Reviewed by Vicky Davis, FNP
Written by Our Editorial Team
It’s 2 a.m. and you’re tossing and turning. What’s to blame? Could it be that second cup of coffee you drank a little too late in the afternoon? That evening yoga session you skipped in favor of a chilled-out night at home watching TV? Anxiety about a busy day at work tomorrow?
Or, could it be finasteride — the hair loss medication you started taking a few weeks ago after you spotted a receding hairline in the mirror?
Can finasteride cause insomnia? Like all medications, finasteride can cause adverse effects in a small percentage of men. However, there’s no scientific evidence to suggest that difficulty falling or staying asleep is one of them.
Below, we’ve discussed how finasteride works as a treatment for male pattern baldness as well as the potential side effects it can cause in men.
We’ve also explained why finasteride probably isn’t to blame if you’ve recently begun to develop sleep issues such as insomnia.
Finally, we’ve shared what you can do if you’re affected by sleep disturbances, from changes to your habits and lifestyle to treatments you can discuss with your healthcare provider.
Finasteride is a prescription medication for androgenetic alopecia, also known as male pattern baldness. It’s available as a generic medication and under the brand name Propecia®.
Along with the medication minoxidil, finasteride is the most effective treatment available for male pattern baldness.
Finasteride belongs to a class of medications called 5α-reductase inhibitors. It works by blocking the conversion of testosterone to dihydrotestosterone (DHT), a hormone that can attach to your hair follicles and cause them to become miniaturized.
As your hair follicles undergo miniaturization, the growth phase of each hair shortens, leading to thinner hairs that are eventually unable to break through your scalp.
Finasteride reduces your DHT levels by around 70 percent — enough to either slow down or stop hair loss in most men. Many men who take finasteride even notice improvements in their hair growth in areas such as the hairline and vertex scalp.
Finasteride has been available since the 1990s, meaning we have access to several decades of scientific research on both its positive effects and its adverse side effects.
Like all medications, finasteride can produce certain side effects. The most common side effects of finasteride are sexual side effects, such as:
These side effects can sound alarming. However, it’s important to put them in context. In clinical trials, only 1.8 percent of men who used finasteride reported developing a lower level of interest in sex, compared to 1.3 percent of men who used a placebo treatment.
Similarly, only 1.3 percent of men who used finasteride to treat male pattern hair loss developed erectile dysfunction.
In other words, sexual dysfunction from finasteride is possible, but it’s uncommon. You can find out more about these potential adverse effects in our full guide to finasteride side effects.
So far, none of the large-scale clinical trials conducted on finasteride have found any sleep-related side effects, such as difficulty falling asleep, changes in your sleep patterns or reduced sleep quality.
In other words, no scientific evidence suggests that finasteride will keep you awake at night or cause you to wake up after you’re asleep.
Finasteride works by lowering DHT levels, and no research suggests that reduced DHT levels impact your sleep patterns or risk of severe insomnia.
There’s also no evidence that finasteride works like a stimulant once it’s in your body or that it’s involved in any biological processes that could affect your ability to fall asleep.
Does finasteride make you tired? Research doesn’t suggest that finasteride has any noticeable impact on your need to sleep, meaning it’s also unlikely to make you feel sleepy.
In other words, if you’ve developed insomnia or other sleep issues after starting treatment with finasteride, it’s unlikely that finasteride is the root cause.
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A variety of factors can contribute to poor sleep — from your mental or emotional state to your use of substances such as caffeine, nicotine or tobacco.
You may be more at risk of developing insomnia if you feel stressed, work during the night or on a shift basis, have a lower income, often travel between time zones, have an inactive lifestyle or have a mental health issue such as depression or anxiety.
You may also have a higher risk of experiencing insomnia or other sleep-related issues if you’re African American.
Insomnia can be acute or chronic. Acute insomnia — an occasional night or two with bad sleep — usually resolves independently. However, chronic insomnia often only improves once you treat the underlying issue that’s affecting your sleep.
Try the following techniques to reduce your risk of insomnia and improve your sleep:
Stick to a consistent sleep schedule. The more consistent your sleep schedule is, the easier you’ll find it to fall asleep. Try to maintain good sleep habits by going to sleep and waking up at the same time every day, including on the weekend.
Like to nap? Try to avoid napping after 3 p.m., as this may make it more difficult for you to fall asleep at night time.
Limit your afternoon coffee consumption. Caffeine is a surprisingly powerful stimulant that can significantly impact your ability to fall asleep. It has a half-life of around five hours, meaning a cup of coffee from 4 p.m. will still be partly in your body at bedtime.
If you’re a fan of coffee, energy drinks or any other beverages that contain caffeine, try to limit your consumption of these drinks in the afternoon, as they may affect your sleep.
Get checked for sleep disorders. If you’re concerned that you might have insomnia, let your healthcare provider know. They’ll be able to talk to you about your sleep habits and, if appropriate, diagnose you with insomnia.
Depending on your symptoms and their severity, your healthcare provider might suggest taking part in a sleep study or using sleep medication before you go to bed.
Consider taking part in therapy. If you suffer from a mental health disorder, you might be at increased risk of developing chronic insomnia. Common mental issues that may affect your ability to fall asleep include depression and anxiety disorders.
Many people with depression and/or anxiety benefit from taking part in a form of therapy called cognitive behavioral therapy (CBT). We offer online therapy as part of our range of mental health services, letting you easily access expert help from your home.
Our full list of sleep hygiene tips goes into even more detail about steps that you can take to fall and stay asleep easier.
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This is the FDA-approved dynamic duo. When used together, men saw better results in clinical trials compared to using either alone.
If you’re looking for something effective but don’t want too many steps in your routine, this once-a-day pill could be right for you.
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Finasteride is one of the most effective medications for hair loss in men, with millions of users in the United States alone.
As such, it’s very understandable to have concerns about potential side effects, including sleep issues such as insomnia.
Can finasteride cause insomnia? There is currently no high-quality scientific evidence to suggest that finasteride affects your sleep in any meaningful way, including by stopping you from falling asleep or staying asleep throughout the night.
In general, here’s what you need to know about finasteride and sleep:
Right now, finasteride isn’t associated with insomnia in any large-scale clinical trials. This doesn’t mean that it’s impossible to develop sleep problems while using finasteride, but it does strongly suggest that finasteride probably isn't responsible for them.
However, finasteride can produce side effects including some that may affect your sex drive and erections. These are rare, but it’s important to talk to your healthcare provider if you feel worried about them.
Finasteride doesn’t cause withdrawal symptoms, meaning you can safely stop using it if you're worried about side effects. However, stopping finasteride can make your hair loss come back, meaning it’s best to talk to your healthcare provider first.
If you’ve noticed changes in your sleep after starting finasteride, the best approach is always to talk to your healthcare provider.
If you’re interested in treating hair loss, you can participate in an online hair loss consultation to find out more about your options, including evidence-based, FDA-approved medications to stop shedding and promote healthy hair growth.