Finasteride (Propecia): What You Need To Know
Written by Ann-Marie D’Arcy-Sharpe / Medically reviewed by Dr. Ashley Steffens
- Only approved for men
- Risk of sexual dysfunction
One pill a day
What Is Finasteride?
What Is Finasteride?
Finasteride is an FDA-approved treatment for androgenetic alopecia, which you might have heard of as male pattern hair loss. It was originally used to treat enlarged prostate glands (specifically, benign prostatic hypertrophy – BPH). A few years later, it was approved to treat androgenic alopecia.
Finasteride for hair loss is typically taken in daily 1 milligram doses. When taken for BPH, finasteride needs to be taken in a larger dose of 5 milligrams per day.
Finasteride can also be used as a treatment for female pattern hair loss, hirsutism (excessive hair growth in women), and polycystic ovarian syndrome. However, these are all off-label applications for this drug. (1) Finasteride is currently only FDA-approved for men.
Is Propecia the Same Thing as Finasteride?
Propecia and finasteride are the same medication. Propecia is a common brand name for finasteride.
Finasteride is a treatment for androgenetic alopecia. This drug is in a class of medicines called 5-alpha reductase inhibitors. It works by blocking the enzymes that turn testosterone into a hormone known as dihydrotestosterone (DHT).
DHT contributes to the progression of pattern hair loss. DHT-blocking drugs like finasteride have been proven to prevent further hair loss in more than 80 percent of patients, promoting hair regrowth. (2)
Branded medications like Propecia contain finasteride as their active ingredient. You might also see finasteride sold under the brand names Proscar, Aindeem, Finastat, Finabald, and more. Different countries may recommend specific brands for use as hair loss treatments.
While brand-name drugs and generic finasteride are essentially the same medications, they contain slight differences in their binding and inactive ingredients. These differences mean you may experience slightly different side effects from the generic drug versus the brand-name drug.
How Much Does Finasteride Cost?
The cost of finasteride varies depending on where you live and how you access your medication. In general, finasteride is a prescription-only drug that requires your doctor’s approval. It’s cost can range between £0.04 and $5.25 per pill.
Based on a 1 milligram dose, generic finasteride sold in the USA costs between $0.16 to $3.23 per pill. Finasteride pills in the UK cost a similar amount, ranging between £0.04 to £1.39 per pill. In Canada, finasteride’s cost averages at CA$1.55 per pill, while in Australia, the average price is AU$0.92.
In general, the generic drug is cheaper than brand name options. For example, in the US, Propecia ranges from $1.38 to $3.88 per pill while Proscar costs between $0.60 to $5.25 per pill.
How Does Finasteride Work?
How Does Finasteride Work?
Finasteride is a dihydrotestosterone (DHT) blocker. It works to lower DHT levels by blocking the conversion of testosterone to DHT. DHT is one of the primary causes of androgenetic alopecia.
Androgenetic alopecia is one of the most common causes of hair loss, affecting 50 million men and 30 million women in the United States alone. (3) It’s known as ‘androgenetic’ because androgens partially cause this form of alopecia.
Androgens are hormones found within the human body. Androgens are generally helpful, playing an essential role in puberty, male sexual development, and hair growth.
When DHT binds to hair follicles, it gradually shrinks them and shortens the hair growth cycle. This results in thinner, weaker strands of hair and delays hair regrowth. Over time, DHT can stop hair growth altogether, resulting in balding. (4)
Finasteride is a DHT blocker capable of reducing serum levels of DHT by 70 percent or more. (5) It stops hair loss by reducing the amount of DHT circulating in the body. Blocking DHT helps thicker, healthier hair regrow.
What Is a DHT Blocker?
DHT blockers lower levels of dihydrotestosterone (DHT), an androgen produced from testosterone. This sex hormone is present in both men and women. Most DHT blockers work by stopping the conversion of testosterone to DHT. A few DHT blockers bind to DHT receptors in order to prevent the hormone from ever reaching hair follicles.
DHT sometimes binds to hair follicles. This causes a gradual shrinkage known as miniaturization. Thinner, weaker hair strands start to grow from these follicles. Over time, hair growth can stop completely. Blocking DHT prevents the progression of hair thinning and further hair loss, allowing hair to regrow.
Finasteride is a type of DHT blocker approved by the FDA to treat androgenic alopecia. It’s typically taken in tablet form, although topical medications with finasteride are also being developed. Doses as low as 1 milligram per day can help counteract hair loss. (5)
Are There Other DHT Blockers for Hair Loss?
There are two main DHT blockers used to treat hair loss: finasteride and dutasteride. Dihydrotestosterone (DHT) is a hormone that plays a major role in the progression of pattern hair loss. DHT blockers work to lower DHT levels and allow hair to regrow.
Finasteride is the most common DHT blocker and is used worldwide as a hair loss treatment. This DHT blocker has been proven to reduce serum levels of DHT by around 70 percent. (5)
Dutasteride is stronger than finasteride and can lower serum DHT levels by up to 99 percent. (5) However, it isn’t used as widely for hair loss. Currently, dutasteride is only approved to treat androgenic alopecia in Japan and South Korea.
You might see dutasteride referred to by its brand name, Avodart. Like finasteride, dutasteride was first used to treat benign prostatic hyperplasia (BPH). It was first approved in the US to treat BPH in 2001. (6) In 2009 it was approved in Japan to treat androgenic alopecia. (7)
There are also natural DHT blockers, like stinging nettle, pumpkin seed oil, rosemary oil, and caffeine. Saw palmetto extract, which comes from the berries of a type palm tree, is one of the most popular natural DHT blockers. (8)
These ingredients are typically added to supplements, multivitamins, shampoos, oils, and other hair products. However, these natural options don’t have the same proven efficacy as medical DHT blockers.
Do All DHT Blockers Work in the Same Way?
Most dihydrotestosterone (DHT) blockers work in a very similar way, however, there are slight differences in their mechanisms of action. DHT is a naturally occurring hormone known as an androgen. It’s also the primary hormone involved in androgenetic alopecia.
In some people, DHT binds to hair follicles, causing them to shrink. This results in thinner, weaker hair and can eventually stop hair growth altogether. Most DHT blockers lower DHT levels in the body to help prevent further hair loss and allow healthy hair strands to grow.
There are small pharmacological differences in how DHT blockers work. DHT is created from testosterone, another hormone. Three types of 5 alpha reductase isoenzymes work to convert testosterone to DHT. They’re simply known as Type 1, Type 2, and Type 3. Out of these three isoenzymes, Types 1 and 2 are thought to be the most important. (9)
There are two primary DHT blockers used to treat pattern hair loss: finasteride and dutasteride. Finasteride inhibits the Type 2 and Type 3 isoenzymes, while dutasteride inhibits all three types. Dutasteride binds irreversibly to the isoenzymes, inhibiting their activity indefinitely. (10) This means it produces longer-lasting results. Therefore, dutasteride is stronger and more effective than finasteride, but it isn’t approved as widely to treat hair loss.
There are also natural DHT blockers, such as the popular saw palmetto, with anti-androgenic effects that work to decrease levels of DHT. Saw palmetto is a 5 alpha reductase blocker, which means it works in a similar way to finasteride and dutasteride. These natural treatments can be found in supplements and topical products, like shampoos or hair oils. However, they aren’t as effective as finasteride or dutasteride because they don’t lower levels of DHT as much. (8)
Ketoconazole is an antifungal treatment that also acts as a DHT blocker. Used as a topical treatment, ketoconazole stops DHT from binding to the hair follicles. (11) It’s a receptor antagonist, which means it binds to the DHT receptors and blocks their action. While it’s still in the early stages of being studied, results suggest this treatment can effectively help treat hair loss.
Does Finasteride Work?
Finasteride works and is proven to be highly effective in treating androgenetic alopecia in men. (5) Finasteride is a dihydrotestosterone (DHT) blocker.
DHT is a naturally occurring hormone that binds to some people’s hair follicles. Follicles affected by DHT produce thinner, weaker hair strands. Eventually, they stop growing hair altogether. DHT is known to be one of the main causes of androgenic alopecia.
Finasteride works by blocking excess levels of DHT in the hair follicles to stop this process. Finasteride can lower DHT levels in the scalp by up to 72 percent, allowing healthy hair to regrow. Many studies have shown that finasteride effectively stops the progression of hair loss in 9 out of 10 men who take 1 milligram of finasteride every day. (12)
Finasteride is currently being tested as a treatment for other types of hair loss, such as female pattern hair loss (FPHL), hirsutism, and frontal fibrosing alopecia (FFA), with promising results. (13) However, finasteride is not yet approved for treatment in women by the FDA.
How Long Does It Take Finasteride to Work?
Finasteride is an FDA-approved treatment for hair loss which is proven to be highly effective. In general, you should see some finasteride results after about 3 months. After around 6 months, you should be able to see a considerable difference in your hair. (6)
Finasteride is a long-term treatment. Consistency is required to see results. Hair growth should increase over time and your hair should gradually become healthier.
We’re all individuals, so your finasteride results timeline may differ from other people’s experiences. However, evidence shows that most people see significant results within 1 year. (6)
How Effective Is Finasteride?
Finasteride is a highly effective treatment for androgenetic alopecia. Research shows that most men taking finasteride saw a decrease in hair loss symptoms and an increase in hair growth within just 3 months of treatment. (6)
Reports by the FDA show that one year into treatment, 65 percent of men taking finasteride saw increased hair growth, compared to 37 percent of men taking the placebo. At the 2 year mark, 80 percent of men taking finasteride saw considerable hair growth. (6) A Japanese study on the long-term effects of finasteride over 10 years reported that 91.5 percent of patients saw continued improvement, while 99.1 percent saw prevention of hair loss progression. (14)
Finasteride is proven to be significantly more effective than many other options, including the popular natural treatment, saw palmetto. Studies have shown that only 38 percent of patients treated with saw palmetto supplements had increased hair growth, compared to 68 percent of patients treated with finasteride. (8)
Does Topical Finasteride Work?
Initial research, including a 2018 systematic review, has shown topical finasteride to be a highly effective and promising treatment. (15,16) This review found that topical finasteride was effective in 73 percent of patients.
Topical finasteride is sometimes found in low concentrations in combination topical treatments. Results also indicate topical finasteride may produce fewer side effects than oral finasteride. However, further research is needed.
While oral finasteride was FDA-approved for the treatment of androgenetic alopecia in 1992, topical finasteride is a new formulation of this drug that isn’t yet approved as a hair loss treatment. However, studies are showing promising results, and this new formulation might be able to be used in a wider variety of ways.
Topical finasteride has shown promise when combined with minoxidil. Minoxidil is a topical treatment that works by increasing blood flow to the scalp. This drug increases the size of the hair follicles, allowing them to produce, thicker, healthier hair. Combining topical minoxidil and topical finasteride also shows potential in treating female pattern hair loss. (15)
Finasteride Side Effects
Does Finasteride Have Side Effects?
Finasteride is generally well tolerated by most patients. However, just like any medication, there are some potential side effects. Many potential finasteride side effects center around sexual dysfunction, including loss of libido, erectile dysfunction, and ejaculation issues.
Not everyone who takes finasteride will experience side effects, but it’s always important to know the risks before making any medical decision. Studies report that finasteride’s side effects are rare, occurring in less than 2 percent of men taking the standard dose: 1 milligram of finasteride. (17) Other common potential side effects include depression, dizziness, weakness, chills, and confusion.
Some people worry that if sexual side effects occur, they may persist even after stopping treatment. On the contrary, research suggests that these side effects will go away for most users once treatment is discontinued. (17)
Interestingly, some studies report that sexual side effects ease when finasteride is taken long-term. One study discovered that by the fifth year of treatment, sexual effects decreased to less than 0.3 percent. (17) This study goes on to explain that the sexual side effects were found to be at similar levels to the placebo at both 1 year and 5 years of treatment.
More recent research suggests that finasteride is not significantly associated with sexual issues when used to treat androgenic alopecia. (5) Overall, finasteride is generally considered to be a safe and effective treatment.
Is Post Finasteride Syndrome Real?
Post finasteride syndrome (PFS) is described as a condition causing adverse sexual, physical, and mental side effects. It affects men who have taken finasteride, dutasteride, or other potent dihydrotestosterone (DHT) blocking medications. These side effects seem to continue even after stopping treatment.
Most of the medical community doesn’t yet recognize PFS given the lack of scientific evidence, leading to the controversy over whether PFS is ‘real’. Many experts discredit the results of the small number of studies that have been done on the subject, stating that these studies were low-quality and biased. (18)
However, to those experiencing these side effects, this syndrome is very real and emotionally distressing. Recent research on the topic discusses how significantly PFS can impact men and emphasises the need for the condition to be taken seriously. (19)
Even though this condition is rare, It’s crucial to acknowledge and validate the experience of these individuals. It’s also vital to make new patients aware of the risks and potential side effects so they can make an informed decision about what’s right for them.
With no definitive answers, the question from prospective patients is often, “is finasteride safe?”. All medications have potential side effects, and you should always be aware of them before you choose to start a new treatment.
In general, finasteride is very safe and highly effective. The US Food and Drug Administration approved this drug to treat hair loss, which is widely understood to mean it’s safe to use.
Only a small number of men who have taken finasteride have reported long-term negative side effects. One of many studies showed that only around 1.2 percent of men under 42 who take finasteride experience lasting sexual side effects. (20) Other symptoms, such as a negative effect on mental health, were very rarely reported.
Are the Side Effects the Same for Oral and Topical Finasteride?
Oral finasteride is an FDA-approved drug that is highly effective in treating androgenic alopecia. However, topical finasteride, a new formulation still being researched, produces fewer systemic side effects than oral finasteride. (16)
Finasteride works as a DHT blocker, preventing the hormone testosterone from being converted into dihydrotestosterone (DHT). DHT needs to be blocked as it can bind to hair follicles, contributing to the progression of androgenetic alopecia.
Since oral finasteride is systemic, it can have sexual side effects. Other potential side effects include dizziness, chills, and skin tenderness.
Topical finasteride has a mechanism of action that’s more localized as it’s applied directly to the scalp. It’s thought to target DHT levels directly at the hair follicles, reducing the risk of systemic side effects. Topical finasteride’s localized application means that it has fewer side effects than oral finasteride. Research suggests that it’s also highly effective. (16)
Some studies have reported no sexual side effects from topical finasteride. (16) While no serious side effects have been reported, scalp irritation can occur in some people. Other side effects can include an increase in liver enzymes, headaches, and testicular pain. Topical finasteride is not yet approved by the FDA or any other international association as a hair loss treatment, so it’s not yet readily available to purchase.
Does Finasteride Have Any Drug Interactions?
Some drugs and nutraceuticals taken with finasteride, like Saint John’s Wort, may affect the finasteride levels in your bloodstream. However, this is rare. (21)
The FDA lists no significant finasteride interactions. It’s always best to check with your doctor for any potential drug interactions before starting any new medication.
Finasteride vs. Dutasteride
There are two main dihydrotestosterone (DHT) blockers used to treat hair loss: finasteride and dutasteride. DHT is a hormone known to be the primary cause of androgenetic alopecia. DHT blockers work to lower levels of this hormone, reducing hair loss and promoting hair growth. Finasteride and dutasteride both work in very similar ways, preventing the conversion of testosterone to DHT. However, there are minor pharmacological differences in how they do this.
Enzymes help to carry out chemical processes that keep our bodies functioning correctly. Three 5-alpha reductase isoenzymes in the body help convert testosterone to DHT. Finasteride inhibits Type 2 and Type 3, while dutasteride inhibits all 3 types. (10) This means that dutasteride is stronger than finasteride and more effective at treating hair loss. Dutasteride also binds to the hair follicles irreversibly, meaning it produces longer-lasting results.
In general, lower doses of dutasteride are needed to produce positive results. For comparison, results have shown that over 2 years, patients taking a 0.5 milligram dose of dutasteride experienced an average serum DHT reduction of 93 percent. On the other hand, over 4 years, patients taking 5 milligrams of finasteride had an average serum DHT reduction of 70 percent. (22) While both results are very positive and potentially life-changing for patients, dutasteride is clearly the more potent DHT blocker.
Both finasteride and dutasteride produce similar side effects and are generally well tolerated by users. Only South Korea and Japan have currently approved dutasteride as an androgenetic alopecia treatment. This drug isn’t yet approved as a hair loss treatment in other countries, though it has gone through several clinical trials in Argentina and Australia. (30)
Topical Finasteride vs. Oral Finasteride
Dihydrotestosterone (DHT) is a hormone derived from testosterone. It’s known to be the primary cause of androgenetic alopecia. Finasteride is a DHT blocker used to treat this condition. In its oral form, it’s approved by the FDA for the treatment of pattern hair loss. The topical formulation of finasteride is still being tested.
Finasteride is taken daily in pill form at a dose of 1 milligram. Although it’s been proven to be highly effective, this drug acts systemically (on the whole body). This method of action causes potential side effects, including sexual dysfunction.
Topical finasteride works similarly, blocking excess DHT to treat androgenic alopecia. It’s applied onto the scalp, which targets hair follicles directly. Topical finasteride is typically used in concentrations between 0.2275 milligrams and 0.91 milligrams. (16) This localized application means systemic side effects are rarely reported, although they are possible.
A systematic review of topical finasteride showed that in some cases an increase in liver enzymes occurred, as well as reports of testicular pain, headaches, presyncope and oropharyngeal pain. (16) However, these side effects are rare.
Developing research shows that topical finasteride can be highly effective at treating androgenic alopecia. (16) However, it’s not yet approved by the FDA. It is sometimes combined with other topical treatments, like minoxidil. (15)
Finasteride vs. Saw Palmetto
Dihydrotestosterone (DHT) is a naturally occurring hormone that contributes to the progression of androgenic alopecia. DHT blockers work to prevent this and allow healthy hair to regrow.
Finasteride is an FDA-approved DHT blocking medication. Saw palmetto extract is a natural DHT blocker extracted from the berries of a type of palm tree native to parts of America. It’s traditionally used by Native Americans as a natural medicinal treatment for a variety of health problems. (23)
Although initial studies show promise, there hasn’t been much research into saw palmetto as a hair loss treatment. A recent systematic review found a 60 percent improvement in hair quality in those using topical or oral saw palmetto. The review also found increased hair density in 83.3 percent of patients, and prevention of continued hair loss in 52 percent. (24)
However, finasteride is stronger and more effective than saw palmetto. It’s also been around longer, has been backed by research, and is approved as safe, while very little research has been done into the side effects and safety of saw palmetto. (8)
Saw palmetto can be taken orally or used topically. Most topical treatments containing saw palmetto also include a range of other ingredients, so it can be challenging to determine the role saw palmetto plays in successful treatment. Saw palmetto and nutraceutical ingredients like stinging nettle, pumpkin seed oil, and caffeine can often be found in topical formulations like shampoos, oils, and sprays.
Finasteride Combination Treatments
Combining Minoxidil and Oral Finasteride
Dihydrotestosterone (DHT) is a hormone that can bind to hair follicles, causing shrinkage and subsequent hair loss. It’s the primary cause of androgenetic alopecia. Oral finasteride is a DHT blocker that works to stop this process and allow healthy hair to regrow. It’s taken as a daily tablet.
Minoxidil is an FDA-approved topical treatment applied to the scalp daily in a liquid or foam form to stimulate hair growth. It works by increasing blood flow to the scalp by vasodilation, which widens blood vessels. This increases the size of the hair follicles and allows them to produce thicker hair. (25)
Using both oral finasteride and minoxidil simultaneously is not FDA recommended. However, many studies show it’s an effective combination with better therapeutic efficiency than either treatment on its own. The combination is primarily studied in Asian countries. Research suggests the combination is safe for use and is generally well tolerated by patients. (26)
Combining Topical Finasteride and Minoxidil
Dihydrotestosterone (DHT), a naturally occurring hormone, is one of the driving forces behind androgenetic alopecia. Finasteride is a DHT blocker that works by inhibiting the conversion of testosterone to DHT. Less DHT promotes hair growth in androgenic alopecia-affected areas of the scalp. Minoxidil is a treatment that stimulates hair growth by dilating the blood vessels and increasing the size of hair follicles. Both medications are available in topical form and have shown positive results individually.
Combining finasteride and minoxidil as a topical treatment is not FDA recommended. However, the combination shows great promise in treating hair loss. A systematic review found recent studies tested a concentration of 5 percent minoxidil and 0.1 percent finasteride on 50 men for a year who were previously treated with oral finasteride and minoxidil. They discovered 80% of patients maintained hair density or experienced an increase in hair growth. (16)
While there are side effects, there are likely fewer systemic side effects compared to oral medications since topical finasteride-and-minoxidil treatment is applied directly to the scalp. This topical combination could potentially treat both males and post-menopausal females. (15) More research is needed to determine exactly how effective this combination is.
Other Finasteride Combination Treatments
Finasteride is a highly effective, FDA-approved treatment for hair loss. Oral finasteride is sometimes used alongside dutasteride. Both are dihydrotestosterone (DHT) blockers. They work to block DHT binding to the hair follicles, which is one of the main causes of androgenic alopecia. This combination is not yet FDA-approved, but research suggests it could be more effective than taking finasteride alone. (27)
Oral finasteride can be taken alongside topical ketoconazole, an antifungal DHT-blocking medicine thought to increase hair growth. Research shows that these combinations could be highly effective at reducing hair loss and promoting increased hair growth. (29)
People often take natural supplements and other topical treatments alongside oral finasteride to try to speed up hair growth and improve their outcomes. It’s important to note that these combination treatments are not recommended by the FDA or any other equivalent authority. Little research has been done into their results and side effects when used in combination.
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Last updated July 2021