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Finasteride is a medication that is primarily used to treat two problems that affect men: androgenic alopecia, or male-pattern hair loss, and benign prostatic hyperplasia (BPH), an enlargement of the prostate that can cause symptoms urinary disorders, such as the need to urinate frequently, difficulty initiating urination, and the inability to completely empty the bladder.
Now, new research has found that finasteride (marketed as Propecia or Proscar) may have another important benefit: lowering cholesterol levels and lowering the overall risk of cardiovascular disease. The study was carried out by researchers at the University of Illinois Urbana-Champaign who have identified significant correlations between the use of finasteride and the reduction of cholesterol levels in men who participated in the National Health and Nutrition Survey between 2009 and 2016.
“When analyzing the men who used finasteride in the survey, we noticed that their cholesterol levels were, on average, 30 points lower than those of men who did not use the drug. “I expected to see the opposite pattern, so the result was very interesting,” explained Jaume Amengual, lead author of the study and assistant professor in the Department of Food Science and Human Nutrition and the Division of Nutritional Sciences, both belonging to the College of Agricultural Sciences. , Consumer and Environmental (ACES) of the U. of I.
Additionally, in mice given high doses of finasteride, researchers observed a decrease in plasma total cholesterol, slower progression of atherosclerosis, reduced liver inflammation, and other related benefits. The results have been published in the Journal of Lipid Research.
How finasteride works to prevent cardiovascular problems
The researchers have warned that the study is observational and has limitations, since, of almost 4,800 respondents who met the general health criteria to be included in the analysis, only 155 – all men over 50 years of age – reported using finasteride. Furthermore, it was not possible to determine the amount or duration of drug consumption by respondents.
But why would a drug to combat hair loss and an enlarged prostate affect cholesterol? Amengual studies atherosclerosis, a condition in which cholesterol plaques clog the arteries, leading to strokes, heart attacks and other cardiovascular problems. Since this disease is much more common in men than in premenopausal women, scientists suspect that the sex hormone testosterone plays an important role in atherosclerosis.
Finasteride works by blocking a protein present in hair follicles and the prostate gland that activates testosterone. This common link, testosterone, was enough to pique Amengual’s interest. After documenting the first observational link between finasteride and cholesterol reduction in men, Amengual and doctoral student Donald Molina Chaves tested whether the pattern held in mice.
Molina Chaves tested four levels of finasteride – 0, 10, 100 and 1000 milligrams per kilogram of food – in male mice genetically predisposed to atherosclerosis. The rodents took the drug along with a high-fat, high-cholesterol Western diet for 12 weeks. Next, Molina Chaves analyzed the levels of cholesterol and other lipids in the mice, along with evidence of atherosclerotic plaques.
“This drug could have a potential beneficial effect in preventing cardiovascular disease not only in cis men, but also in transgender individuals”
He also examined gene expression in the liver, analyzed bile acid metabolism, and studied steroids, triglycerides, immune activity, and more. “The mice that received a high dose of finasteride showed lower levels of cholesterol both in the plasma and in the arteries,” said Molina Chaves. “There were also fewer lipids and inflammatory markers in the liver.”
Although the effects were only significant at the highest dose – a level considered excessive for humans – Amengual explains that mice metabolize finasteride differently than people. Humans take daily doses of 1 milligram or 5 milligrams of finasteride for hair loss and enlarged prostate, respectively. The fact that a clear pattern was seen in a survey of men likely taking one of these doses suggests that the drug could be lowering cholesterol without the megadoses tested in mice.
The next step is for doctors to start monitoring cholesterol in patients taking finasteride or conduct a clinical trial to verify its effect. Amengual notes that it could be especially important to understand how finasteride affects trans people.
“In the last decade, doctors have begun prescribing this drug to individuals transitioning from male to female or female to male. In both cases, hormonal changes can trigger hair loss,” he said. “What’s interesting is that transgender people also have a higher risk of cardiovascular diseases. “So this drug could have a potential beneficial effect in preventing cardiovascular disease not only in cis men, but also in transgender individuals.”
Amengual warns, however, that, like any medication, finasteride is not without risks, and that it is necessary to consult your doctor for more information and for this professional to determine the possible risks and benefits of taking this drug.
