Finasteride for Hair Loss: Benefits, Side Effects, Alternatives, and More

Collage by Andre Jabur

Finasteride is one of the best ways to treat and prevent hair loss, but it’s not without risks.

Finasteride is one of the best treatments for hair loss, but it’s also one of the most controversial. Finasteride reduces the conversion of testosterone into the hormonal byproduct known as DHT (dihydrotestosterone), which is largely responsible for male-pattern hair loss.

Simply put: With finasteride, you stifle the thing that shrinks your hair follicles. But finasteride side effects are well known and are often enough to scare guys away from ever trying the drug. I do hope you’ll read the below to decide if it’s right for you, but to also read about alternatives to oral finasteride that are becoming more commonplace.

Disclaimer: Do not take this article as tailored medical advice. You need to see a doctor for your own personalized feedback and recommendations, as well as for discussion on how to incorporate treatments into your routine.

What Is Finasteride?

Oral finasteride is the generic of Propecia, and is taken in daily 1mg doses as a cosmetic treatment against androgenic alopecia (male-pattern shedding). Larger doses (typically 5mg) are used to treat enlarged prostates, and it was through that medicine that the cosmetic benefits of the drug were discovered. (Men who were being treated for prostate enlargement found that their head hairs started growing back, so docs downed the dosage into a cosmetic option.)

Compared to the other common hair loss treatment (minoxidil), finasteride targets the actual culprit behind the problem (the DHT). Minoxidil, on the other hand, fortifies hairs with better circulation and nutrient delivery (almost as an added defense against DHT as opposed to an offensive approach from finasteride). Together, the two drugs are fantastic in terms of their results when taken early in one’s hair loss journey.

Also, finasteride is generally much more effective for anyone targeting hair recession, while minoxidil is better used to target general thinning around the crown. However, hair recession cannot be grown back—only thinning around the crown has the potential to grow back after lying dormant for a year or two; so, any hair you’ve already lost to recession is gone, unless you relocate some hairs with a hair transplant. Thus, using finasteride will stop any further recession.

And of course, the sooner you start either or both of these drugs (and stick with them), the surer it is you’ll experience and maintain results.

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The Best Alternative: Topical Finasteride

Topical finasteride is becoming increasingly common and widely available through prescriptions. It is applied directly to the scalp (as a spray, serum, or gel), where it can be absorbed and targeted at the DHT that has gathered at the follicles. In this way, it can address the problem without circulating throughout the body as aggressively—thus reducing potential side effects.

Some companies like the five below all offer hybrid topical treatments too, combining finasteride with minoxidil so that you can get both medicines at once. However, you won’t see them advertising these hybrid solutions anywhere (except on their own websites), since the FDA prohibits the marketing of any such compound drugs.

Hims | XYON | Ro | Happy Head

They all have board-certified dermatologists and can send you prescriptions through the mail, while also administering checkups, progress reports, and being available for any concerns.

Topical finasteride is a bit more expensive than oral finasteride right now, but these compound solutions help simplify things financially, and they also streamline your regimen.

Finasteride Alternatives: Hair Growth Supplements to Consider

For the past couple years, after migrating from oral finasteride to topical, I also decided to take targeted supplements that also help target DHT in the body—but without the risks associated with oral finasteride. You can read about those in my hair growth supplements article, but studies behind two of them, saw palmetto and pumpkin seed oil, show significant promise in preventing this conversion of testosterone into DHT, with little-to-no risk of toxicity.

Again, I cover those bases (and other supplements) in the supplements article, and have recommendations for daily dosage there, too.

Risks and Side Effects of Finasteride

Finasteride is often too good to be true, though: Its oral version comes with some significant risks—namely sexual side effects in about 2% of patients. (Many studies report mixed findings in regards to impact on libido and/or erectile and ejaculatory dysfunction.) The generally accepted percentage is somewhere in the low-single digits (2-4%) with many of those being placebo side effects.

But I’m not here to tell you that those numbers are to be ignored. I think the risks are scary: Do you want to compromise your sex life for the sake of your hairline? Plus, while most people will shed those side effects by discontinuing oral finasteride usage, a fraction of users report permanent compromise to their sex life, and some even report depressive symptoms (occasionally as severe as suicidal thoughts).

This is why finasteride remains a prescribed and closely monitored treatment, as opposed to minoxidil (which is now available over the counter). Any finasteride usage—particularly oral—needs to be closely observed, especially in those first months as you understand your body’s response.

Again, topical finasteride is proving to be equally effective at treating hair loss, but with far lower risk of side effects—almost none—which is why I try to encourage every guy to consider it alongside minoxidil as their primary effort against hair loss.

Where to Get Finasteride

A board-certified dermatologist will need to observe your hair loss patterns and potential for regrowth before prescribing you finasteride (oral or topical). Remember, if your hair loss is too progressed, it might be futile to even try. And once you start finasteride, you need to keep taking it if you want to maintain those results. (Stick with it through 6-7 months and you will truly notice the fantastic results, too, which will encourage you to continue.)

I mentioned the most popular telemedicine providers above—the ones who all sell compound finasteride-minoxidil topical treatments.

Hims | XYON | Ro | Happy Head

Most of them offer oral finasteride options, too, as well as minoxidil (which, again, is available OTC, although oral minoxidil should also be considered of late, and is paired nicely with standalone topical finasteride). Of the above brands, Ro and Hims have made it easiest so far to get oral minoxidil to your doorstep.

As someone who hates waiting for a damn dermatologist appointment to open up—and who hates those huge co-pays, I have to give it to these telemedicine brands for making it convenient and simple. I’ll give my money to anyone who can save me stress and time. (And ship directly to my door, no less.)

Read about all the best hair loss treatments, from minoxidil to LLLT (laser therapy) to PRP (plasma injections).