Finasteride is a prescription hair loss medication used by million of men worldwide. The standard dosage for hair loss 1 mg. Sometimes, however, doctors can prescribe lower doses. These can often provide the same hair growth with fewer side effects.
This article will compare finasteride 1 mg to some of the lower, lesser-known dosages. We will discuss the various studies that compare their use. The results suggest that, in consultation with your doctor, it could be possible to take a smaller dosage and still enjoy most of finasteride’s regrowth.
What Is Finasteride?
Finasteride is an oral medication that is only available by prescription. The FDA initially approved it for the treatment of Benign Prostatic Hyperplasia (BPH) in 1992 (1).
In 1997, the FDA also approved finasteride for male pattern hair loss (Androgenetic Alopecia – AGA), under the brand name Propecia.
How Does It Work?
To understand how finasteride works, we need to briefly explain the physiological mechanism of hair loss.
Why We Go Bald
Androgenetic Alopecia (AGA) is the most common cause of hair loss among men (2).
While researchers do not know its exact mechanism, they believe it involves sensitivity to the male hormone dihydrotestosterone (DHT).
DHT regulates sexual maturation and is a necessary hormone for male development. Adolescents who don’t produce DHT can suffer various problems, including improperly formed secondary sexual characteristics (3).
For reasons that we don’t yet understand, in adulthood DHT can be problematic. Researchers believe that some men are sensitive to the effects of DHT in the scalp, and that this sensitivity is the ultimate cause of AGA.
The hallmark of AGA is a process known as hair follicle miniaturization.
Under the influence of DHT, the hair follicles become progressively smaller and weaker. If left untreated, the hair shafts will soon fail to protrude through the scalp. In this way, most of the scalp can eventually become completely bald.
How Finasteride Stops Baldness
Our body naturally synthesizes DHT through testosterone (3). An enzyme called 5-alpha-reductase (5AR) attaches to finasteride and converts it to DHT. There are other biochemical pathways of DHT production, but the 5AR pathway is by far the most important one.
Without 5AR, the body can only make a tiny fraction of its normal DHT production.
Finasteride achieves this because its chemical structure is similar enough to testosterone that it “tricks” the 5AR into binding with it. Once they bind to finasteride, the 5AR molecules are irreversibly trapped, and become biologically inactive.
The result is that DHT levels in the body plummet (we will see exactly by how much in the following section).
With low DHT levels in the system, the hair follicles get a respite. The hair follicle miniaturization process freezes, and hair loss stops. For around two-thirds of men, this drop in DHT will also be enough for them to regrow some new hair (4).
How to Take Finasteride
As discussed above, the FDA has approved finasteride for two different indications: hair loss and benign prostate enlargement (BPL).
BLP is a non-life-threatening condition also linked to DHT. It also responds to finasteride. The approved dosage for BLP is 5mg daily.
The approved dosage for hair loss is far lower, 1mg daily.
You should take the 1mg pill at the same time of the day. If you miss a dose one day, do not try to compensate for it by taking more the following day. Just continue to take your daily pill as if you had never missed a dose.
Before you start treatment, make sure to read the patient information sheet and ask your doctor if you have any questions. Most importantly, only take finasteride as ordered by your doctor – never take more or less.
Tinkering with the Standard Dosage
There is no benefit to taking more than 1mg daily for your hair loss. There is zero chance you will see better results, and will only be more likely to experience unpleasant side effects. You will understand why this is so as you read through this article.
The aim of this discussion is to see if it is possible to take a dosage that is lower than 1mg daily.
A lower dosage might interest balding men for many reasons:
- Firstly, there is significant evidence that a lower dosage will be as effective – or nearly as effective – at fighting hair loss (see below).
- At the same time, the lower dosage is less likely to cause side effects. Side effects, particularly sexual ones, are usually the biggest concern of finasteride users (4).
- Setting side effects aside, finasteride is a very powerful medication, and treatment is meant to last indefinitely – for life. For this reason, you want to be ingesting as little of it as possible.
- A smaller dosage also costs less. Given that finasteride treatment lasts indefinitely, the savings can add up over the years.
Serum vs Scalp DHT Levels
Before we get into the research, it is important to understand what biomarkers are used. When speaking of finasteride, the two most common are serum DHT and scalp DHT levels.
DHT is synthesized in various tissues, but primarily in the liver. It then circulates throughout the body by way of blood (serum). It finally arrives at the scalp and attaches to the follicles’ androgen receptors.
When assessing various finasteride dosages for hair loss, the levels of DHT in the blood and hair follicle are therefore the most important.
What Does the Research Say?
Hair Regrowth with the Various Dosages
To determine the best dosage for therapeutic purposes, Merck, the makers of Propecia, funded a large-scale study in the 1990s. They recruited men ages of 18 – 36. All had moderate vertex male-pattern hair loss (5).
The men in the studies were randomly assigned to receive 5 mg, 1 mg, 0.2 mg, or 0.01 mg of finasteride daily. There were also some who received a placebo.
The researchers determined efficacy by counting the number of hairs in a small area of the scalp that was 1 inch in diameter. They also looked at the before and after head photographs of the patients.
6 Month Results
After 6 months, the researchers found that the efficacy of 0.01 mg finasteride was similar to placebo. On average, men in both these groups lost hair. After 12 months, the placebo-treated men lost an average of 20 hairs, compared to 18 hairs for those on 0.01mg finasteride.
However, the other 3 doses of finasteride all resulted in hair gains. After 12 months, here were the results:
- 5mg daily: 93 new hairs
- 1mg daily: 85 new hairs
- 0.2mg daily: 65 new hairs
Two dermatologists also reviewed the before and after head photographs of all the patients. These dermatologists were “blinded” as to the treatment. This means they did not know which treatment each man in the photos had received. These dermatologists gave the following evaluations:
- 5mg daily: 48% of men showed visible improvement
- 1mg daily: 54% of men showed visible improvement
- 0.2mg daily: 38% of men showed visible improvement
- 0.01mg daily: 10% of men showed visible improvement
- placebo: 3% of men showed visible improvement
Another study followed 249 male subjects with AGA. The men were given either a placebo pill or 0.01, 0.05, 0.2, 1 or 5mg daily of finasteride. This continued for 42 days. (6).
Scalp biopsies were taken from all participants both before and after the study. Researchers also measured the levels of DHT in the blood. This gave them a good idea of the various dosages’ effectiveness at the molecular level. You can see the results in these two graphs.
The graph on the left shows how the various dosages reduce scalp DHT. The longer the vertical bar, the greater the reduction. In line with the previous clinical results, the 0.01 dosage essentially gave no reduction compared to the placebo. Surprisingly, the slightly higher dosage of 0.05mg was enough to lower scalp DHT levels as high as all the greater dosages, including 1mg and 5mg!
The 0.05mg dosage was also effective in reducing serum DHT, though not as much as the other larger dosages. The next dosage up, 0.2mg, gave essentially the same reduction in blood DHT levels as the 1mg and 5mg dosages.
What Does All This Suggest?
The results of these clinical studies suggest that increasing finasteride dosages quickly run into the problem of diminishing returns. In other words, you get the most benefits from a very small dosage of finasteride, which is far smaller than the standard 1mg daily dosage (between 0.05 and 0.2mg).
You must then need to increase the finasteride dosage many times over for a marginal further increase in hair growth and DHT suppression.
In a nutshell, there is a very small difference in terms of biochemical effectiveness and hair regrowth between the standard 1mg daily dosage and doses as small as 0.2mg or even 0.05mg.
Statistically, the 1mg dosage will give slightly better regrowth for the average user. But this difference will be very small compared to a 0.2mg dosage.
The other thing to consider is that finasteride’s main benefit is that it stops further hair loss. To the extent that users regrow hair, this regrowth will be meager. And the available data suggests that a dosage that is five or twenty times smaller than the standard 1mg dosage might stop hair loss just as effectively.
Speaking to Your Doctor
As mentioned, finasteride is prescription only. That means you need to consult a physician to begin treatment and determine the right dosage for you.
If you are concerned that the 1mg dosage might be too much for you, discuss this with your doctor. Together, you can decide on a lower dosage regimen, which will most likely be around 0.2mg.
Finasteride pills are not available in strengths lower than 1mg. This means that if you want to take a lower dosage, your doctor can advise you on a) either skipping the pill on certain days or b) cutting the pill into smaller pieces with a pill cutter.
Finasteride Side Effects
As a DHT blocker, finasteride has some significant side effects associated with its use (7).
The most common symptoms are sexual:
- Loss of libido
- Difficulty getting/maintaining an erection
- Loss of ejaculatory volume
- Changes in sperm parameters (concentration, motility etc).
Less common side effects are psychiatric in nature. They include:
- Suicidal thoughts (very rare)
For most users, these side effects will resolve once they stop taking finasteride or lower the dosage. In many cases, they will often go away even while the patient continues finasteride treatment. For a small minority of patients, however, these side effects may continue even after they stop taking finasteride (7).
(Learn more about finasteride’s side effects – and what you can do to lessen their impact – here.)
Are the Risks Worth It?
Only you can answer this question.
For many men, the adverse effects will make finasteride an unattractive choice. Sexual side effects like impotence can have devastating psychological effects. These will often far outweigh any subjective psychological benefits from better hair.
For these men, there are alternatives. Research over the past few decades suggests that there are various naturally occurring plant substances that can block DHT like finasteride. (You can learn more about natural DHT blockers here).
Natural DHT blockers will not typically be as powerful as finasteride in blocking DHT. On the other hand, their use is generally free of any serious adverse events. This means you can experience hair growth benefits, with fewer (or no) adverse symptoms.
When to Stop Taking Finasteride
If you experience side effects, particularly of a sexual nature, speak to your doctor immediately. Together you can decide how to approach this problem.
Working together with your doctor, you can decide to:
- Continue treatment and see if the side effects resolve on their own.
- Lower the dosage
- Discontinue treatment altogether.
Coming off Finasteride
A common problem for finasteride users is what happens when they stop using the drug. The main consideration is that any new hair they have regrown will fall out within 6-12 months after they stop taking Propecia. In other words, finasteride’s benefits last only as long as the treatment continues.
Having said that, there are ways to reduce hair loss and mitigate any ill effects.
Foremost, you can begin to implement other treatments, like natural or plant-based compounds (discussed below). You can introduce these alongside finasteride so when you do stop, the loss will not be so drastic.
You can also slowly taper off finasteride over the next few months.
For example, instead of taking it every day, you can begin to take it every other day. Continue this for a month, and then reduce it to every second day. Continue this pattern until you are taking finasteride every fourth or fifth day, and then stop altogether. Working with your physician, you can decide on a tapering protocol that works for you.
Propecia vs. Generic Finasteride: A Difference?
While results are important to hair loss sufferers, so is cost. Brand-name prescription drugs can be costly, and you could end up spending thousands per year.
Propecia is the brand name of the original finasteride. It was the only available brand until 2006. Since then, multiple generic brands came to market as the patent expired.
Both Propecia and generic brands include the active ingredient finasteride. It is the inactive ingredients, packaging, and branding that differ from brand to brand.
Overall, this should not cause any problems for patients. By definition, inactive ingredients are not biologically active. This suggests most users will get comparable results switching from Propecia to generic.
One thing to consider, however, is the quality of the manufacturing process. It is possible that generic finasteride will have lower-quality inactive ingredients.
If you are considering purchasing generic finasteride, discuss this with your doctor. You can also speak to your pharmacist and read online reviews of other users.
How Much Does Finasteride Cost?
Most insurance policies will not cover finasteride. It may cost you anywhere from $70 to $120 per month for a 1mg dose for the branded Propecia.
The exact price will depend upon your location, pharmacy, dosage, and whether you have access to coupons or other discounts.
The price for generic finasteride is substantially lower, between $20 and $40 a month.
Is Finasteride Right for Me?
You may like to know whether finasteride is the right hair loss treatment for you. While the answer will differ for each person, there are a few things to consider before making the decision.
As a treatment option that covers the symptoms of hair loss but does not treat it, keep in mind you will need to continue treatment indefinitely. This could mean you will be taking finasteride for the rest of your life if you want to maintain the benefits.
You should also remember that some side effects associated with finasteride can continue even after the drug has left your system. This can negatively impact your sexual function and can contribute to symptoms of anxiety and depression.
Finally, the drug – especially the branded Propecia -can be costly. Considering you will need to take it indefinitely, it will add up to many thousands of dollars over your lifetime.
Ultimately, only you can decide whether finasteride is right for you.
How to Get the Best Results
There are a number of steps you can take to get the best possible results from finasteride.
Combine It With Other Treatments
There is nothing to stop you from combining finasteride with minoxidil, the other FDA-approved treatment for male baldness. These two drugs do not interact, and results will typically be superior to either treatment on its own.
There are also various natural compounds you can try, some of which will be oral and others topical. Some of the most popular topical treatments are caffeine, castor oil, and various essential oils (8, 9).
Use a Hair Growth Shampoo
There is no shortage of hair loss shampoos currently on the market. When selecting one, read the ingredients on the label carefully to ensure there are no chemicals like sulfates, artificial colors, and fragrances. Manufacturers include these in the bottle to increase the formula’s pleasantness and lower the costs, but they can actually be detrimental to the health of your hair and scalp.
An example of a shampoo that does not go down this path is the Hairguard Caffeine shampoo. The caffeine stimulates hair growth, and the formula includes all-natural ingredients with no harsh chemicals.
What Else Can You Do?
In addition to chemical treatments, there is one more thing you can do for your hair: increase scalp circulation.
As your follicles miniaturize, the blood flow to the follicles slowly decreases. Eventually, it can become restricted altogether, which only worsens the hair fall. This means no oxygen or nutrients are getting to your scalp, which can lead to fibrosis if not treated.
To combat this, you can implement numerous techniques to increase blood flow to the scalp.
Scalp massages can be performed using your fingertips or a scalp massager, and they can be performed anywhere, anytime.
You can even incorporate the use of oils and herbs into your massages, to make them more effective and relaxing.
To massage your scalp, form your hands into claws. Place them at both sides of your head (just above the ears), and gently move your fingertips in a circular motion. As you continue the circular motions, slowly work your way up to the crown of your scalp.
You can backtrack to previous areas as you go along, just as long as you’re sure to not miss any spots.
Massage the crown for one to two minutes, and then move towards the hairline and temples. Gently massage for one to two minutes, and then return to the sides of the scalp and finally to the base.
The entire process should take about 10 to 15 minutes, and it is most effective when repeated daily.
To take your technique to the next level, try scalp exercises. These incorporate the use of both your fingers and muscles, so your scalp will get a full workout.
The three basic steps are:
- Lift your eyebrows as high as possible, and hold for one to two minutes. Then return to resting position.
- Furrow your eyebrows as deep as possible, and hold for one to two minutes. Then return to resting position.
- Lift your eyebrows as high as possible, and hold for one to two minutes. Then furrow your eyebrows as deep as possible, and hold for one to two minutes. Finally, return to resting position.
You can also use your fingertips to intensify the exercises. While performing the steps above, use your fingertips to gently push and pull the skin.
Finally, you can add dermarolling/dermastamping to your routine on a weekly basis.
This technique involves the use of tiny needles to puncture the scalp. As the micro-wounds heal, the skin and hair follicles regenerate (10).
All you need to start is a microneedling tool such as a dermaroller or dermastamp.
Deciding which tool to use is ultimately up to you. The dermaroller is the more popular tool and gives excellent results. On the other hand, the dermastamp is easier to target and less likely to remove present hairs.
When it comes to determining the ‘right’ dose of finasteride, the standard 1mg dosage seems to be on the high side. You can get comparable regrowth with a dosage that is many times smaller. The research suggests that a dosage of around 0.2mg daily might be the sweet spot. At this dosage, you can get most of finasteride’s regrowth benefits.
At the same time, you will be consuming a fraction of this drug’s dosage. This means you are likely to dramatically lower your probability of experiencing unpleasant side effects.
When considering any changes to your finasteride treatment, it is important to consult with your doctor. Together you can weigh the pros and cons of the various options and decide on the optimal dosage.