Finasteride is the only pill that’s FDA-approved to treat androgenetic alopecia. It works as a hormone blocker, reducing levels of dihydrotestosterone (DHT) in the body. Lowering DHT levels is important since this androgen is the primary hormonal component involved in the progression of pattern hair loss. (1)
Although blocking DHT is helpful in preventing balding, lowered levels of this androgen can also cause side effects. This occurs because DHT reduction after taking finasteride happens systemically, affecting the whole body, rather than just the scalp and hair follicles.
What Is Finasteride Prescribed For?
Finasteride is an oral medication used to treat androgenetic alopecia, commonly referred to as pattern baldness, and benign prostatic hyperplasia, also known as an enlarged prostate. When used for hair loss, this drug is meant to be taken in 1 milligram daily doses. When used to treat an enlarged prostate, the dose increases to 5 milligrams per day. (1)
At the moment, the Food and Drug Administration has only approved this DHT-blocking medication’s use for men, though it’s sometimes used off-label for conditions like hirsutism in women. However, this drug should never be taken or even touched by pregnant women or women who may become pregnant as it can cause birth defects. (1,2)
What Are the Side Effects of Taking Finasteride?
A variety of different side effects have been reported after taking finasteride in both 1-milligram and 5-milligram doses. Generally, the severity of these side effects and their likelihood of occurring are thought to be dose-dependent.
Finasteride side effects include (1-6):
- Breast tissue discomfort, enlargement, or pain
- Decreased sex drive
- Dizziness or lightheadedness
- Low blood pressure
- Postural hypotension (low blood pressure when sitting up or lying down)
- Sexual dysfunction
- Shortness of breath
- Suicidal ideation
- Testicular pain
How Common Are the Side Effects of Finasteride?
Finasteride side effects have been reported by a fairly small percentage of users and are considered to be rare. However, men taking higher doses – usually those being treated for enlarged prostates – are more likely to experience side effects.
The FDA labeling says that the most common side effects, which have been reported in 1% or less of patients treated with the brand-name version of finasteride, Propecia, are decreased libido, erectile dysfunction, and ejaculation disorder. (7) The UK’s National Health Service agrees, reporting that around one in every hundred men experience issues such as reduced libido, problems getting an erection, difficulties ejaculating, or lack of semen during ejaculation. (2) About one in every thousand men experience more serious side effects affecting their mental health or breast tissue. (2)
However, you should know that more recent studies have reported much higher rates of these side effects. For example, issues like erectile dysfunction have been reported in as much as 5-19% of patients, while ejaculatory dysfunction has been reported in 1-7%, and reduced sex drive has been reported in 2-10%. (3-6) Additionally, postural hypotension – which causes feelings of lightheadedness, dizziness, weakness, and low blood pressure – has been reported in 9% of users. (1)
6 Ways To Reduce the Side Effects of Finasteride
Like all medications, finasteride has the potential to cause a range of side effects. And unfortunately, like with all other pharmaceuticals, the main way to prevent side effects from a medication is to simply not take that particular drug. However, there are still a number of things you can do to reduce the likelihood of experiencing side effects from finasteride.
1. Only Take the Prescribed Dose
If you’re definitely set on taking finasteride, the best thing you can do is take the medication at the set dosage you’ve been prescribed. Taking more than the recommended dose is likely to increase your risk of side effects.
2. Don’t Double Dose
It’s also sensible to try and take your finasteride pill at the same time every day. Don’t take a double dose if you miss a day, and don’t take doses too close together (such as one dose late in the evening and another early the next morning). This can also increase the likelihood of you experiencing side effects. If you’ve forgotten to take your daily dose or more than 6 hours have gone by since you were meant to take your finasteride pill, it’s better to skip that day’s medication. (2)
3. Consider Dosage Adjustments
If you’re already taking finasteride and have started to experience side effects, you should consult your doctor or pharmacist. They may want to adjust your medication’s dosage, suggest that you take finasteride every other day, or might simply recommend that you try an alternative hair loss treatment.
Be sure to talk to your doctor if you experience one of finasteride’s serious side effects. These include lumps, pain, or swelling around your chest, discharge from your nipples, depression, and thoughts of harming yourself. (2)
4. Make Your Doctor Aware of Prior Health Issues
Finasteride should be safe for almost all adult men. However, it’s metabolized by your liver. If you have a history of liver problems or are currently taking any medications for liver issues, make sure to let your doctor know as finasteride may not be suitable for you. (1)
5. Consider Trying Out Finasteride Alternatives
If finasteride’s laundry list of potential side effects has put you off taking this medication — or you’re already experiencing side effects and want to stop taking this drug, you may want to consider some of the alternatives to finasteride. You can choose from other FDA-approved hair loss treatments, nutraceutical and cosmeceutical alternatives, or alternative drug formulations.
If you prefer to use FDA-approved hair loss treatments, you have two more to choose from: minoxidil and low-level laser therapy. Minoxidil is a topical liquid or foam that’s applied to your scalp twice a day, while low-level laser therapy is applied to your scalp using light-emitting devices.
Another increasingly popular alternative to finasteride pills is topical finasteride. Like oral finasteride, topical finasteride requires a prescription and needs to be prepared by a pharmacist. Since they don’t act systemically, finasteride sprays and serums have the potential for less serious side effects compared to oral finasteride. The most serious reported side effects include issues like scalp irritation, contact dermatitis, headaches, testicular pain, throat pain, lightheadedness and weakness, and bed wetting. However, you should be aware that topical finasteride products are not approved by the FDA. (8)
Nutraceutical products, like supplements, and cosmeceutical products, like shampoos and leave-in hair products, can also be prepared with natural DHT blockers. These products often contain extracts of natural DHT blockers like saw palmetto, pumpkin seed, and green tea. (9,10)
While these DHT-blocking nutraceuticals may work, they are considered to be much weaker than finasteride. This means that they are unlikely to produce side effects, even when taken orally. However, few of these products are likely to be effective in stopping hair loss on their own. This means that they’re best when used as a complementary component of your hair loss treatment program.
6. Tell Your Doctor About Any Medications You’re Taking
Considering finasteride alternatives may be a good option for your needs, but make sure that you don’t combine these natural DHT blockers with finasteride without informing your doctor first. While natural DHT blockers are weaker than finasteride, they can have an additive effect when used together. Combining these medications could mean you end up with a similar effect to taking a higher finasteride dose – which would increase your risk of side effects.
Also, make sure to talk to your doctor if you’re taking any alpha-blockers. Finasteride can lower blood pressure, and taking alpha blockers along with finasteride can increase your likelihood of experiencing side effects related to postural hypotension. (1)
Are Finasteride Side Effects Permanent?
Finasteride is a very effective hormone-blocking medication that is unfortunately accompanied by a laundry list of side effects. In some studies, finasteride side effects have been reported to improve over time. (4) But this can take years. For people who are not so patient, it may seem easier to simply stop taking this medication.
When you stop taking a medication, the side effects typically go away. Unfortunately, this isn’t always the case with finasteride. A small number of users experience post-finasteride syndrome, which is when finasteride’s side effects continue even after discontinuing the drug. (3-6)
It’s possible for finasteride to continue to cause decreased libido, ejaculation issues, and ejaculatory dysfunction even after you stop taking the medication. It’s also possible for the mental health issues associated with finasteride to continue. It’s not known exactly what percentage of people are affected by this problem, but younger men seem to be more likely to be affected. (3-6)
If you’re worried about finasteride’s potential side effects, talk to your doctor about other hair loss treatment options. Minoxidil, low-level laser hair treatments, and even natural DHT blockers may be better suited to your needs. And while it’s not free of side effects, topical finasteride can also be a good option. Although it’s not yet FDA-approved as a hair loss treatment, topical finasteride side effects are fewer and less severe compared to the oral version of this drug.
- Zito, P. M., Bistas, K. G., & Syed, K. (2023). Finasteride. In StatPearls. StatPearls Publishing.
- Finasteride: A medicine used to treat benign prostate enlargement and hair loss. (2020, August 28). NHS UK.
- Finasteride: MedlinePlus Drug Information. (n.d.). Retrieved April 18, 2023.
- Mysore V. (2012). Finasteride and sexual side effects. Indian dermatology online journal, 3(1), 62–65
- Nestor, M. S., Ablon, G., Gade, A., Han, H., & Fischer, D. L. (2021). Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of Cosmetic Dermatology, 20(12), 3759-3781.
- Nguyen DD, Marchese M, Cone EB, Paciotti M, Basaria S, Bhojani N, Trinh QD. Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride. JAMA Dermatol. 2021 Jan 1;157(1):35-42. doi: 10.1001/jamadermatol.2020.3385. PMID: 33175100; PMCID: PMC7658800.
- PROPECIA® (finasteride) tablets for oral use – Prescribing Information. MERCK & CO, INC. Revised 04/2012. Accessed 10 February 2022.
- Lee, S. W., Juhasz, M., Mobasher, P., Ekelem, C., & Mesinkovska, N. A. (2018). A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. Journal of Drugs in Dermatology : JDD, 17(4), 457–463.
- Gupta, A. K., Talukder, M., & Bamimore, M. A. (2022). Natural products for male androgenetic alopecia. Dermatologic Therapy, 35(4), e15323.
Last updated August 2023