Finasteride is one of the most popular hair loss treatments on the market (next to Rogaine). However, you may be surprised to learn that it isn’t necessarily the most effective.
In this post, I’ll introduce you to finasteride and how it works. You’ll also learn:
- The most common side effects and complications.
- How Propecia differs from generic finasteride.
- How Propecia differs from Proscar, and which is best for fighting hair loss.
- Whether topical finasteride is a viable option.
- The price of finasteride, as well as possible discounts.
- How to get a prescription for finasteride.
- The natural alternatives to finasteride that I recommend.
I’ll also discuss how you can determine whether finasteride is right for you.
- What Is Finasteride?
- Finasteride Side Effects & Complications
- Propecia vs. Generic Finasteride: Is There a Difference?
- Propecia (1 mg finasteride) vs. Proscar (5 mg finasteride)
- Topical Finasteride: Another Option?
- Finasteride Price: A Comparison
- Is Finasteride Right for You?
- Are There Natural Alternatives to Finasteride?
What Is Finasteride?
Over time, it was discovered that one “side effect” of finasteride was hair growth. In 1997, it was finally released for the treatment of Androgenetic Alopecia (AGA, also known as MPB).
How Does It Work?
Unlike Rogaine – another common hair loss drug found on the market – finasteride works from the inside out.
In short, it interrupts the process that converts testosterone (the male sex hormone) to DHT (the hormone mainly responsible for hair follicle miniaturization).
It does this by inhibiting (or slowing down) the enzyme 5-alpha-reductase (5AR), which is responsible for the conversion process.
When taken orally, finasteride targets the enzyme before the development of DHT occurs. This is in contrast to Rogaine, which just makes it possible for hair follicles to survive in the presence of DHT.
Finasteride Side Effects & Complications
If DHT is responsible for MPB (and also Female-Pattern Hair Loss (FPHL)), why does the body produce it? DHT actually plays a crucial role in the body, specifically as it relates to male genital maturation and development of the prostate.
Considering the role it plays, blocking the development of DHT can have serious side effects and complications for the user.
The majority of side effects are related to sexual function. For example:
- Loss of libido
- Difficulting achieving/maintaining an erection
- Decreased ejaculatory volume
Warning! While side effects can subside once finasteride use stops, some individuals may experience long-lasting symptoms.
Propecia vs. Generic Finasteride: Is There a Difference?
One of the most common ways to save money on Propecia is by purchasing generic (i.e. store brand) finasteride. The costs can be significantly lower, and the effects are exactly the same. So, what exactly is the difference?
In short, there really isn’t one.
The active ingredient – finasteride – is present in Propecia as well as generic brands. Though, the inactive ingredients can differ from brand to brand.
For most people, this causes no problems. However, certain individuals may react differently to different finasteride brands.
There may be a few reasons for this. One, the more affordable brands may use lower-quality products. Two, you may have an allergy to one of the inactive ingredients.
Propecia (1 mg finasteride) vs. Proscar (5 mg finasteride)
When discussing treatment methods, it’s common for hair loss sufferers to consider higher doses. After all, a higher dose will mean faster and better results, right?
Not necessarily. And in fact, it can mean increased side effects and price.
As mentioned above, Propecia is the original brand of finasteride that’s used to treat MPB. Proscar is also a finasteride-containing drug, but one used in the treatment of Benign Prostatic Hyperplasia (BPH).
The other difference between the two drugs is their finasteride dose. Propecia is just 1 milligram, while Proscar is 5 milligrams.
So, should you go straight to using Proscar if you’d like to speed up the process?
The main reason being, there is no proof that a higher dose of finasteride will lead to faster or better results.
In the majority of studies conducted on finasteride use for hair loss, the patients who say positive results did so with just the 1 mg dose. There’s no need to increase to 5 mg to see results.
Of course, a higher dose can also mean increased risk of side effects.
With more finasteride in your body, the more 5AR is inhibited. This means even less DHT is being naturally produced within the body, which can have many sexual and hormonal consequences.
Topical Finasteride: Another Option?
While oral finasteride has been the only option for decades, a new formula has entered the market: topical finasteride.
The main difference is that oral finasteride works from the inside out, while topical finasteride inhibits 5AR only in the problem area – the hair follicle.
If oral finasteride has proven to be effective, why was a topical formula developed? For many hair loss sufferers, the body-wide side effects associated with the oral treatment may deter them from treatment.
The hope with the development of topical finasteride was less side effects with similar (or better) hair growth results.
The main study done comparing oral and topical finasteride was performed in 2009 by Indian researchers.
The study consisted of 45 young men with AGA, seven of which were later excluded. These men were split into four groups, and they were given one of four treatments:
- A 1 mg oral dose of finasteride
- A oral placebo
- A 1 mg topical dose of finasteride
- A topical placebo
In both the active pill and active gel groups, an increase in mean hair count and number of terminal hairs was seen. Both of the active treatment groups also saw a decrease in the sizes of an alopecia patch:
So, is topical finasteride a viable option?
At this time, more research is necessary. And while a few companies are selling it in its topical formula, it’s not available in the majority of the world, including the United States.
Finasteride Price: A Comparison
A common factor when pursuing treatment for hair loss and balding is cost. How much will treatment cost you on a monthly basis, and is it affordable in the long term?
Let’s look at the costs of a 30-day supply of pills from the most popular pharmacies in the United States:
Rite Aid: $80
Sam’s Club: $37
While I don’t recommend taking a 5mg dose of finasteride to treat hair loss, it can be a cheaper option in some cases. I’d suggest splitting the pills into four so you don’t risk adverse effects.
Rite Aid: $76
Sam’s Club: $26
Note: Prices vary by state, as well as pharmacy.
As you can see, finasteride prices vary greatly. You should do your research prior to picking a pharmacy.
Are There Discounts Available?
In many cases, your insurance company may not cover Propecia or a generic brand. However, you may be able to get a discount from the manufacturer, Merck.
Depending on the pharmacy you use, you may also be able to get a discount by ordering a 90-day supply as opposed to the usual 30-day supply. However, it’d be best to try the 30-day supply first to ensure you don’t suffer from any adverse effects.
With the availability of generic brands, finasteride can be purchased from just about any pharmacy. However, a prescription is necessary.
How to Obtain a Finasteride Prescription
While your Primary Care Physician (PCP) may be able to write you a prescription, it’s always a good idea to get a second opinion from a Hair Loss Specialist.
There are different types of hair loss specialists, though the most common (and only one able to prescribe medication) is a dermatologist. By seeing a dermatologist who specializes in hair loss, you can get a better understanding of the cause of your balding.
The doctor will perform an examination, which may involve a physical exam, a blood test, and a scalp biopsy. Using the results, your doctor may decide that finasteride is a good option for you. Or, they may recommend a different method.
Is Finasteride Right for You?
Finasteride is one of the most popular hair loss drugs on the market. However, there are many things to consider before deciding it’s the right treatment for you. For example:
- Do you want to treat your hair loss, or temporarily cover the issue?
- Are you aware of and prepared for common side effects, including sexual dysfunction?
- Do you understand that finasteride is a treatment you’ll need to take for a lifetime, and that stopping treatment will result in a recurrence of hair loss?
The answers to the above questions will give you a solid place to start; though, only you and your doctor can decide whether finasteride is right for you and your situation.
Are There Natural Alternatives to Finasteride?
One of the best ways to avoid the side effects of finasteride – as well as the cost – is to use natural alternatives. These can be just as effective (if not more so), and have less (if any) side effects.
If you’re looking for a direct alternative to finasteride, an 5AR inhibitor is your best bet. After all, inhibiting 5AR is finasteride’s main mechanism.
As with finasteride, natural 5AR inhibitors can be used to interrupt the DHT development process. This means less DHT is interacting with your follicles and, theoretically, less hair loss.
A few of the more potent 5AR inhibitors include:
A more direct way to “treat” AGA is by blocking DHT. Using DHT blockers, the DHT will still be created within the body because the 5AR enzyme is still active. However, the DHT will then be “blocked” to prevent hair loss.
There are two ways to block DHT – internally and topically. While both can be effective, the topical method has less risk of side effects.
The more powerful topical DHT blockers include:
If you’d like to avoid internal or topical methods, or if you’d like to combine them with another effective treatment method, you may want to consider the methods below. They help to increase blood circulation to the scalp, which is crucial to defeating hair loss.
As DHT attaches to the sensitive follicles and initiates miniaturization, the blood flow to the follicles is severely restricted. It becomes even more so over time until, eventually, no blood at all is reaching the follicles.
This has serious consequences, as blood helps to deliver oxygen and nutrients to each follicle. They also remove buildup, such as DHT.
An easy (and relaxing) way to increase blood flow is with scalp massage. You can perform it yourself, either using your fingertips or a scalp massager.
Using your fingertips, place your middle finger, index finger, and thumb on either side of your head above your ears. Press firmly (but not enough to dislodge any hairs) and begin to massage in a circular motion. Slowly work your way to the top of your scalp, though you can backtrack to previous areas and then rework your way back up.
Continue the circular motions at the crown, and be sure to focus on areas with pronounced thinning and loss. Work your way towards the front of your head, and then to your temples.
Stay at forehead and temples for 2-3 minutes, and then slowly return to the sides of the scalp. Finally, massage your way to the base of your scalp.
The entire exercise should take about 10 minutes, and it’s one you should repeat on a daily basis.
Another way to increase circulation is by using your fingers and facial muscles to manipulate your scalp.
Using your fingertips, apply pressure to areas of hair loss using your index and middle fingers. Use the pressure to gently pull the skin from side to side. You can also vary the amount of pressure while “pulling”.
Now it’s time to give your muscles a workout. More specifically, your forehead muscles. To do so:
- Lift your eyebrows as high as possible, and hold in place for 1-2 minutes. Slowly return to resting position.
- Furrow your eyebrows as deep as possible, and hold in place for 1-2 minutes. Slowly return to resting position.
- Lift your eyebrows as high as possible and hold for 1-2 minutes. Then immediately furrow as deep as possible and hold for 1-2 minutes. Return to neutral.
With a combination of daily scalp massages and exercises, you can effectively increase the blood flow to your scalp and follicles.
If you’d like to up your efforts, I recommend microneedling. It’s a method where you use tiny needles to puncture the scalp and, essentially, “wound” it. When healed, these wounds help to regenerate healthy skin and hair follicles. They also increase blood flow.
Does wounding the scalp seem counterproductive? Here’s the proof that microneedling can be used to increase hair growth:
As shown above from a 2013 study, individuals who received both microneedling therapy and minoxidil performed better than those who just received minoxidil!
The two tools most commonly used in microneedling are the dermaroller and the dermastamp. While I’ve previously recommended the dermaroller, the dermastamp can be more effective and cause less unintentional damage.
Which Option is the Best?
While 5-Alpha-Reductase and DHT blockers can work temporarily, they aren’t long-term treatments that I would recommend. This is because they tend to cover up the issue, instead of treating it.
This is why I highly recommend you focus on scalp circulation.
When follicles are sensitive to DHT, a process known as hair follicle miniaturization takes place. Essentially, the inflammation and irritation causes the follicle to miniaturize. This means the hair strands become thinner and, eventually, fall out.
If not treated promptly, this can result in irreversible balding.
It’s true that 5AR and DHT blockers can stop miniaturization preemptively. But, it can also cause side effects such as sexual dysfunction and depression.
By boosting blood circulation to the scalp, you essentially make it possible for the hair follicles to thrive despite the presence of DHT. This means you can stop – and possibly even reverse hair loss – without the use of medications or hormone-blocking supplements.
There are many products on the market that claim to stop hair loss and regrow your hair. Finasteride, also known as Propecia, is one of the more popular options. And, while many users will experience positive results while using it, these results stop as soon as the product is discontinued.
Talk to a qualified medical professional and find out the right hair loss treatment for you.