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Finasteride, sold under the brand names Proscar and Propecia among others, is a medication used for the treatment of benign prostatic hyperplasia (BPH) and male pattern baldness (MPB).^[1]^[2] It is a type II and type III 5α-reductase inhibitor;^[3] 5α-reductase, an enzyme, converts testosterone to dihydrotestosterone (DHT).^[2]

Medical uses

Benign prostatic hyperplasia

Physicians use finasteride for the treatment of BPH, informally known as an enlarged prostate. Finasteride may improve the symptoms associated with BPH such as difficulty urinating, getting up during the night to urinate, hesitation at the start of urination, and decreased urinary flow. It provides less symptomatic relief than alpha-1 blockers such as tamsulosin and symptomatic relief is slower in onset (six months or more of treatment with finasteride may be required to determine the therapeutic results of treatment). Symptomatic benefits are mainly seen in those with prostate volume > 40 cm³. In long-term studies finasteride but not alpha-1 inhibitors reduce the risk of acute urinary retention (−57% at 4 years) and the need for surgery (−54% at 4 years). If the drug is discontinued, any therapeutic benefits reverse within about 6–8 months.^[4]^[5]^[6]

Male pattern baldness

Finasteride is used to treat male pattern hair loss (androgenetic alopecia) in men only.^[7] Treatment provides about 30% improvement in hair loss after six months of treatment, and effectiveness only persists as long as the drug is taken.^[8]

Off-label uses

Finasteride is sometimes used in hormone replacement therapy for male-to-female transsexuals in combination with a form of estrogen due to its antiandrogen properties. However, little clinical research of finasteride use for this purpose has been conducted and evidence of efficacy is limited.^[9]

Contraindications

Finasteride is not approved for use in women, especially due to risks of birth defects in a fetus. It is classified in the FDA pregnancy category X.^[7]

Adverse effects

Adverse effects from finasteride are rare.^[4] Compared with placebo, men taking finasteride are at increased risk for impotence, erectile dysfunction, decreased libido, and ejaculation disorder for the first year of treatment.^[4] The rates of these effects becomes indistinguishable from placebo after 2–4 years and these side effects usually get better over time.^[4] The FDA has added a warning to 5α-reductase inhibitors concerning an increased risk of high-grade prostate cancer, as the treatment of BPH lowers PSA (prostate-specific antigen), which could mask the development of prostate cancer.^[10]^[11] Although overall incidence of male breast cancer in clinical trials for finasteride 5 mg was not increased, there are post-marketing reports of breast cancer in association with its use. Available evidence does not provide clarity as to whether there is a causative relationship between finasteride and these cancers.^[7]^[12]

A 2015 meta analysis found that none of the clinical trials testing finasteride in hair loss had adequate safety reporting and did not provide sufficient information to establish the safety profile for finasteride as a treatment for hair loss. The study concluded the existing clinical trials of finasteride for hair loss provide very limited information on toxicity,are of poor quality, and seem to be systematically biased toward under detection of adverse events. Moreover, the trials submitted to the FDA for approval for hair loss excluded most men who would normally be prescribed finasteride for androgenic alopecia.^[13]^[14]

Sexual function

Whether finasteride causes long-term sexual dysfunction in some men after stopping drug treatment is unclear.^[13] There are case reports of persistent diminished libido or erectile dysfunction after stopping the drug and the FDA has updated the label to inform people of these reports.^[8]^[15] A 2010 review found moderate quality evidence that finasteride increased the risk of sexual dysfunction, but not that people stopped using it because of sexual side effects.^[16]

When finasteride was originally approved for hair loss in 1997, the FDA approval review reported that it appears well tolerated, with the most common side effects being related to sexual function.^[17] In many people these side effects resolve if the medication is stopped and occasionally resolve even if the medication is continued.^[17] They additionally state "the sexual functioning questionnaire seems to have given a sensitive reflection of the disturbance on sexual functioning".^[17]

Mechanism of action

Finasteride is a 5α-reductase inhibitor, specifically the type II and III isoenzymes.^[3]^[18] By inhibiting 5α-reductase, finasteride prevents conversion of testosterone to dihydrotestosterone (DHT) by the type II and III isoenzymes, resulting in a decrease in serum DHT levels by about 65–70% and in prostate DHT levels by up to 85–90%,^[3]^[19] where expression of the type II isoenzyme dominates. Unlike triple inhibitors of all three isoenzymes of 5α-reductase like dutasteride which can reduce DHT levels in the entire body by more than 99%,^[3] finasteride does not completely suppress DHT production because it lacks significant inhibitory effects on the 5α-reductase type I isoenzyme, with 100-fold less affinity for I as compared to II.^[7] In addition to blocking the type II and III isoenzymes, finasteride competitively inhibits the 5β-reductase type II isoenzyme,^[20] though this is not believed to affect androgen metabolism.^{[citation needed]}

By blocking DHT production, finasteride reduces androgen activity in the scalp. In the prostate, inhibition of 5α-reductase reduces prostate volume, which improves BPH and reduces risk of prostate cancer. Inhibition of 5α-reductase also reduces epididymal weight, and decreases motility and normal morphology of spermatozoa in the epididymis.^[21]

DHT helps activate the GABA_A receptor, which functions to tamp down signaling among neurons; because finasteride prevents the formation of DHT, it may contribute to a reduction of GABA_A activity. Reduced GABA_A has been implicated in depression, anxiety, and sexual dysfunction.^[22]^[23]^[24]

Physical and chemical properties

Finasteride is a 4-azasteroid analogue of testosterone and is lipophilic.^[25]

Drug trade names include Propecia and Proscar, the former marketed for male pattern baldness (MPB) and the latter for benign prostatic hyperplasia (BPH), both are products of Merck & Co. There is 1 mg of finasteride in Propecia and 5 mg in Proscar. Merck's patent on finasteride for the treatment of BPH expired on June 19, 2006.^[26] Merck was awarded a separate patent for the use of finasteride to treat MPB. This patent expired in November 2013.^[27]

History

In 1974, Julianne Imperato-McGinley of Cornell Medical College in New York attended a conference on birth defects. She reported on a group of intersex children in the Caribbean who appeared sexually ambiguous at birth, and were initially raised as girls, but then grew external male genitalia and other masculine characteristic after onset of puberty. Her research group found these children shared a genetic mutation, causing deficiency of the 5α-reductase enzyme and male hormone dihydrotestosterone (DHT), which was found to have been the etiology behind abnormalities in male sexual development. Upon maturation, these individuals were observed to have smaller prostates which were underdeveloped, and were also observed to lack incidence of male pattern baldness.^[28]^[29] It was developed under the code name MK-906.^{[citation needed]}

In 1975, copies of Imperato-McGinley's presentation were seen by P. Roy Vagelos, who was then serving as Merck's basic-research chief. He was intrigued by the notion that decreased levels of DHT led to the development of smaller prostates. Dr. Vagelos then sought to create a drug which could mimic the condition found in these children to treat older men who were suffering from benign prostatic hyperplasia.^[30]

In 1992, finasteride (5 mg) was approved by the U.S. Food and Drug Administration (FDA) for treatment of BPH, which Merck marketed under the brand name Proscar.^{[citation needed]}

In 1997, Merck was successful in obtaining FDA approval for a second indication of finasteride (1 mg) for treatment of MPB, which was marketed under the brand name Propecia.^{[citation needed]}

Society and culture

From 2005 to 2009, the World Anti-Doping Agency banned finasteride because it was discovered that the drug could be used to mask steroid abuse.^[31] It was removed from the list effective January 1, 2009, after improvements in testing methods made the ban unnecessary.^[32] Notable athletes who used finasteride for hair loss and were banned from international competition include skeleton racer Zach Lund, bobsledder Sebastien Gattuso, footballer Romário and ice hockey goaltender José Théodore.^[32]^[33]

According to a 2012 article in the Australian Financial Review, men in the US and Canada concerned about persistent sexual side effects of finasteride "coined the phrase 'post finasteride syndrome', which they say is characterized by sexual, neurological, hormonal and psychological side effects that can persist in men who have taken finasteride for hair loss or an enlarged prostate".^[34]^[35] In 2012, a health advocacy group called the Post-Finasteride Syndrome Foundation was formed with the primary goal of finding a cure for the reported syndrome and a secondary goal of raising awareness.^[34] According to the company's 1Q2016 financial filing, Merck is a defendant in 1,385 product liability lawsuits which have been filed by customers alleging they have experienced persistent sexual side effects following cessation of treatment with finasteride.^[36]

The Food and Drug Administration advises that donation of blood or plasma be deferred from for at least one month after taking the last dose of finasteride.^[37]

Research

Finasteride has been clinically tested for baldness in women; the results were no better than placebo.^[38]

References

^ J. Buckingham (1987). Dictionary of Organic Compounds. CRC Press. p. 3147. ISBN 978-0-412-54090-5.
^ ^a ^b I.K. Morton; Judith M. Hall (6 December 2012). Concise Dictionary of Pharmacological Agents: Properties and Synonyms. Springer Science & Business Media. pp. 121, 246. ISBN 978-94-011-4439-1.
^ ^a ^b ^c ^d Yamana K, Labrie F, Luu-The V (January 2010). "Human type 3 5α-reductase is expressed in peripheral tissues at higher levels than types 1 and 2 and its activity is potently inhibited by finasteride and dutasteride". Hormone Molecular Biology and Clinical Investigation 2 (3). doi:10.1515/hmbci.2010.035.
^ ^a ^b ^c ^d Tacklind, J; Fink, HA; Macdonald, R; Rutks, I; Wilt, TJ (Oct 6, 2010). "Finasteride for benign prostatic hyperplasia.". The Cochrane database of systematic reviews (10): CD006015. doi:10.1002/14651858.CD006015.pub3. PMID 20927745.
^ Proscar label
^ "Treatment of Non-neurogenic Male LUTS | Uroweb".
^ ^a ^b ^c ^d "Propecia label" (PDF).
^ ^a ^b Varothai, S; Bergfeld, WF (Jul 2014). "Androgenetic alopecia: an evidence-based treatment update.". American journal of clinical dermatology 15 (3): 217–30. doi:10.1007/s40257-014-0077-5. PMID 24848508.
^ Knezevich EL, Viereck LK, Drincic AT (January 2012). "Medical management of adult transsexual persons". Pharmacotherapy 32 (1): 54–66. doi:10.1002/PHAR.1006. PMID 22392828.
^ FDA. Posted 9 June 2011. 5-alpha reductase inhibitors (5-ARIs): Label Change - Increased Risk of Prostate Cancer
^ Walsh PC (April 2010). "Chemoprevention of prostate cancer". The New England Journal of Medicine 362 (13): 1237–8. doi:10.1056/NEJMe1001045. PMID 20357287.
^ Medicines and Healthcare products Regulatory Agency Drug Safety Update. December 2009 Finasteride: potential risk of male breast cancer
^ ^a ^b Belknap, SM; Aslam, I; Kiguradze, T; Temps, WH; Yarnold, PR; Cashy, J; Brannigan, RE; Micali, G; Nardone, B; West, DP (1 April 2015). "Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis.". JAMA dermatology 151: 600–6. doi:10.1001/jamadermatol.2015.36. PMID 25830296.
^ Moore, TJ (1 April 2015). "Finasteride and the Uncertainties of Establishing Harms.". JAMA dermatology 151: 585–6. doi:10.1001/jamadermatol.2015.37. PMID 25831198.
^ FDA (11 April 2012). "Questions and Answers: Finasteride Label Changes". US FDA. Retrieved 26 October 2014.
^ Mella, JM; Perret, MC; Manzotti, M; Catalano, HN; Guyatt, G (October 2010). "Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review.". Archives of Dermatology 146 (10): 1141–50. doi:10.1001/archdermatol.2010.256. PMID 20956649.
^ ^a ^b ^c FDA. "Summary of Key Safety Findings" (PDF). p. 98.
^ Aggarwal S, Thareja S, Verma A, Bhardwaj TR, Kumar M (February 2010). "An overview on 5alpha-reductase inhibitors". Steroids 75 (2): 109–53. doi:10.1016/j.steroids.2009.10.005. PMID 19879888.
^ Bartsch G, Rittmaster RS, Klocker H (April 2000). "Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia". European Urology 37 (4): 367–80. doi:10.1159/000020181. PMID 10765065.
^ Drury JE, Di Costanzo L, Penning TM, Christianson DW (July 2009). "Inhibition of human steroid 5beta-reductase (AKR1D1) by finasteride and structure of the enzyme-inhibitor complex". The Journal of Biological Chemistry 284 (30): 19786–90. doi:10.1074/jbc.C109.016931. PMC 2740403. PMID 19515843.
^ Robaire B, Henderson NA (May 2006). "Actions of 5alpha-reductase inhibitors on the epididymis". Molecular and Cellular Endocrinology 250 (1-2): 190–5. doi:10.1016/j.mce.2005.12.044. PMID 16476520.
^ Finn DA, Beadles-Bohling AS, Beckley EH, et al. (2006). "A new look at the 5alpha-reductase inhibitor finasteride". CNS Drug Reviews 12 (1): 53–76. doi:10.1111/j.1527-3458.2006.00053.x. PMID 16834758.
^ Römer B, Gass P (December 2010). "Finasteride-induced depression: new insights into possible pathomechanisms". Journal of Cosmetic Dermatology 9 (4): 331–2. doi:10.1111/j.1473-2165.2010.00533.x. PMID 21122055.
^ Gunn BG, Brown AR, Lambert JJ, Belelli D (2011). "Neurosteroids and GABA(A) Receptor Interactions: A Focus on Stress". Frontiers in Neuroscience 5: 131. doi:10.3389/fnins.2011.00131. PMC 3230140. PMID 22164129.
^ Azeem A, Khan ZI, Aqil M, Ahmad FJ, Khar RK, Talegaonkar S (May 2009). "Microemulsions as a surrogate carrier for dermal drug delivery". Drug Development and Industrial Pharmacy 35 (5): 525–47. doi:10.1080/03639040802448646. PMID 19016057.
^ Primary Patent Expirations for Selected High Revenue Drugs
^ fda.gov | Patent Expiration for Propecia
^ Imperato-McGinley J, Guerrero L, Gautier T, Peterson RE (December 1974). "Steroid 5alpha-reductase deficiency in man: an inherited form of male pseudohermaphroditism". Science 186 (4170): 1213–5. doi:10.1126/science.186.4170.1213. PMID 4432067.
^ Emerick JE et al. for WebMD. Last Updated Updated: 29 May 2014 5-Alpha-Reductase Deficiency
^ Freudenheim, Milt (February 16, 1992). "Keeping the Pipeline Filled at Merck". The New York Times.
^ Sandomir, Richard (2006-01-19). "Skin Deep; Fighting Baldness, and Now an Olympic Ban". The New York Times. Retrieved 2010-05-02.
^ ^a ^b Staff, The Australian. 28 October 2008 WADA removes Finasteride from ban list
^ Staff, Sydney Morning Herald. 9 October 2008 WADA takes Romario's drug off banned list
^ ^a ^b Jill Margo for the Australian Financial Review. 26 Sept 2012 Looking at care with a critical eye
^ Post-Finasteride Syndrome Foundation official website
^ Merck & Co., Inc. Form 10-Q, 1st Quarter 2016, p. 19.
^ "Deferral of Blood and Plasma donors -- Medications (7/28/93)" (PDF). FDA. 28 July 1993. Retrieved April 2016.
^ Levy, LL; Emer, JJ (Aug 29, 2013). "Female pattern alopecia: current perspectives.". International journal of women's health 5: 541–56. doi:10.2147/IJWH.S49337. PMC 3769411. PMID 24039457.

External links

Proscar | Official website
Propecia | Official website

UpToDate Contents

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1. 男性における男性型脱毛症の治療 treatment of androgenetic alopecia in men
2. 前立腺癌における化学的予防策 chemoprevention strategies in prostate cancer
3. 前立腺肥大症の内科的治療 medical treatment of benign prostatic hyperplasia
4. 女性型脱毛症（女性のアンドロゲン性脱毛症）：治療および予後 female pattern hair loss androgenetic alopecia in women treatment and prognosis
5. 男性型多毛症の治療 treatment of hirsutism

English Journal

The 5α-reductase inhibitor Dutasteride but not Finasteride protects dopamine neurons in the MPTP mouse model of Parkinson's disease.

Litim N1, Bourque M1, Al Sweidi S1, Morissette M2, Di Paolo T3.
Neuropharmacology.Neuropharmacology.2015 Oct;97:86-94. doi: 10.1016/j.neuropharm.2015.05.015. Epub 2015 May 23.
Finasteride and Dutasteride are 5α-reductase inhibitors used in the clinic to treat endocrine conditions and were recently found to modulate brain dopamine (DA) neurotransmission and motor behavior. We investigated if Finasteride and Dutasteride have a neuroprotective effect in 1-methyl-4-phenyl-1,
PMID 26006269

Reactive stroma in the prostate during late life: The role of microvasculature and antiangiogenic therapy influences.

Montico F1, Kido LA1, San Martin R2, Rowley DR2, Cagnon VH1.
The Prostate.Prostate.2015 Oct;75(14):1643-61. doi: 10.1002/pros.23045. Epub 2015 Jul 17.
BACKGROUND: Prostate cancer is associated to a reactive stroma microenvironment characterized by angiogenic processes that are favorable for tumor progression. Senescence has been identified as a predisposing factor for prostate malignancies. In turn, the relationships between aging, reactive stroma
PMID 26184673

Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: results of a systematic literature review and international consensus validation process (LUTS-FORTA 2014).

Oelke M1, Becher K2, Castro-Diaz D3, Chartier-Kastler E4, Kirby M5, Wagg A6, Wehling M7.
Age and ageing.Age Ageing.2015 Sep;44(5):745-55. doi: 10.1093/ageing/afv077. Epub 2015 Jun 23.
AIM: we aimed to systematically review drugs to treat lower urinary tract symptoms (LUTS) regularly used in older persons to classify appropriate and inappropriate drugs based on efficacy, safety and tolerability by using the Fit fOR The Aged (FORTA) classification.METHODS: to evaluate the efficacy,
PMID 26104505

Japanese Journal

Ginsenoside F2 Reduces Hair Loss by Controlling Apoptosis through the Sterol Regulatory Element-Binding Protein Cleavage Activating Protein and Transforming Growth Factor-β Pathways in a Dihydrotestosterone-Induced Mouse Model

Shin Heon-Sub,Park Sang-Yong,Hwang Eun-Son [他]
Biological & pharmaceutical bulletin 37(5), 755-763, 2014-05
NAID 40020048798

フィナステリドの男性型脱毛に対する効果に体毛の濃さは関係するか? (特集最近のトピックス2012 Clinical Dermatology 2012) -- (皮膚科医のための臨床トピックス)

稲冨徹,福地君朗,三上正憲 [他]
臨床皮膚科 66(5), 161-163, 2012-04
NAID 40019309839

臨床研究男性型脱毛症患者のQOL評価とフィナステリド治療による改善

山崎正視,宮倉崇,保母彩子 [他]
皮膚科の臨床 53(1), 77-82, 2011-01
NAID 40017659715

Related Pictures

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リンク元

「フィナステリド」

Finasteride
Systematic (IUPAC) name
	N-(1,1-dimethylethyl)-3-oxo-; (5α,17β)-4-azaandrost-1-ene-17-carboxamide
Clinical data
Trade names	Propecia, Proscar
AHFS/Drugs.com	monograph
MedlinePlus	a698016
Pregnancy; category	X (will cause birth defects in a fetus);
Routes of; administration	Oral
Legal status
Legal status	UK: POM (Prescription only); US: ℞-only;
Pharmacokinetic data
Bioavailability	63%
Metabolism	Hepatic
Biological half-life	Elderly: 8 hours; Adults: 6 hours
Excretion	Feces (57%) and urine (39%) as metabolites
Identifiers
CAS Number	98319-26-7
ATC code	G04CB01 (WHO) D11AX10 (WHO)
PubChem	CID 57363
IUPHAR/BPS	6818
DrugBank	DB01216
ChemSpider	51714
UNII	57GNO57U7G
KEGG	D00321
ChEBI	CHEBI:5062
ChEMBL	CHEMBL710
Chemical data
Formula	C23H36N2O2
Molar mass	372.549 g/mol
	SMILES O=C(NC(C)(C)C)[C@@H]2[C@]1(CC[C@H]3[C@H]([C@@H]1CC2)CC[C@H]4NC(=O)\C=C/[C@]34C)C ;
	InChI InChI=1S/C23H36N2O2/c1-21(2,3)25-20(27)17-8-7-15-14-6-9-18-23(5,13-11-19(26)24-18)16(14)10-12-22(15,17)4/h11,13-18H,6-10,12H2,1-5H3,(H,24,26)(H,25,27)/t14-,15-,16-,17+,18+,22-,23+/m0/s1 ; Key:DBEPLOCGEIEOCV-WSBQPABSSA-N ;
(verify)

　　[★]

英: finasteride
商: プロペシア Propecia、Proscar
関: 前立腺肥大症、脱毛症、男性型脱毛症

テストステロン5α還元酵素阻害
前立腺肥大治療

参考

プロペシア錠０．２ｍｇ／プロペシア錠１ｍｇ

http://www.info.pmda.go.jp/go/pack/249900XF1021_2_01/249900XF1021_2_01?view=body

[Buckingham1987-1] J. Buckingham (1987). Dictionary of Organic Compounds. CRC Press. p. 3147. ISBN 978-0-412-54090-5.

[MortonHall2012-2] I.K. Morton; Judith M. Hall (6 December 2012). Concise Dictionary of Pharmacological Agents: Properties and Synonyms. Springer Science & Business Media. pp. 121, 246. ISBN 978-94-011-4439-1.

[Yamana2010-3] Yamana K, Labrie F, Luu-The V (January 2010). "Human type 3 5α-reductase is expressed in peripheral tissues at higher levels than types 1 and 2 and its activity is potently inhibited by finasteride and dutasteride". Hormone Molecular Biology and Clinical Investigation 2 (3). doi:10.1515/hmbci.2010.035.

[Cochrane2010-4] Tacklind, J; Fink, HA; Macdonald, R; Rutks, I; Wilt, TJ (Oct 6, 2010). "Finasteride for benign prostatic hyperplasia.". The Cochrane database of systematic reviews (10): CD006015. doi:10.1002/14651858.CD006015.pub3. PMID 20927745.

[ProscarLabel-5] Proscar label

[6] "Treatment of Non-neurogenic Male LUTS | Uroweb".

[PropeciaLabel-7] "Propecia label" (PDF).

[2014AArev-8] Varothai, S; Bergfeld, WF (Jul 2014). "Androgenetic alopecia: an evidence-based treatment update.". American journal of clinical dermatology 15 (3): 217–30. doi:10.1007/s40257-014-0077-5. PMID 24848508.

[TranssexualMgmnt2012-9] Knezevich EL, Viereck LK, Drincic AT (January 2012). "Medical management of adult transsexual persons". Pharmacotherapy 32 (1): 54–66. doi:10.1002/PHAR.1006. PMID 22392828.

[10] FDA. Posted 9 June 2011. 5-alpha reductase inhibitors (5-ARIs): Label Change - Increased Risk of Prostate Cancer

[pmid20357287-11] Walsh PC (April 2010). "Chemoprevention of prostate cancer". The New England Journal of Medicine 362 (13): 1237–8. doi:10.1056/NEJMe1001045. PMID 20357287.

[12] Medicines and Healthcare products Regulatory Agency Drug Safety Update. December 2009 Finasteride: potential risk of male breast cancer

[Belknapp-13] Belknap, SM; Aslam, I; Kiguradze, T; Temps, WH; Yarnold, PR; Cashy, J; Brannigan, RE; Micali, G; Nardone, B; West, DP (1 April 2015). "Adverse Event Reporting in Clinical Trials of Finasteride for Androgenic Alopecia: A Meta-analysis.". JAMA dermatology 151: 600–6. doi:10.1001/jamadermatol.2015.36. PMID 25830296.

[14] Moore, TJ (1 April 2015). "Finasteride and the Uncertainties of Establishing Harms.". JAMA dermatology 151: 585–6. doi:10.1001/jamadermatol.2015.37. PMID 25831198.

[15] FDA (11 April 2012). "Questions and Answers: Finasteride Label Changes". US FDA. Retrieved 26 October 2014.

[16] Mella, JM; Perret, MC; Manzotti, M; Catalano, HN; Guyatt, G (October 2010). "Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review.". Archives of Dermatology 146 (10): 1141–50. doi:10.1001/archdermatol.2010.256. PMID 20956649.

[FDA1997-17] FDA. "Summary of Key Safety Findings" (PDF). p. 98.

[pmid19879888-18] Aggarwal S, Thareja S, Verma A, Bhardwaj TR, Kumar M (February 2010). "An overview on 5alpha-reductase inhibitors". Steroids 75 (2): 109–53. doi:10.1016/j.steroids.2009.10.005. PMID 19879888.

[pmid10765065-19] Bartsch G, Rittmaster RS, Klocker H (April 2000). "Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia". European Urology 37 (4): 367–80. doi:10.1159/000020181. PMID 10765065.

[pmid19515843-20] Drury JE, Di Costanzo L, Penning TM, Christianson DW (July 2009). "Inhibition of human steroid 5beta-reductase (AKR1D1) by finasteride and structure of the enzyme-inhibitor complex". The Journal of Biological Chemistry 284 (30): 19786–90. doi:10.1074/jbc.C109.016931. PMC 2740403. PMID 19515843.

[pmid16476520-21] Robaire B, Henderson NA (May 2006). "Actions of 5alpha-reductase inhibitors on the epididymis". Molecular and Cellular Endocrinology 250 (1-2): 190–5. doi:10.1016/j.mce.2005.12.044. PMID 16476520.

[pmid16834758-22] Finn DA, Beadles-Bohling AS, Beckley EH, et al. (2006). "A new look at the 5alpha-reductase inhibitor finasteride". CNS Drug Reviews 12 (1): 53–76. doi:10.1111/j.1527-3458.2006.00053.x. PMID 16834758.

[pmid21122055-23] Römer B, Gass P (December 2010). "Finasteride-induced depression: new insights into possible pathomechanisms". Journal of Cosmetic Dermatology 9 (4): 331–2. doi:10.1111/j.1473-2165.2010.00533.x. PMID 21122055.

[pmid22164129-24] Gunn BG, Brown AR, Lambert JJ, Belelli D (2011). "Neurosteroids and GABA(A) Receptor Interactions: A Focus on Stress". Frontiers in Neuroscience 5: 131. doi:10.3389/fnins.2011.00131. PMC 3230140. PMID 22164129.

[micro-25] Azeem A, Khan ZI, Aqil M, Ahmad FJ, Khar RK, Talegaonkar S (May 2009). "Microemulsions as a surrogate carrier for dermal drug delivery". Drug Development and Industrial Pharmacy 35 (5): 525–47. doi:10.1080/03639040802448646. PMID 19016057.

[26] Primary Patent Expirations for Selected High Revenue Drugs

[27] .gov | Patent Expiration for Propecia

[pmid4432067-28] Imperato-McGinley J, Guerrero L, Gautier T, Peterson RE (December 1974). "Steroid 5alpha-reductase deficiency in man: an inherited form of male pseudohermaphroditism". Science 186 (4170): 1213–5. doi:10.1126/science.186.4170.1213. PMID 4432067.

[29] Emerick JE et al. for WebMD. Last Updated Updated: 29 May 2014 5-Alpha-Reductase Deficiency

[30] Freudenheim, Milt (February 16, 1992). "Keeping the Pipeline Filled at Merck". The New York Times.

[31] Sandomir, Richard (2006-01-19). "Skin Deep; Fighting Baldness, and Now an Olympic Ban". The New York Times. Retrieved 2010-05-02.

[Australian-32] Staff, The Australian. 28 October 2008 WADA removes Finasteride from ban list

[33] Staff, Sydney Morning Herald. 9 October 2008 WADA takes Romario's drug off banned list

[Margo-34] Jill Margo for the Australian Financial Review. 26 Sept 2012 Looking at care with a critical eye

[35] Post-Finasteride Syndrome Foundation official website

[36] Merck & Co., Inc. Form 10-Q, 1st Quarter 2016, p. 19.

[37] "Deferral of Blood and Plasma donors -- Medications (7/28/93)" (PDF). FDA. 28 July 1993. Retrieved April 2016.

[FPArev-38] Levy, LL; Emer, JJ (Aug 29, 2013). "Female pattern alopecia: current perspectives.". International journal of women's health 5: 541–56. doi:10.2147/IJWH.S49337. PMC 3769411. PMID 24039457.

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