Finasteride is the most effective single medication for androgenetic alopecia, but it is not the right fit for every man. This comparison covers all major alternatives, explains when switching makes sense, and provides the data you need to make an informed decision with your doctor.
This content is for informational purposes only and does not constitute medical advice.
Head-to-Head Comparison Table
| Treatment | Mechanism | Efficacy | Side Effects | Cost (Monthly) | FDA Approved |
|---|---|---|---|---|---|
| Finasteride 1 mg (oral) | Blocks Type II 5-alpha reductase, reduces DHT ~70% | 80-90% halt loss, 65% regrowth | Sexual in 2-4%, reversible | $10-30 (generic) | Yes |
| Minoxidil 5% (topical) | Vasodilation, extends anagen phase | 40-60% moderate regrowth | Scalp irritation, initial shedding, facial hair | $15-40 | Yes |
| Dutasteride 0.5 mg (oral) | Blocks Type I and II 5-alpha reductase | More effective than finasteride | Higher incidence than finasteride | $30-60 | No (off-label) |
| Topical finasteride | Local DHT reduction at scalp | Similar to oral (emerging data) | Potentially lower systemic effects | $40-80 (compounded) | No |
| PRP therapy | Growth factor stimulation | 30-40% density increase (studies) | Injection site discomfort | $500-2,000/session | N/A |
| LLLT | Photobiomodulation at 650-670 nm | Modest density improvement | None significant | $200-800 (device) | Cleared |
| Hair transplant (FUE) | Surgical follicle relocation | Permanent in transplanted area | Surgical recovery 7-10 days | $3,200-30,000 total | N/A |
Finasteride vs Minoxidil
These two treatments are frequently compared because they are the only FDA-approved options for male pattern hair loss.
How They Differ
Finasteride addresses the root cause of androgenetic alopecia by reducing DHT, the hormone that triggers follicle miniaturization. Minoxidil does not affect DHT. Instead, it increases blood flow to follicles and extends the anagen (growth) phase.
When Minoxidil Is the Better Choice
- You experience finasteride side effects and need to stop
- You are a woman (finasteride is not approved for female hair loss)
- You prefer a topical-only approach with no systemic hormonal effects
- Your hair loss is primarily in the vertex/crown area, where minoxidil tends to be most effective
When Finasteride Is the Better Choice
- You want to address the hormonal driver of hair loss directly
- You are at Norwood stage 2-4 and want the highest probability of halting progression
- You prefer a daily pill over twice-daily topical application
- You want stronger clinical evidence behind your treatment choice
Best Approach: Use Both
The combination of finasteride + minoxidil addresses hair loss through two independent pathways and consistently outperforms either treatment alone in clinical studies. There is no contraindication to using both.
Finasteride vs Dutasteride
Dutasteride (0.5 mg daily) inhibits both Type I and Type II 5-alpha reductase, producing more complete DHT suppression than finasteride.
| Factor | Finasteride | Dutasteride |
|---|---|---|
| DHT reduction | ~70% | ~90% |
| 5-alpha reductase targets | Type II only | Type I and II |
| FDA-approved for hair loss | Yes | No (off-label) |
| Half-life | 5-6 hours | 4-5 weeks |
| Side effect incidence | 2-4% | Higher than finasteride |
| Washout period | ~1 month | ~6 months |
When to Consider Dutasteride
- Finasteride has not produced sufficient results after 12+ months
- Your doctor recommends escalation to a stronger DHT blocker
- You understand the higher side effect risk and longer washout period
Dutasteride should be considered a second-line option, not a first choice. Its extended half-life means side effects, if they occur, take much longer to resolve after discontinuation.
Finasteride vs PRP Therapy
PRP (platelet-rich plasma) therapy involves drawing your blood, concentrating the platelets, and injecting the plasma into the scalp. The growth factors in PRP may stimulate dormant follicles.
Key Differences
- Cost: PRP costs $500-$2,000 per session, with 3-4 initial sessions needed. Finasteride costs $10-30 per month.
- Evidence level: Finasteride has decades of large clinical trials. PRP evidence comes primarily from smaller studies.
- Mechanism: PRP stimulates growth factors; finasteride blocks DHT. They are complementary, not competing.
- Maintenance: PRP requires ongoing sessions every 3-6 months. Finasteride requires a daily pill.
When PRP Makes Sense
PRP is best used as an add-on to finasteride, not a replacement. Men who want additional density beyond what finasteride provides, especially at the vertex and crown, may benefit from PRP sessions.
Finasteride vs Hair Transplant
This is not always an either/or decision. In many cases, the answer is both.
When Finasteride Alone Is Sufficient
- Norwood stage 2-3 with early miniaturization
- Good response to medication (stabilization or regrowth within 12 months)
- No cosmetically significant bald areas that require surgical restoration
- Budget constraints that make surgery impractical
When a Hair Transplant Is Needed
- Norwood stage 4+ with areas where follicles are permanently dormant
- Finasteride has stabilized loss but not restored desired density
- Specific cosmetic goals (hairline reconstruction, filling the crown) that medication cannot achieve
- Sufficient donor supply (back and sides of the head)
Graft Requirements by Stage
| Norwood Stage | Grafts Needed | FUE Cost (Turkey) | FUE Cost (USA) | FUE Cost (UK) |
|---|---|---|---|---|
| Stage 2 | 800-1,500 | $800-$3,000 | $3,200-$9,000 | $2,400-$7,500 |
| Stage 3 | 1,500-2,200 | $1,500-$4,400 | $6,000-$13,200 | $4,500-$11,000 |
| Stage 4 | 2,500-3,500 | $2,500-$7,000 | $10,000-$21,000 | $7,500-$17,500 |
| Stage 5 | 3,000-4,500 | $3,000-$9,000 | $12,000-$27,000 | $9,000-$22,500 |
| Stage 6 | 4,000-6,000 | $4,000-$12,000 | $16,000-$36,000 | $12,000-$30,000 |
| Stage 7 | 5,500-7,500 | $5,500-$15,000 | $22,000-$45,000 | $16,500-$37,500 |
FUE recovery time is 7-10 days with a 90-95% graft survival rate. For a detailed cost and outcome analysis, see our finasteride vs hair transplant analysis.
Finasteride vs LLLT (Low-Level Laser Therapy)
LLLT uses FDA-cleared devices emitting light at 650-670 nm to stimulate follicle activity through photobiomodulation.
- Effect size: LLLT produces modest density improvement, substantially less than finasteride
- Side effects: Essentially none
- Best use: Adjunct to finasteride and minoxidil, not a standalone replacement
- Devices: Laser caps ($200-800) used at home for 20-30 minutes per session
LLLT is not a viable alternative to finasteride for men with progressive androgenetic alopecia. It is best considered a supplementary tool.
Decision Framework: When to Switch
Use this framework to evaluate whether a switch is appropriate:
| Situation | Recommended Action |
|---|---|
| Side effects within first 8 weeks | Wait; many resolve as the body adjusts |
| Side effects persisting beyond 3 months | Discuss dose reduction, topical finasteride, or switching to minoxidil with your doctor |
| No results after 12 months of consistent use | Add minoxidil; consider dutasteride or PRP; evaluate for transplant |
| Good results but want more density | Add minoxidil, PRP, or consider targeted transplant |
| Advanced stage (Norwood 5+) with limited medication response | Transition to surgical planning with finasteride as maintenance |
Find Your Starting Point
The best treatment depends on your current Norwood stage. Use the free AI assessment at myhairline.ai/analyze to determine where you stand. Your result will help you and your doctor choose between finasteride, alternatives, or a combination approach.
For complete finasteride dosing and monitoring protocols, read our complete finasteride guide.
This article is for educational purposes only. It does not replace professional medical advice. Consult a board-certified dermatologist or hair restoration specialist before making treatment decisions.