Are there any substitutes for finasteride? Exploring a Range of Alternatives

October 9, 2025 •

5 min read

Androgenetic alopecia, or pattern hair loss, affects an estimated 50 million men and 30 million women in the United States [1.9.2]. For those seeking treatment, the question often arises: are there any substitutes for finasteride?

Quick Summary

An exploration of medical and natural alternatives to finasteride for treating hair loss. The article details options like dutasteride, minoxidil, topical solutions, and herbal supplements, comparing their mechanisms and efficacy.

Key Points

Dutasteride as a Potent Alternative: Dutasteride is a more potent 5-alpha-reductase inhibitor than finasteride, showing greater efficacy in increasing hair count, but is used off-label for hair loss and may have a higher risk of side effects [1.3.1, 1.3.4].
Minoxidil as a Non-Hormonal Option: Topical minoxidil (Rogaine) works by increasing blood flow to follicles and is a widely available OTC option for men and women that avoids the hormonal side effects of finasteride [1.2.1, 1.2.3].
Topical Finasteride for Reduced Side Effects: Applying finasteride directly to the scalp may offer similar efficacy to the oral pill but with significantly lower systemic absorption, potentially reducing the risk of sexual side effects [1.4.1, 1.4.4].
Natural DHT Blockers: Supplements like saw palmetto and pumpkin seed oil are believed to inhibit the DHT-producing enzyme, offering a natural but generally milder alternative to pharmaceuticals [1.2.3, 1.6.1].
Combination Therapy is Effective: Combining treatments, such as using microneedling with minoxidil or adding ketoconazole shampoo to a regimen, can often lead to better results than a single therapy alone [1.2.3, 1.8.1].
Procedural Treatments Exist: Low-Level Laser Therapy (LLLT) and microneedling are non-medicinal procedures that stimulate hair follicles and can be effective, especially in combination with other treatments [1.8.1, 1.8.4].
Consultation is Key: The best substitute for finasteride depends on individual factors like the cause of hair loss and health status; consulting a healthcare provider is essential for a personalized plan [1.2.5].

Understanding Finasteride and the Search for Alternatives

Finasteride is a prescription medication belonging to a class of drugs called 5-alpha-reductase inhibitors [1.2.3]. It works by blocking the enzyme that converts testosterone into dihydrotestosterone (DHT), a hormone that is a primary driver of androgenetic alopecia (male pattern baldness) [1.2.3, 1.9.1]. By lowering DHT levels, finasteride can slow hair loss and, in many cases, stimulate regrowth [1.2.3]. In one 10-year study, 99% of men taking finasteride experienced no worsening of their hair loss [1.2.3]. However, some individuals seek substitutes due to concerns about side effects—which can include sexual dysfunction, depression, and gynecomastia (enlarged breast tissue in men)—or because they are not achieving their desired results [1.2.2, 1.11.4]. Additionally, finasteride is not typically prescribed for women, particularly those of child-bearing potential, due to the risk of birth defects in a male fetus [1.2.3, 1.11.1].

Prescription Medication Alternatives

For those looking for a different pharmaceutical approach, several options exist, often requiring a consultation with a healthcare provider.

Dutasteride (Avodart)

Dutasteride is another 5-alpha-reductase inhibitor, similar to finasteride. The key difference is its potency and mechanism. While finasteride primarily inhibits the Type II 5-alpha-reductase enzyme, dutasteride inhibits both Type I and Type II enzymes [1.3.5]. This results in a more significant reduction of serum DHT—up to 99% with dutasteride compared to about 70% with finasteride [1.3.3].

Studies have shown that a 0.5 mg daily dose of dutasteride is more effective at increasing hair count and thickness than a 1 mg dose of finasteride [1.3.1, 1.3.2]. Because of this increased potency, it may be prescribed off-label for men who have not responded well to finasteride [1.2.3]. However, this increased strength may also come with a heightened risk of similar side effects [1.2.2, 1.3.4]. Dutasteride is not FDA-approved for hair loss in the U.S. but is approved for this use in South Korea and Japan [1.3.5].

Minoxidil (Rogaine)

Minoxidil is one of the most well-known and widely used treatments for hair loss and is available over-the-counter in topical formulations (solution or foam) [1.2.1]. Unlike finasteride, its mechanism is not hormonal. Minoxidil is a vasodilator, meaning it widens blood vessels, which is believed to increase the flow of blood, oxygen, and nutrients to hair follicles [1.2.3, 1.7.1]. It also helps to shorten the resting (telogen) phase of the hair cycle and prolong the growth (anagen) phase [1.7.3].

Because it does not have the systemic hormonal effects of finasteride, topical minoxidil is a popular alternative for those concerned about sexual side effects [1.2.1]. It can be used by both men and women [1.2.5]. While effective, some studies suggest it may not be quite as effective as finasteride on its own [1.2.1]. For enhanced results, some treatments combine topical minoxidil with finasteride in a single spray, which has been shown to be more effective than either treatment used individually [1.2.3, 1.2.4].

Topical Finasteride

For those who want the DHT-blocking benefits of finasteride with a potentially lower risk of systemic side effects, topical formulations are an emerging option. Applied directly to the scalp as a gel or spray, topical finasteride targets DHT locally [1.4.1]. Studies have shown that it can be comparable in effectiveness to the oral version but results in blood concentrations over 100 times lower, potentially reducing the risk of side effects like decreased libido [1.4.1]. Topical finasteride is not yet FDA-approved and is typically available through compounding pharmacies, often combined with minoxidil [1.4.1, 1.4.4].

Comparison of Primary Finasteride Alternatives


Feature	Finasteride (Oral)	Dutasteride (Oral)	Minoxidil (Topical)	Topical Finasteride
Mechanism	Inhibits Type II 5-alpha reductase, reducing DHT systemically [1.2.3].	Inhibits Type I & II 5-alpha reductase, reducing DHT more potently [1.3.5].	Vasodilator; prolongs anagen (growth) phase [1.2.3, 1.7.3].	Inhibits 5-alpha reductase locally on the scalp [1.4.1].
Application	Daily pill [1.2.1].	Daily pill [1.3.5].	Twice-daily topical solution or foam [1.2.1].	Once or twice-daily topical spray/gel [1.4.1].
FDA Approval (for Hair Loss)	Yes (for men) [1.2.3].	No (prescribed off-label) [1.3.3].	Yes (for men and women) [1.2.3].	No (prescribed off-label) [1.4.1].
Key Side Effects	Sexual dysfunction, decreased libido, depression [1.11.2, 1.11.4].	Similar to finasteride, potentially more intense [1.2.2].	Scalp irritation, unwanted hair growth [1.2.2].	Local scalp irritation; lower risk of systemic side effects [1.4.1, 1.4.5].

Natural and Supplementary Substitutes

Many individuals prefer to explore natural alternatives, though the scientific evidence for their effectiveness is often less robust than for prescription medications [1.2.1, 1.5.4].

Saw Palmetto

This extract from a palm plant is one of the most popular natural alternatives. It is believed to work similarly to finasteride by inhibiting the 5-alpha-reductase enzyme to reduce DHT levels [1.2.3]. A meta-analysis found that saw palmetto led to improved hair quality in 60% of participants and increased hair density in over 83% [1.2.3]. However, its effect is generally considered milder than finasteride [1.2.3, 1.6.4].

Pumpkin Seed Oil

Rich in phytosterols, pumpkin seed oil is another natural substance suggested to block the 5-alpha-reductase enzyme [1.2.3, 1.6.1]. One small study in 2014 found that men taking 400 mg of pumpkin seed oil daily for 24 weeks had a 40% increase in average hair count, compared to a 10% increase in the placebo group [1.6.1, 1.6.2].

Other Supportive Treatments

Ketoconazole Shampoo: This antifungal shampoo, available in 1% (OTC) and 2% (prescription) strengths, is primarily used for dandruff but has shown benefits for hair loss [1.10.4]. It has anti-inflammatory properties and is thought to have a mild DHT-blocking effect on the scalp [1.10.3].
Low-Level Laser Therapy (LLLT): This non-invasive treatment uses red light delivered via helmets or combs to stimulate cellular activity in hair follicles, improve blood flow, and prolong the growth phase [1.8.3, 1.8.4]. It is FDA-cleared for treating androgenetic alopecia in both men and women [1.8.2, 1.8.4].
Microneedling: This procedure involves using a device with fine needles to create micro-injuries in the scalp. This stimulates the body's healing response, boosting collagen production and blood flow [1.8.1]. Studies show it is particularly effective when combined with topical minoxidil, significantly enhancing hair growth compared to minoxidil alone [1.2.3, 1.8.1].

Conclusion

Yes, there are numerous substitutes for finasteride, ranging from more potent prescription medications like dutasteride to widely available topical treatments like minoxidil, and a variety of natural supplements and therapeutic procedures. The best choice depends on the individual's type and severity of hair loss, tolerance for potential side effects, and personal preference for medical versus natural approaches [1.2.5]. Topical finasteride offers a promising middle ground, potentially providing the benefits of the oral medication with a lower risk of systemic side effects [1.4.4]. Combining treatments, such as using microneedling with minoxidil or adding ketoconazole shampoo to a routine, can also enhance results [1.2.3, 1.2.5]. Consulting with a dermatologist or healthcare provider is crucial to determine the most suitable and effective treatment plan for your specific situation [1.2.5].

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any treatment for hair loss.

Visit the American Hair Loss Association for more information on hair loss treatments.

Frequently Asked Questions

Studies suggest that dutasteride is more potent and effective at increasing hair count and thickness than finasteride because it blocks two types of the 5-alpha-reductase enzyme, compared to finasteride's one [1.3.1, 1.3.5]. However, it is not FDA-approved for hair loss and may have a higher risk of side effects [1.3.3, 1.3.4].

Yes, minoxidil is a common, FDA-approved over-the-counter alternative to finasteride [1.2.1, 1.2.3]. It works differently by stimulating blood flow to the scalp and does not have the systemic hormonal side effects associated with finasteride, making it a suitable option for both men and women [1.2.2, 1.7.3].

Natural supplements like saw palmetto and pumpkin seed oil are believed to inhibit the enzyme that produces DHT, similar to finasteride [1.2.3]. While some studies show they can improve hair quality and density, they are generally considered less potent than prescription medications like finasteride [1.2.3, 1.6.4].

Topical finasteride is a gel or spray applied directly to the scalp. It is designed to reduce DHT locally with minimal absorption into the bloodstream. Research indicates it can be as effective as oral finasteride but with a significantly lower risk of systemic side effects, such as sexual dysfunction [1.4.1, 1.4.4].

Yes, there are several effective alternatives to stop or slow hair loss. Options include topical minoxidil, off-label use of dutasteride, low-level laser therapy (LLLT), and natural supplements [1.2.2, 1.2.3]. Combining treatments often yields better results [1.2.3].

Ketoconazole shampoo (e.g., Nizoral) is an antifungal treatment that can help with hair loss by reducing scalp inflammation and acting as a mild DHT blocker on the scalp [1.10.2, 1.10.3]. It is often used as a supportive treatment alongside other primary hair loss therapies like minoxidil or finasteride [1.10.4].

Microneedling is a procedure that stimulates the scalp's healing process to promote hair growth [1.8.1]. While it can be effective on its own, studies show it works best as a complementary treatment to enhance the absorption and effectiveness of topical products like minoxidil [1.2.3, 1.8.1].