Finasteride is a common hair loss medication used by men and women worldwide. The most common dose prescribed is 1 mg, however both lower and higher doses do exist and some may provide better hair growth results over time.
This article will compare finasteride 1 mg to some of the lesser-known available doses: 0.01, 0.05, 0.2, and 5 mg. This will include a discussion of the various studies that compare their use, as well as a potential future alternative – topical finasteride.
The article will also outline some natural alternatives to finasteride that you may want to consider.
What Is Finasteride?
Finasteride is an oral medication that is only available by prescription. It was initially used in the treatment of Benign Prostatic Hyperplasia (BPH), but the unintentional side effect made it popular in the treatment of Androgenetic Alopecia (AGA) (1).
Finasteride was approved for use in the treatment of hair loss in 1997, and it was marketed under the brand name Propecia.
How Does It Work?
In simplest terms, finasteride works by inhibiting the enzyme 5-alpha-reductase (5AR). It slows down and/or stops its production, which is necessary for reducing the amount of free DHT within the body.
What does this have to do with hair loss?
Androgenetic Alopecia (AGA) is the most common cause of hair loss among men. It is also present in females.
While the exact mechanism is unknown, it is a genetic disorder believed to be caused by a sensitivity to the androgen DHT.
Dihydrotestosterone (DHT) is a necessary hormone, especially within males. It is responsible for sexual maturation and, without it, it can cause numerous adverse sexual effects (2).
However, when DHT attaches to the hair follicles, it leads to a process known as hair follicle miniaturization. The irritation leads to inflammation which, eventually, causes the hair strands produced to become shorter and shorter. If left untreated, the hair will soon fail to poke through the scalp and baldness will occur.
Finasteride works by directly inhibiting 5AR, which creates DHT as a byproduct when it interacts with free testosterone (3). The less 5AR present, the less DHT is produced.
Finasteride Doses for Hair Loss: 0.5 mg vs. 1 mg vs. 5 mg
Finasteride is a prescription medication and there are a few different doses prescribed and approved for hair loss treatment. The most commonly prescribed dose of finasteride is 1mg.
While your doctor may prescribe finasteride 5mg, it is commonly only used for the treatment of BPH.
Due to the side effects associated with finasteride use, it is best to stick with the lowest dose possible. You may still experience adverse effects, but they will likely be less severe than if your dose was higher (4).
Effects on Prostate vs 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 three most common are prostate DHT, serum DHT, and scalp DHT levels.
DHT is produced in the prostate and then circulated throughout the body by way of blood (serum). It finally arrives at the scalp and attaches to the follicles androgen receptors. When determining how different finasteride dosages affect the body’s DHT levels, these three areas (prostate, serum, and scalp) are considered the most heavily.
As a side note, prostate DHT levels are more commonly considered when studying finasteride’s effects on BPH. Though, it can also be used in hair loss studies. The most common levels tested, then, are serum and scalp.
These help us to better understand how finasteride interacts with DHT levels in various places throughout the body.
What Does the Research Say?
To determine the best dosage for therapeutic purposes, numerous studies have been conducted. The results were then collected by researchers and two papers are of notable mention.
The first was a review consisting of two clinical studies, which included men from the ages of 18 – 36 (5). All had moderate vertex male-pattern hair loss.
The men in both studies were given either 5 mg, 1 mg, 0.2 mg, or 0.01 mg of finasteride daily, or a placebo.
Ultimately, the efficacy of 0.01 mg finasteride was similar to placebo. However, both 1 mg and 5 mg had significant effects over 0.2 mg.
The next study followed 249 male subjects with AGA (6). The men were given either a placebo pill, or 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride. This continued for 42 days.
Scalp biopsies were taken from all participants both before and after the study, which gave researchers a good look into finasteride’s effects on hair growth.
As expected, the positive effects on hair growth increased as the dose increased.
As shown above, serum levels decreased much more significantly than scalp levels. This likely has to do with how finasteride works, as it inhibits 5AR and reduces DHT within the body on a systemic level.
However, the difference between the two highest doses – 1 mg and 5 mg – was insignificant. This means that 1 mg of finasteride is sufficient to see positive hair growth results.
It is likely that over time, scalp DHT levels would decrease more drastically than in the beginning. This would occur as the scalp DHT is ‘used up, and less and less is being delivered by the serum.
Propecia vs. Generic Finasteride: A Difference?
While results are important to hair loss sufferers, so is cost. After all, brand-name prescription drugs can be costly, and you could be spending thousands per year just to regrow your hair.
Propecia is the brand name of finasteride, and it was the only-available brand until 2006. However, with more generic brands entering the market, you may be wondering what the actual difference is.
Both Propecia and generic brands include the active ingredient finasteride. It is the inactive ingredients that differ from brand to brand.
Overall, this should not cause any problems for patients. In fact, the majority will do just fine when switching from Propecia to generic. However, it is possible to have a negative reaction to new inactive ingredients.
This is because generic brands may use lower-quality ingredients, as it helps them to keep their prices low. It could also just be a matter of an allergic reaction, which is unavoidable unless you know you are allergic.
Ultimately, the difference between Propecia and generic finasteride is not something to worry about.
Topical Finasteride: An Option for Hair Loss Sufferers?
As of the publishing of this article, oral finasteride is the only form FDA-approved and prescribed for hair loss treatment. Though, topical finasteride has begun to make its way into the research.
Topical finasteride is just as it sounds – a gel version of finasteride applied directly to the scalp. In theory, this would deliver the same dose of finasteride to the hair follicles while reducing side effects associated with oral use.
But is topical finasteride as effective?
A 2009 research study set out to answer this exact question (7).
The study consisted of 45 young adult men diagnosed with alopecia (though seven were later excluded). The study was double-blind, which means both participants and researchers were unaware of which patients received which active treatment.
The participants were each given a tablet and a gel. The tablet was to be taken once per day, and it contained either finasteride 1% or a placebo. The gel was to be applied twice daily, and it contained either finasteride 1% or a placebo.
To ensure that each patient was only given one active treatment, a neutral third party was involved in oversight.
In both groups, an increase in mean hair count and the number of terminal hairs were apparent. Both groups also saw a decrease in the size of their alopecia patch:
So, which of the treatments performed better?
As expected by researchers, both treatments worked similarly. Moderate results were seen in 54.5% of oral finasteride patients, while 56% were seen in topical finasteride patients.
Another study was performed in 2015, though the finasteride was used as a maintenance dose (8).
The study consisted of 50 AGA patients. They ranged in age from 20 to 40, and all had used both minoxidil and finasteride (oral) for two years of active treatment.
Five of the 50 patients stopped treatment for eight to 12 months prior to maintenance, though the other 45 went directly from treatment to maintenance.
All 50 participants were treated with a minoxidil solution fortified with finasteride.
Of the 45 patients who went directly from treatment to maintenance, the majority saw moderate to excellent maintenance results:
Of the five patients who took a 8 – 12 months break prior to maintenance, similar results were seen:
This study does not necessarily support topical finasteride’s use as an effective hair loss treatment. However, it does show it can be used to maintain hair growth once active regrowth has occurred.
Finasteride Side Effects
As a DHT blocker, finasteride has some significant side effects associated with its use (9). The less severe symptoms include:
- Dizziness and lightheadedness
- Swelling of the hands and feet
Some of the more severe symptoms include:
- Loss of libido
- Difficulty getting/maintaining an erection
- Loss of ejaculatory volume
- Loss of energy
- Loss of muscle power
If the above was not troubling enough, there have been recent findings to show that these side effects may continue even after you stop taking finasteride (10).
Other considerations to make are whether you are pregnant, nursing, or trying to conceive. The effects of finasteride on pregnant woman/infants is unknown, so it is best to avoid at all costs. The drug should also be avoided as a male if you are having unprotected sex, as birth defects may be possible.
(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.
I decided for myself that the side effects associated with use weren’t worth it. In fact, sexual side effects alone were enough to make me stop using it and instead consider alternative methods.
That’s where my search for DHT blockers began.
But since both finasteride and natural alternative block DHT, won’t the symptoms be the same?
The fact is, natural and non-natural (e.g. finasteride) DHT blockers work along different pathways. This means you can experience the same positive effects, with less (or no) adverse symptoms.
When to Stop Taking Finasteride
You may get to a point where you realize that the side effects are too much. However, there are also certain points where you should stop taking finasteride and consider alternative methods.
You should stop taking finasteride immediately if you experience symptoms of an allergic reaction such as:
- Difficulty breathing/swallowing
- Swelling of the mouth/lips/tongue/throat
You should also seek out emergency medical attention, as the above symptoms can be life-threatening.
Even without an allergic reaction, you may feel compelled to stop use. This is especially important if you feel that the drugs are negatively impacting your quality of life (such as sexual side effects) or if feelings of anxiety and/or depression develop or worsen.
What Happens When You Do Stop
A common problem for finasteride users is what happens when they stop using the drug. In fact, all the hair you have gained while on the drug is lost within six to 12 months after you have stopped taking it.
This can be extremely disheartening, but there are ways to reduce hair loss and mitigate any ill effects.
Foremost, you can begin to implement the natural alternative treatments mentioned below. These can be done alongside finasteride so when you do stop, the loss will not be so drastic.
You can also slowly reduce your dosage of finasteride over the next few months. This is best done alongside the previously mentioned tip, and it’s easy to do.
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 to every second day. Continue this pattern until you are taking finasteride every fourth or fifth day, and then stop altogether.
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 unless you want to reverse the effects of the drug.
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, which can also lead to (or worsen) symptoms of anxiety and depression.
Finally, the drug can be costly (depending on your insurance). And, considering you will need to take it for as long as you want to see the positive results, you could be out thousands of dollars in your lifetime.
Ultimately, only you can decide whether finasteride is right for you.
Are There Natural Alternatives to Finasteride?
There are some natural ingredients that have been shown to do just what finasteride does – inhibit the activities of 5-alpha-reductase. Here is a closer look at some of these ingredients.
One of the more underrated 5AR inhibitors, reishi mushroom can actually be just as effective as inhibiting 5AR as finasteride:
A 2005 Japanese study tested the 5AR inhibitory effects of 19 different mushroom species (11). One species was Ganoderma lucidum, also known as reishi.
The researchers prepared extracts of each of the 19 mushroom species and then added them to a suspension containing rat liver enzymes and prostate microsomes. They then tested the samples to see what percentage of 5AR was inhibited by each species:
As clearly shown above, reishi outperformed the other species of mushrooms by a wide margin. In fact, it inhibited 5AR between 70% and 80%. To put this in perspective, the next most-effective mushroom species, pleurotus osteratus, showed an inhibitory percentage of around 60%.
As DHT attaches to sensitive hair follicles, a process known as hair miniaturization takes place. The follicles inflame, which leads to smaller hairs being produced.
While peppermint oil provides various benefits to the scalp – including scalp and follicle cleansing – its main benefit is its anti-inflammatory effects. This is due to one of the oil’s main components, menthol (12).
When applied to the scalp, peppermint essential oil can reduce and even eliminate inflammation. This will reverse the process of miniaturization, which means new hairs will be able to grow to their full potential.
Have you ever wondered why peppermint oil, and other oils from the mint family, cause a cooling sensation? This is another effect of menthol!
During miniaturization, the blood vessels can become detached from the follicle. This is especially true in more advanced stages of hair loss. Without proper blood flow, your follicles will then receive less oxygen and nutrients.
When menthol makes contact with your skin’s nerve endings, it automatically increases blood circulation to the area. This is great for delivering much-needed nutrients, as well as removing buildup (sebum, dirt, pollution, etc.) and waste (such as DHT).
An unfortunate side effect of hair loss is a process known as scalp calcification. Essentially, this is a build-up of calcium on the scalp which can soon lead to the narrowing and eventual blockage of the blood vessels.
If left without treatment, this can lead to irreversible hair loss. After all, once the connection between the blood vessels and hair follicles is lost, they are gone forever.
Fortunately, you can counteract calcification. And one of the ways to do so is with magnesium oil.
Magnesium is an essential mineral, which means it is responsible for our bodies functioning normally. Its main tasks are enzymatic and biochemical regulation. It can also dissolve excess calcium found throughout the body (including the scalp).
When calcification begins, the scalp begins to ‘harden’. It can also lead to increased inflammation and plaque from calcium deposits.
By applying magnesium oil to your scalp, you can nourish the tissues and hydrate the skin. The oil will also dissolve the calcium ions found within the hair follicles!
As an essential oil commonly used in aromatherapy, rosemary oil is a surprisingly effective component in the fight against hair loss.
Rosemary has been used for centuries as a folk treatment, and its more recently become widespread in food, cosmetics, and even pharmaceuticals. Its various properties include analgesic, antibacterial, antifungal, anti-inflammatory, and even antioxidant.
Even further, rosemary oil has been proven to promote hair growth in mice when applied topically (13). Considering our hair growth cycles are similar to that of mice, this shows rosemary is a promising ingredient in any hair loss treatment.
Did you know that caffeine – a major component of your morning cup o’ joe – can be used to stimulate the hair follicles and increase circulation to the scalp?
First, caffeine has been proven to suppress DHT which is the main cause of hair loss in people with AGA.
In 2012, scalp biopsies were taken from patients suffering from AGA (14). These samples were cultivated with different concentrations of testosterone and/or caffeine for anywhere from 120 to 192 hours.
When concentrations as small as 0.001% of caffeine were added, they were shown to counteract the effects of testosterone much more effectively than the control group. In fact, higher shaft elongation was noted by researchers in all samples treated with caffeine.
Interestingly, one study found that women’s hair follicles were more likely to respond to caffeine’s effects than men (15). However, both men and women can see positive results.
There are millions of different types of proteins within the body, and one of those is keratin – the main component of human hair, skin, and nails.
When consumed, taurine increases keratin levels in the body which leads to stronger, healthier hand strands. It has also been shown to decrease cortisol (stress hormone) levels, which can further improve the health of your hair and scalp.
What Else Can You Do?
In addition to using the natural ingredients above, there is one other big thing you can do for your hair: increase scalp circulation.
As your follicles miniaturize, the blood flow to the follicles is slowly cut off. 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, dermarolling/dermastamping can be added 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 get regenerated.
All you need is a microneedling tool — such as a dermaroller or dermastamp — to get started.
Deciding which tool to use is ultimately up to you. I’ve previously used the dermaroller myself, though the dermastamp is much easier to target and less likely to remove present hairs.
When it comes to determining the ‘right’ dose of finasteride, 1 mg seems to be the one. However, finasteride is not the only option when it comes to effectively fighting hair fall.
The best option is to talk to a qualified medical professional and consider the right FDA-approved treatments for you.