Finasteride is one of the most commonly prescribed treatments for male pattern baldness and is licensed by the MHRA. However, despite its proven track record in clinical trials as an effective treatment, it won’t suit everybody.
That’s why we’ve put together a list of alternative treatments you may consider if you are interested in treating your hair loss, but not so keen on Finasteride.
What is Finasteride?
Finasteride counteracts hair loss by blocking the enzyme 5-alpha reductase, which converts testosterone into its more potent form: dihydrotestosterone (DHT). DHT binds to hair follicles and causes them to ‘miniaturize’ – the process where the follicle gradually shrinks, producing shorter, thinner hairs with each growth cycle. By blocking the 5-a reductase enzyme, Finasteride has been shown in studies to be effective at stopping, and even reversing, the process of hair loss in men with AGA (androgenetic alopecia).
But it’s not a one-size fits all approach. For some, Finasteride is simply not effective and will not stop the progressive loss of hair. In others, Finasteride can cause side effects. These can include reduced libido, lower semen quality, and, in some cases, potential worsening of depression – making it unsuitable for people with a history of mental health issues. For some, the risk of these side effects is enough to put them off the idea of using Finasteride altogether.
Medical alternatives
Dutasteride
Like Finasteride, Dutasteride is a 5-alpha reductase inhibitor that helps slow hair loss by blocking the conversion of testosterone into DHT. The key difference is that Dutasteride blocks both type 1 and type 2 versions of the enzyme, whereas Finasteride only blocks type 2.
Due to this, Dutasteride was shown to reduce DHT levels by 93%, compared to Finasteride which reduced levels by about 70% over the same 4 year period. Clinical studies also suggest it may be more effective for hair growth: participants taking 0.5 mg Dutasteride tablets daily experienced greater increases in hair count compared to those taking 1 mg of Finasteride.
However, Dutasteride is not licensed for hair loss treatment (though it is approved in the UK for treating enlarged prostate glands). It can, however, be prescribed off-label for male pattern baldness.
In terms of safety, Dutasteride carries a similar side effect profile to Finasteride, including potential effects on sexual function and mood. If you’ve experienced side effects with Finasteride, Dutasteride may not be a suitable option. On the other hand, if you’ve tolerated Finasteride well but aren’t seeing the results you’d like, Dutasteride could offer more noticeable improvements.
Alternative formats
For both Dutasteride and Finasteride, using topical formulations may help reduce the risk of side effects, since absorption is more localized to the scalp rather than systemic. Instead of being absorbed directly into the bloodstream like oral tablets, the spray works next to the site of action (aka the scalp), and only a small amount is absorbed into the blood and circulated around the body. For this reason, the chance of side effects is lower. If you have experienced side effects with oral Finasteride or Dutasteride, or you are worried about the risk, you might consider a topical version.
Topical Finasteride is believed to be as effective as the oral based on existing evidence. For example, a 2022 study found that no serious adverse events were reported in a group using topical finasteride for 24 weeks, and the increase in hair count was comparable between topical and oral Finasteride. The idea is you should see the benefits from a topical formulation, with a lower risk side effects.
Minoxidil
Minoxidil can be used by itself or in combination with Finasteride. It is a vasodilator, which means it expands the blood vessels. It boosts blood flow to the scalp, which helps counteract the miniaturization underway in men with AGA, by supplying oxygen and nutrients to the hair follicles to support normal and healthy hair growth. With regular and consistent application, it has been shown in studies to be effective at stopping hair loss and even promoting regrowth. When combined with a derma roller, which is a microneedling tool you can use at home, this may boost the efficacy of topical Minoxidil even further.
Low-level light therapy (LLLT)
LLLT treats hair loss using red light. Not just any old red LED light, but rays of light at a specific wavelength of 600-950nm, are thought to stimulate cell activity in the hair follicles. Not only this, red light may encourage follicles to re-enter and prolong the growth (anagen) phase, which helps increase hair density and reduce shedding.
This treatment can be performed in a specialist clinic, or devices can be purchased for at-home use.
Hair Transplant
You may consider a hair transplant, which involves taking hair follicles from a part of the scalp not vulnerable to the effects of DHT, and strategically placing them in thinning areas (usually around the hairline and crown). There are two types of transplants: FUE (Follicular Unit Extraction) and FUT (Follicular Unit Transplantation). FUE involves extracting individual hair follicles directly from the scalp and implanting them, whereas with FUT the surgeon will remove a strip of skin from the donor area, and individually extract the follicles for transplantation.
The downsides of transplants are that they involve surgery, which is more invasive, a bigger upfront cost, and involves recovery time compared to medication. Furthermore, many clinics will advise using medication before and after a transplant to prevent further hair loss of the native (original) hairs and thus improve the overall look of the transplant. However, the results from hair transplants are permanent, so a more long-term solution than medication, which must be used indefinitely to maintain results. Plus, hair transplants can significantly improve density if hair loss is extensive, providing there are enough healthy donor hairs to provide the coverage required.
Natural alternatives to Finasteride
Saw Palmetto
Saw Palmetto is a supplement made from the fruit of the Serenoa repens tree. Like Finasteride and Dutasteride, it is a DHT-blocker.
One study compared a 320mg supplement of Saw Palmetto vs 1mg of Finasteride, and found that whilst Saw Palmetto did improve hair growth in 38% of those using it, Finasteride was more effective – 68% saw an increase in hair growth with Finasteride. In another study, a topical serum of Saw Palmetto saw a 4.9% increase in total hair count after 24 weeks.
While Saw Palmetto appears to benefit hair growth both as a supplement and topically, it is less potent than Finasteride and unlikely to deliver the same results. On the plus side, it is generally well tolerated, with only mild side effects such as headaches occasionally reported.
Pumpkin seed oil
Pumpkin seed oil (PSO) can also be applied topically or taken as a supplement. It is believed to help with hair loss due to its antioxidant and anti-inflammatory properties, and may even block DHT too – however, more research is needed to say for sure.
The efficacy of PSO was tested on 76 men with mild to moderate hair loss, who took 400mg per day for 24 weeks, which led to a 40% increase in hair count. In an animal study, topical PSO vs topical Minoxidil was also tested on mice treated with testosterone. PSO counteracted the effects of testosterone and encouraged hair regrowth after 3 weeks, though it was not as effective as Minoxidil.
Overall, pumpkin seed oil shows promise as a natural hair growth aid, but its effectiveness is not yet as well established as conventional treatments.
The takeaway
While a number of medical and natural alternatives to Finasteride exist, the quality and strength of research vary widely. Limitations in research mean it is hard to say if natural remedies like plant extracts and oils compare to Finasteride in terms of effectiveness. Ultimately, the best approach depends on your individual needs, goals, and tolerance for potential side effects. Some people may prefer the proven efficacy of licensed treatments such as Finasteride or Minoxidil, while others may opt for gentler, more natural alternatives, even if the results are less dramatic.
If you’d like some guidance on the best treatment for your hair loss, you can take our free consultation for personalised recommendations.
All of our blog articles are reviewed by our Medical Director before publication.
