Exploring Alternatives: What to do if I can't take finasteride?

October 8, 2025 •

5 min read

While finasteride effectively treats androgenetic alopecia by blocking DHT, up to 3% of men experience sexual side effects, and others face contraindications that make it unsuitable. This reality leads many to ask, "What to do if I can't take finasteride?"—a question with a growing number of promising answers ranging from other medications to advanced therapies.

Quick Summary

For individuals unable to use finasteride due to side effects or health concerns, a wide range of alternative hair loss treatments is available. These include pharmaceutical options like Minoxidil and Dutasteride, non-invasive therapies such as LLLT and PRP, surgical hair transplantation, and natural supplements like Saw Palmetto.

Key Points

Consider Minoxidil: A widely available over-the-counter topical or oral treatment that stimulates hair growth by increasing blood flow to the follicles, suitable for both men and women.
Explore Dutasteride: A stronger, prescription DHT blocker that can be more effective than finasteride, though it carries a higher risk of similar side effects.
Try Non-Invasive Therapies: Low-Level Laser Therapy (LLLT) uses light to stimulate follicles, while Platelet-Rich Plasma (PRP) therapy uses injections of your own blood to promote growth, both offering non-pharmaceutical options.
Opt for Hair Transplant Surgery: For a permanent solution to hair loss, a hair transplant can relocate healthy follicles to balding areas, though it is invasive and costly.
Look into Natural Supplements: Saw Palmetto is a milder, natural alternative to finasteride that blocks DHT, though its effects are less potent and less studied.
Use Spironolactone: Women with female-pattern hair loss can benefit from this prescription anti-androgen, often used in conjunction with Minoxidil.

Reasons You Might Need an Alternative

Before exploring alternatives, it is crucial to understand the common reasons people cannot or choose not to take finasteride. The medication is a 5-alpha reductase inhibitor that works by reducing dihydrotestosterone (DHT), a hormone that contributes to hair follicle miniaturization in those with a genetic predisposition. However, a number of factors can make it a non-viable option.

Potential Side Effects

Though often well-tolerated, some individuals experience side effects that necessitate discontinuing the drug. These can include:

Sexual dysfunction: Decreased libido, erectile dysfunction, and ejaculation issues.
Mood changes: Depression and anxiety.
Physical symptoms: Testicular pain, gynecomastia (breast enlargement), and dizziness.

In rare cases, a condition known as Post-Finasteride Syndrome (PFS) may occur, in which adverse effects persist even after stopping treatment.

Medical Contraindications

Certain health conditions make finasteride use unsafe. These include:

Liver disease: Finasteride is metabolized in the liver, posing a risk to those with pre-existing liver issues.
Pregnancy and women: Finasteride is not approved for women and can cause fetal harm, particularly affecting the development of a male fetus. Pregnant women must not handle crushed or broken tablets.

Pharmaceutical Alternatives to Finasteride

For those who cannot take finasteride, other medications offer different mechanisms of action to combat hair loss.

Minoxidil (Rogaine)

Minoxidil is an FDA-approved, over-the-counter topical medication available in foam and liquid solutions. It is thought to work by increasing blood flow to hair follicles, prolonging their growth phase, and stimulating growth.

How it works: Applied directly to the scalp, it acts locally to revitalize follicles.
Pros: OTC availability, approved for both men and women, and fewer systemic side effects compared to oral finasteride.
Cons: May cause scalp irritation, requires consistent twice-daily application, and results are only maintained with continued use.

Dutasteride (Avodart)

Dutasteride is a more potent 5-alpha reductase inhibitor than finasteride, blocking both type I and type II of the enzyme. While FDA-approved for enlarged prostate (BPH), it is often prescribed off-label for hair loss, particularly when finasteride has proven ineffective.

How it works: Reduces DHT levels more significantly than finasteride, which may lead to more substantial regrowth.
Pros: Potentially more effective for hair regrowth and stabilization.
Cons: A prescription is required, and it may have similar or potentially more intense sexual side effects due to its stronger DHT-blocking action.

Spironolactone (For Women)

For women with female-pattern hair loss (FPHL), spironolactone is a prescription medication sometimes used off-label. It is an anti-androgen that works by blocking the effects of hormones responsible for hair loss.

How it works: Decreases androgen activity, which can help stabilize and improve hair density.
Pros: Effective for FPHL, especially when combined with Minoxidil.
Cons: Not suitable for men, requires a prescription, and has potential side effects like menstrual irregularities and dizziness.

Non-Pharmaceutical and Surgical Options

Beyond medication, several other hair restoration methods can be explored.

Low-Level Laser Therapy (LLLT)

LLLT is a non-invasive, FDA-cleared therapy that uses low-energy laser light to stimulate hair follicles. At-home devices like laser combs, caps, or helmets are commonly used.

How it works: The laser light stimulates cellular activity, increases blood flow to the scalp, and improves hair follicle health.
Pros: Non-invasive, safe, and can be done at home with minimal to no side effects.
Cons: Requires consistent, long-term use and results may vary.

Platelet-Rich Plasma (PRP) Therapy

PRP involves drawing a small amount of the patient's blood, processing it to concentrate the platelets and growth factors, and injecting it into the scalp.

How it works: The injected growth factors are believed to stimulate hair follicles, promoting new growth and thickening existing hair.
Pros: Uses the patient's own blood, minimizing the risk of allergic reactions, and can show visible results within months.
Cons: An in-clinic procedure, it requires multiple sessions and periodic maintenance treatments.

Hair Transplant Surgery

For advanced hair loss, surgical transplantation is an effective, long-term solution. Techniques like Follicular Unit Extraction (FUE) or Follicular Unit Transplantation (FUT) relocate healthy, DHT-resistant hair follicles to balding areas.

How it works: Healthy follicles from a donor site (typically the back of the head) are moved to the balding area.
Pros: Offers a permanent solution and natural-looking results.
Cons: Invasive, expensive, and requires a recovery period. Future hair loss in non-transplanted areas may still occur.

Natural Supplements and Topical Treatments

For those seeking a more holistic approach, natural options and specific topicals may offer some benefit, though with less potent and less predictable results than prescription medications.

Saw Palmetto

Often referred to as a natural DHT blocker, saw palmetto is an herbal supplement that inhibits 5-alpha reductase, similar to finasteride but with a milder effect.

How it works: Reduces the conversion of testosterone to DHT, although less effectively than finasteride.
Pros: A natural option with potentially fewer side effects.
Cons: Much less potent and with less robust clinical evidence than finasteride. Efficacy and standardization can vary widely among products.

Medicated Shampoos

Shampoos containing ingredients like ketoconazole, a mild anti-androgen and anti-inflammatory, can help treat inflammation-related hair loss and supplement other treatments.

Comparison of Alternatives


Treatment Option	Type	Mechanism	Suitable For	Pros	Cons
Minoxidil	OTC Topical/Oral	Increases blood flow to follicles	Men & Women	Widely available, well-tolerated, less systemic side effects	Requires consistent use, can cause scalp irritation, less potent than finasteride
Dutasteride	Rx Oral/Topical	Potent DHT blocker (Type 1 & 2)	Men	More effective than finasteride for regrowth in some cases	Prescription needed, higher risk of side effects, off-label for hair loss
LLLT	Non-Invasive Device	Stimulates follicles with laser light	Men & Women	Non-invasive, safe, minimal side effects, home treatment	Requires long-term consistency, results can vary, may be costly upfront
PRP Therapy	In-Clinic Injection	Uses growth factors from patient's blood	Men & Women	Minimizes allergic reactions, natural, potentially effective	Requires multiple clinic visits, expensive, not always covered by insurance
Hair Transplant	Surgery	Relocates healthy follicles	Men & Women with sufficient donor hair	Permanent solution, natural-looking results	Invasive, costly, recovery time, multiple sessions may be needed
Saw Palmetto	Supplement/Topical	Natural DHT blocker (milder)	Men & Women	Natural, fewer systemic risks	Less effective and studied than finasteride, variable efficacy

Conclusion

While finasteride remains a highly effective treatment for androgenetic alopecia, not everyone can take it due to side effects, medical contraindications, or personal preference. Fortunately, a robust landscape of alternatives exists, offering multiple pathways to managing hair loss.

From pharmaceutical options like minoxidil and dutasteride to non-invasive therapies like LLLT and PRP, and the permanent solution of hair transplant surgery, individuals have a variety of effective choices. For those seeking a gentler, more natural route, supplements like saw palmetto and medicated shampoos can also play a role, though results may be less dramatic.

Ultimately, the best path forward involves a personalized approach. It is essential to consult with a dermatologist to determine the underlying cause of hair loss and to discuss which alternative treatment, or combination of treatments, is safest and most likely to yield the desired results.

Note: The content provided is for informational purposes only and does not constitute medical advice. Consult a healthcare professional before starting any new treatment regimen.

Visit the NIH page on Finasteride for more detailed drug information.

Frequently Asked Questions

Yes, Minoxidil (Rogaine) is a popular and effective OTC alternative to finasteride. It is available in foam and liquid solutions for both men and women.

Dutasteride is a stronger DHT blocker and is sometimes prescribed off-label for hair loss, particularly if finasteride is not effective. However, it can have similar or stronger side effects and is not FDA-approved for hair loss.

Yes, Minoxidil can be used effectively on its own to stimulate hair growth. While combining it with finasteride often produces better results, many people, especially women, achieve significant improvement with Minoxidil alone.

Some natural alternatives include Saw Palmetto, pumpkin seed oil, and rosemary oil, which are believed to have mild DHT-blocking properties. However, their efficacy is less consistent and less clinically proven compared to finasteride.

For advanced hair loss, hair transplant surgery is often the most effective option. It offers a permanent solution by relocating healthy, DHT-resistant hair follicles to balding areas.

PRP is a promising alternative that uses growth factors from your own blood to stimulate hair follicles. It is a series of in-clinic injections but is considered safe with minimal side effects because it uses your own biological material.

Yes, women have several viable alternatives. Finasteride is not recommended for women of childbearing age due to birth defect risks. Instead, options like Minoxidil, Spironolactone, and Low-Level Laser Therapy (LLLT) are commonly used and often effective.