Alternatives to Finasteride for Hair Loss: A Comprehensive Guide

Finasteride is a well-known (and loved) treatment option for hair loss, with extensive research backing its efficacy. But just because something works well doesn’t mean it’s for everyone.

If you’re noticing hair loss or a receding hairline and finasteride isn’t your jam for whatever reason (we won’t ask why), there’s a treasure trove of finasteride alternatives out there.

Below, we’ll dive into the pros and cons of various finasteride alternatives with insight from one of our medical reviewers, board-certified dermatologist Knox Beasley, MD.

Read on for a brief recap of what finasteride is and how it works, plus a rundown of finasteride alternatives.

Finasteride is one of two medications with approval from the FDA (U.S. Food & Drug Administration) for the treatment of male pattern baldness (aka androgenetic alopecia or AGA). It’s the active ingredient in hair loss medication Propecia®.

Finasteride is also used in a higher dosage to treat an enlarged prostate, known as benign prostatic hyperplasia (or BPH). For this use, the medication often goes by the brand name Proscar®.

How Finasteride Works and What It Does

Finasteride is in a class of medications known as 5 alpha-reductase inhibitors, or 5ARIs. 5 alpha-reductase is an enzyme that converts testosterone into dihydrotestosterone (DHT), another male hormone.

DHT isn’t all bad — during male fetal development and puberty it’s the hormone that develops male characteristics like facial hair and a deeper voice (thanks, man). But later on, DHT can bind to receptors in hair follicles, causing gradual hair thinning and hair loss in people genetically sensitive to its effects.

Finasteride is a DHT blocker, preventing the hormone from getting into your hair follicles in the first place. Generally, lower DHT levels mean more hair (and research points to higher DHT levels on balding men’s scalps).

Consider this a quick summary of how finasteride works. For more in-depth information, check out our guide to finasteride side effects, dosage, and more.

Finasteride works very well for most men with male pattern baldness. In one of the longest-term studies on the medication (done over a ten-year period on 523 Japanese men), 99 percent of those taking finasteride experienced no worsening of hair loss during treatment. And just over 91 percent saw improvements in hair growth while using finasteride.

But some people aren’t good candidates for finasteride. Below, you’ll find out who should skip the drug or consider a finasteride alternative hair loss treatment.

Women

Finasteride isn’t FDA-approved for use in women because of its potential to cause congenital abnormalities (what some call birth defects) in male babies, specifically their genitalia.

Some research even suggests that pregnant women shouldn’t handle crushed or broken finasteride tablets. However, other data show minimal risk to female partners of men taking finasteride because the amount of medication transferred through semen is so low.

In some cases, finasteride might be prescribed to post-menopausal women. But there are other treatment options for women, including minoxidil or spironolactone.

People Whose Hair Loss Isn’t Hormonal

As noted, finasteride blocks DHT, a male hormone (or androgen) that causes AGA. But not all types of hair loss have a hormonal component.

For example, telogen effluvium is hair loss caused by stress, illness, or injury, and traction alopecia is hair loss caused by overly tight hairstyles. Finasteride won’t help with these forms of hair loss — alternative hair loss treatments like minoxidil would be more effective here.

People Who Experience Side Effects

It’s natural to be concerned about a medication’s adverse effects, but most men don’t need to worry about the side effects of finasteride.

According to the FDA, sexual side effects — including decreased libido, erectile dysfunction, and reduced ejaculate volume — are rare. They affect less than two percent of men and tend to resolve over time.

If you’re in that two percent, though, it’s understandable to be interested in seeking a finasteride alternative.

If finasteride isn’t for you, don’t sweat it. There are plenty of other ways to fight hair loss, which we’ll break down below.

You’ll also find efficacy, side effects, and ease of use rankings for each finasteride alternative treatment from Dr. Beasley, who specializes in hair loss.

Minoxidil

Remember how we said finasteride was one of two FDA-approved medications for hair loss? We know you’ve been on the edge of your seat waiting to find out what the other one is. Enter: minoxidil.

Minoxidil is the active ingredient in Rogaine®, and topical minoxidil is used to treat hair loss. Oral minoxidil isn’t FDA-approved for hair loss (it’s for high blood pressure) but is sometimes prescribed by healthcare providers off-label for AGA.

Minoxidil is a vasodilator, meaning it dilates blood vessels (that’s why it works to lower blood pressure), bringing blood, nutrients, and oxygen to the scalp. It also prolongs the anagen (growth) phase of the hair growth cycle — one way it’s similar to finasteride.

How to Get Minoxidil Online

We offer minoxidil foam and minoxidil solution, both of which are applied topically to the scalp using either your fingertips or the dropper provided with the liquid solution.

As mentioned, oral minoxidil is also available with a prescription. Our oral offering comes in the form of minoxidil chews designed to be taken once daily.

Minoxidil and finasteride also pair well together, like with our dual-action topical finasteride & minoxidil spray.

If you’re looking for a finasteride substitute because you haven’t seen the results you want, clinical trials show that using these two hair loss medications together is actually more effective than either alone.

Dr. Beasley Rating:

Minoxidil Topical Solution:

• Efficacy: ★★★★★

• Side Effects: ★★★★

• Ease of Use: ★★★

Oral Minoxidil:

• Efficacy: ★★★★★

• Side Effects: ★★★★

• Ease Of Use: ★★★★★

“Minoxidil is one of the gold standard treatments for male pattern hair loss and should be an important part of everyone’s regimen when able,” Dr. Beasley says.

Dutasteride

Dutasteride, like finasteride, is a 5-alpha-reductase inhibitor, slowing or stopping the conversion of testosterone to DHT.

A 2006 study found that dutasteride increased scalp hair growth in men with pattern hair loss. In another study, the treatment actually seemed to work slightly better than finasteride. It may be prescribed off-label for folks who aren’t seeing the results they wanted from finasteride.

That said, dutasteride works similarly to finasteride (and therefore has a similar side effect profile). So it’s not a good option for those who stopped finasteride because of adverse effects or whose hair loss isn’t hormonal.

If you’re unsure what hair loss medication is right for you, seek medical advice.

Dr. Beasley Rating:

• Efficacy: ★★★★

• Side Effects: ★★★★

• Ease of Use: ★★★★★

“Dutasteride does not have as much data as finasteride and minoxidil, and it’s not FDA-approved to treat male-pattern hair loss — however, newer data shows that it may be an effective alternative,” says Dr. Beasley.

Microneedling

Microneedling involves using a dermaroller tool (a rolling cylinder with tiny needles on it) on the scalp. It sounds scary, but the needles are less than one millimeter long, so it doesn’t really hurt.

The idea is to create teeny-tiny injuries to the skin so that blood and oxygen rush to the scalp to heal these micro-wounds. As a result, it might stimulate hair follicles to produce new hair.

Most of the research on microneedling for hair loss is on microneedling paired with a topical hair loss treatment, like minoxidil. In one study, participants who used a dermaroller weekly and minoxidil twice a day saw thicker hair — and the positive results were still present eight months after the study.

There aren’t many studies on microneedling for hair loss as a monotherapy (meaning used on its own). But a small study on four men with androgenic alopecia who hadn’t responded well to other treatments found that with microneedling alone, there was no worsening of hair loss (but no hair regrowth, either).

Dr. Beasley Rating:

• Efficacy: ★★★

• Side Effects: ★★★

• Ease of Use: ★★★

“Microneedling likely works best when used in addition to a topical medication like minoxidil to help it absorb better,” Dr. Beasley says. “There is also no consensus on the best depth of microneedling for hair growth.”

Scalp Massage

There’s a lot to love about scalp massages — but beyond feeling amazing, they may help with hair health.

One small study (on just nine men who actually weren’t experiencing hair loss) looked at the effects of scalp massage four minutes a day for 24 weeks using a massager device.

The study found an increase in hair thickness after 24 weeks. This could be because massaging the scalp stretches hair follicles, which can increase the diameter of each hair. Or it could have been a result of enhanced blood flow to the area.

In a larger study on over 300 men, roughly 69 percent reported hair loss stabilization or regrowth after getting a daily scalp massage for 11 to 20 minutes for seven months. But this study lacked a control group and was self-reported, meaning confirmation bias could be at play (people putting that much effort into scalp massage understandably expected to see results).

Dr. Beasley Rating:

• Efficacy: ★

• Side Effects: ★★★★★

• Ease of Use: ★★★★

“There is very limited research on scalp massage and hair growth. However, it probably feels great and has no side effects,” Dr. Beasley says.

Low-Level Light Therapy

There’s little research on the effectiveness of low-level light therapy (LLLT) for hair loss. But existing studies show some potential — and at the very least, it’s safe to try.

Low-level light therapy was actually FDA-approved in 2007 for treating androgenetic alopecia in men and women. It’s sometimes confused with laser therapy — the two are similar but not the same.

A meta-analysis looking at various hair loss treatments concluded that LLLT effectively stimulates hair growth in men with androgenetic alopecia.

Research from 2013 showed that LLLT improved various non-scarring alopecias, including androgenic alopecia, alopecia areata, and chemotherapy-induced alopecia.

LLLT can be an in-office treatment administered by a professional. Or you can do it at home using a lighted helmet (so you’ll obviously look really cool).

The light frequency encourages hair follicles to re-enter the anagen phase of the hair growth cycle, where active hair growth occurs.

Dr. Beasley Rating:

• Efficacy: ★★★

• Side Effects: ★★★★★

• Ease of Use: ★★★★

Here’s what Dr. Beasley had to say: “There’s not much independent research on LLLT and hair growth, but the risk of side effects is very low, and it may be helpful in combination with other medications.”

Biotin Supplements

Biotin is a buzzy ingredient in the hair loss world, but it can be a little tricky to figure out if you actually need to supplement with it.

According to the National Institutes of Health, “severe biotin deficiency in healthy individuals eating a normal mixed diet has never been reported.”

Having said that, if you follow an extreme diet or have inherited biotinidase deficiency (a rare genetic condition that prevents the body from recycling biotin), you might not get enough of this B vitamin from food.

Your healthcare provider can check your biotin levels with a simple blood test. While getting your biotin checked, you may want to also look into your iron and zinc levels, as each deficiency has been associated with hair loss.

We offer over-the-counter biotin gummies that contain other ingredients to support healthy hair, like vitamin D, vitamin B6, and folic acid.

Dr. Beasley Rating:

• Efficacy: ★★

• Side Effects: ★★★★★

• Ease of Use: ★★★★★

“A biotin supplement is really only helpful if you have a biotin deficiency,” says Dr. Beasley. “In those cases, it can be effective for hair growth.”

Saw Palmetto

Saw palmetto is an extract from a small palm plant typically found in the southeastern United States. It works similarly to finasteride in that it blocks DHT (at least to a certain extent) by inhibiting the 5 alpha-reductase enzyme.

Our thickening shampoo contains saw palmetto.

Though research on saw palmetto and hair loss is limited, some findings are available.

One meta-analysis looked at the effects of both oral and topical forms of saw palmetto and found that 60 percent of participants experienced an improvement in overall hair quality. Just over 83 percent reported increased hair density, and 27 percent saw an increase in total hair count.

Dr. Beasley Rating:

• Efficacy: ★★★

• Side Effects: ★★★★

• Ease of Use: ★★★★★

“High-quality data are lacking, but studies have shown that saw palmetto may be an effective treatment for male pattern hair loss,” Dr. Beasley says.

Essential Oils

Essential oils get a bad rap (largely thanks to your sister’s friend-of-a-friend from high school who’s selling them on social media). While the research on their efficacy is limited, essential oils may have some benefits for hair health — and if you’re into natural alternatives, they could be worth a shot.

One older study suggested that a mix of plant-based oils (including essential oils like lavender and rosemary) can effectively treat alopecia areata.

You don’t normally think of pumpkin seed as an essential oil, but it is. Research is scarce, but some suggests that the phytosterols (plant compounds) in pumpkin seed oil could potentially block 5-alpha reductase. The same is true of linoleic acid, an omega-6 fatty acid found in pumpkin seeds.

• Efficacy: ★★

• Side Effects: ★★★★

• Ease of Use: ★★★

According to Dr. Beasley, “There isn’t much independent research supporting essential oils for hair growth, but they are not likely to be harmful if you dilute them correctly.”

If you don’t want to use finasteride for any reason, there are plenty of alternative treatments you can try.

Here’s the TL;DR on finasteride or Propecia alternatives:

• Finasteride works very well for most men experiencing hair loss, but it’s not for everyone. Women (due to potential risks of birth defects in male babies) and those with non-hormonal hair loss types aren’t good candidates for finasteride. Additionally, people experiencing side effects may be interested in alternatives.

• Each alternative has unique benefits and considerations. For instance, dutasteride shows promise in studies but shares similar side effects with finasteride. Microneedling — while potentially effective when combined with minoxidil — lacks robust standalone evidence.

• Dermatologist Dr. Knox Beasley gave oral minoxidil the best rating as a finasteride alternative. It was rated slightly better than topical minoxidil, specifically when it came to ease of use.

If you’re worried about thinning hair or hair loss, we can help you connect with a healthcare professional online so you can access the treatment you need.