist or further improve by the tenth year.
Let’s do a deeper look here…
So let's do some quick explanations of what these colors mean
Darker Blue: Higher probabilities, indicating greater likelihood of the condition remaining stable or improving from the 5th to the 10th year. For example, the darkest blue square (value of 1) indicates that all patients with the highest positive response at year 5 remained positive at year 10.
Lighter Blue/Green: Lower probabilities, indicating a lower likelihood of the condition remaining the same or less certainty about the outcome. The lighter the color, the lower the probability. For instance, a light blue square (value of 0.14) suggests a smaller chance that patients who had no change at year 5 would see improvement by year 10.
Yellow/Green Tones: The lowest probabilities, representing the least likely transitions. For example, a green square with a value close to 0 indicates a very low probability of transition from one state to another.
The heatmap provides a visual representation of how patients' responses to Finasteride treatment for hair growth evolved between the fifth and tenth year of the study. On the horizontal axis, we have the response at the 5-year mark, with values ranging from -3 to 3; negative numbers likely indicate worsening hair growth, while positive numbers indicate improvement. The vertical axis shows the response at the 10-year mark, using the same scale. The color intensity within each cell reflects the probability of a patient transitioning from their 5-year response to their 10-year response, with darker colors denoting higher probabilities.
The cells that fall along the diagonal line of the heatmap are particularly noteworthy, as they indicate the probability of a patient's condition remaining consistent over time. For example, a cell intersecting the point where both the 5-year and 10-year responses are marked as "1" exhibits a probability of 0.73. This suggests that patients who were in a slightly improved state at the 5-year checkpoint had a 73% chance of maintaining that level of improvement at the 10-year mark.
Looking at the cells that do not fall on the diagonal provides insights into the changes in patients' conditions. Take, for instance, a cell where the 5-year response is "0", signifying no change, and the 10-year response is "1", indicating improvement; this cell has a probability of 0.14. This indicates that there was a 14% chance that patients who saw no change at the 5-year mark would experience improvement by the 10-year mark.
From this heatmap, it's clear that a significant number of patients either maintained their initial level of hair growth or experienced improvement as the treatment progressed, demonstrating a tendency for the condition to remain stable or improve between the 5-year and 10-year milestones.
The heatmap above was created based on data from Yearly Modified Global Photographic Assessment Scores (0-10 Years) Long-term (10-year) efficacy of finasteride in 523 Japanese men with androgenetic alopecia Masayuki Yanagisawa and colleagues (2019).
You can find the full study data here: https://www.oatext.com/pdf/CRT-5-273.pdf
The heat map visualizes the changes in Modified Global Photographic Assessment (Modified Global Photographic Assessment) scores from year 0 (before treatment) through to year 10. The Modified Global Photographic Assessment scores are represented for different Norwood-Hamilton scale groups, which classify the stages of hair loss.
Vertical Axis (Rows): Represents different Norwood-Hamilton scale groups, ranging from I to VII, including a total. These groups are indicative of the severity or stage of hair loss at the first visit.
Horizontal Axis (Columns): Represents the years, from 0 to 10.
Color Scale: The color intensity in each cell indicates the Modified Global Photographic Assessment score. Warmer colors (redder) denote higher scores, while cooler colors (bluer) represent lower scores.
Cell Values: Each cell contains the Modified Global Photographic Assessment score for a specific Norwood-Hamilton group at a particular year. The values are means, indicating the average Modified Global Photographic Assessment score of individuals in that group for that year.
From this heat map, we can observe trends such as:
Generally, Modified Global Photographic Assessment scores increase over the years across all groups, suggesting an improvement or a positive response to treatment over time.
Some groups show more significant changes than others, which might indicate differences in how various stages of hair loss respond to the treatment.
Mean Modified Global Photographic Assessment Scores for Year Ranges (1 to 5, 5 to 10, and 1 to 10 Years)
The second heat map focuses on the mean Modified Global Photographic Assessment scores over three specific year ranges: 1-5 years, 5-10 years, and 1-10 years.
Vertical Axis (Rows): Again, the different Norwood-Hamilton scale groups are displayed.
Horizontal Axis (Columns): This time, the columns represent three time ranges: 1-5 years, 5-10 years, and 1-10 years.
Color Scale and Cell Values: Similar to the first map, the color intensity and cell values indicate the mean Modified Global Photographic Assessment score for each group over the specified time ranges.
This map helps in understanding:
The average response over broader time periods, which smooths out year-to-year variations.
A comparison between the first half (1 to 5 years) and the second half (5 to 10 years) of the decade-long period, providing insights into whether the treatment effects strengthen, weaken, or remain consistent over time.
The overall decade-long effectiveness of the treatment across different stages of hair loss.
Both heat maps together provide a detailed and nuanced view of the treatment's effectiveness over time and across varying severities of hair loss
Again, these probabilities give an insight into the likely course of treatment outcomes based on the initial response. They don't directly state the percentage of all patients who improved or worsened; instead, they indicate the chances of changing states (improving, worsening, or staying the same) over time for those who had a specific initial response.
The study provides detailed statistics regarding the outcomes for patients treated with Finasteride over a 10-year period. Based on the data provided, here's a breakdown:
Among those who showed improvement in the first year, 68% either maintained their hair growth or saw further improvement after 10 years. This represents 37 out of 54 patients who had improved initially.
Additionally, among those who had unchanged or worse results in the first year, 32.2% (19 out of 59) showed improvement by the 10th year.
The study indicates that a significant number of patients maintained their hair condition over the years. However, exact figures for those who remained unchanged throughout the study aren’t explicitly provided.
Combining the figures for those who improved and those who remained unchanged, 86% of the participants (excluding those who worsened) benefited from the treatment. This includes those who saw improvements and those whose condition did not worsen over the 10-year period.
Around 14% of the patients experienced a worsening of their condition by the 10th year. This percentage is derived from the total number of patients who were followed up for 10 years.
The study shows that while there is a slight decline in the effectiveness of Finasteride between years 5 and 10 for some patients, the overall efficacy at year 10 remains higher than at year 1. This indicates that Finasteride is generally a viable long-term treatment option for male androgenetic alopecia, although individual responses may vary.
References
Rossi, A., Cantisani, C., Scarnò, M., Trucchia, A., Fortuna, M. C., & Calvieri, S. (2011). Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up. Dermatologic Therapy, 24(4), 455–461. https://doi.org/10.1111/j.1529-8019.2011.01441.x
Yanagisawa, M., Fujimaki, H., Takeda, A., Nemoto, M., Sugimoto, T., & Sato, A. (2019). Long-term (10-year) efficacy of finasteride in 523 Japanese men with androgenetic alopecia. Clinical Research and Trials, 5(5). https://doi.org/10.15761/crt.1000273