Compare Fincar (Finasteride) with Alternatives for Hair Loss and Enlarged Prostate

Finasteride is one of the most prescribed medications for male pattern hair loss and benign prostatic hyperplasia (BPH). Sold under the brand name Fincar in many countries, it’s been used by millions since the 1990s. But it’s not the only option. If you’re considering Fincar-or already using it-you might be wondering: Are there better, safer, or more effective alternatives? The answer isn’t simple. It depends on your goal, your body, and what side effects you’re willing to tolerate.

How Finasteride Actually Works

Finasteride blocks the enzyme 5-alpha-reductase, which turns testosterone into dihydrotestosterone (DHT). DHT is the main hormone that shrinks hair follicles in genetically prone men, leading to thinning and balding. It also causes the prostate to swell. By lowering DHT levels by up to 70%, Finasteride slows or reverses both processes.

For hair loss, studies show that about 65% of men using 1 mg daily see improved hair growth after a year. For BPH, 5 mg daily reduces prostate size by about 20-30% over 6-12 months. But it doesn’t work for everyone. And for some, the side effects are too much to ignore.

Common Side Effects of Finasteride

Most men tolerate Finasteride fine. But around 1-4% report sexual side effects: lower libido, erectile dysfunction, reduced semen volume. These usually go away after stopping the drug-but for a small group, they persist. A 2012 study in the Journal of Sexual Medicine found that 2.1% of users still had sexual side effects after stopping Finasteride for over a year. That’s rare, but it’s real.

Other possible side effects include breast tenderness, depression, and fatigue. These are less common, but they matter. If you’re already dealing with stress, anxiety, or low energy, Finasteride might make it worse.

Alternative #1: Dutasteride (Avodart, Zagorin)

Dutasteride is often called the "stronger" version of Finasteride. It blocks both types of 5-alpha-reductase (Type I and II), while Finasteride only blocks Type II. This means Dutasteride cuts DHT levels by about 90-95%, compared to Finasteride’s 70%.

In hair loss trials, Dutasteride showed slightly better results: 70-80% of men saw improvement after 12 months, versus 65% with Finasteride. For BPH, it reduces prostate size more quickly and lowers the risk of needing surgery.

But here’s the catch: Dutasteride has a longer half-life-about 5 weeks. That means it stays in your system much longer. If side effects happen, they might stick around longer too. It’s also not FDA-approved for hair loss, though doctors prescribe it off-label all the time. In Ireland, it’s available by prescription for BPH, but not officially for hair thinning.

Alternative #2: Minoxidil (Rogaine, Regaine)

Minoxidil is the only FDA-approved topical treatment for male pattern baldness. It’s sold as a liquid or foam you apply to the scalp twice a day. Unlike Finasteride, it doesn’t touch hormones. Instead, it opens potassium channels in hair follicles, increasing blood flow and extending the growth phase.

Studies show about 40-50% of men using 5% minoxidil see moderate to dense regrowth after 4-6 months. It works best on the crown and top of the scalp. It won’t help a receding hairline as much. And you have to keep using it forever-if you stop, you lose the gains in 3-6 months.

Side effects are mild: scalp irritation, dryness, itching. Rarely, it can cause unwanted facial hair or heart palpitations in sensitive people. It’s safe to combine with Finasteride. In fact, many doctors recommend both together-they work in different ways, and the combo boosts results by up to 20%.

Alternative #3: Saw Palmetto

Saw palmetto is a herbal supplement made from the berries of the American dwarf palm tree. It’s been used for centuries in Native American medicine for urinary issues. Today, it’s marketed as a "natural Finasteride" for hair loss and prostate health.

Some small studies suggest it may mildly inhibit 5-alpha-reductase, but the effect is weak-maybe 10-20% DHT reduction. A 2012 trial in Phytotherapy Research found saw palmetto was as effective as Finasteride for mild BPH symptoms, but the study was small and short-term. For hair loss, results are inconsistent. Most men don’t see noticeable regrowth.

The upside? Fewer side effects. Most users report no sexual issues. The downside? It’s not regulated like medicine. Supplements vary wildly in potency. One bottle might have 320 mg of extract; another might have 80 mg. You can’t trust the label. And if you’re relying on it for serious hair loss, you might be delaying real treatment.

Alternative #4: Low-Level Laser Therapy (LLLT)

LLLT devices-like laser combs, caps, or helmets-use red light to stimulate hair follicles. The theory is that photons boost cellular energy (ATP), helping follicles stay in growth mode longer.

Several FDA-cleared devices exist: the iRestore, Capillus, and Theradome. A 2019 meta-analysis in Lasers in Surgery and Medicine found LLLT increased hair density by about 17-20% over 16-26 weeks. Results are slower than drugs-expect to wait 4-6 months. But side effects? None reported. It’s safe, non-invasive, and can be used with other treatments.

The catch? Cost. A good laser cap costs €300-€800. You need to use it 3-4 times a week for life. It’s not a magic fix, but for men who can’t tolerate pills or want to avoid them, it’s a solid option.

Alternative #5: Spironolactone (for men)

Spironolactone is a diuretic usually prescribed for high blood pressure or heart failure. It also blocks androgen receptors-meaning it stops DHT from binding to hair follicles. It’s commonly used for female pattern hair loss, but some doctors prescribe it off-label for men with mild to moderate hair thinning.

Studies are limited, but a 2020 case series in Journal of the American Academy of Dermatology showed improvement in 5 out of 7 men using 50 mg daily. Side effects can include breast enlargement, fatigue, and electrolyte imbalances. It’s not ideal for men with kidney or heart issues. Most men avoid it because of the risk of feminizing effects.

Alternative #6: Hair Transplant Surgery

If you’ve lost a lot of hair and other treatments haven’t worked, a transplant might be your best bet. Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) move healthy hair follicles from the back of your head to thinning areas.

Results are permanent. A skilled surgeon can restore a natural hairline. But it’s expensive-€4,000 to €12,000 in Europe. Recovery takes weeks. You’ll need to keep using Finasteride or Minoxidil afterward to protect the remaining hair. It’s not a cure-it’s a restoration.

Which Alternative Is Right for You?

Here’s a simple way to decide:

• If you want the strongest DHT blocker and don’t mind long-term medication → Dutasteride
• If you want something topical, safe, and easy to combine → Minoxidil
• If you prefer natural options and have mild symptoms → Saw Palmetto (but manage expectations)
• If you want zero pills and can invest upfront → LLLT
• If you’ve lost most of your hair and want immediate visual results → Hair transplant
• If you’re young, have early thinning, and want to prevent further loss → Finasteride + Minoxidil combo

Most men who stop Finasteride do so because of side effects. But many don’t realize that stopping without a plan leads to rapid hair loss. If you’re thinking about switching, don’t quit cold turkey. Talk to your doctor. Taper off slowly. Start your new treatment before stopping the old one.

What Doctors in Ireland Are Saying

In Dublin and Cork, dermatologists and urologists agree: Finasteride remains the gold standard for male pattern hair loss and BPH. But they’re seeing more patients ask about alternatives. Many are turning to Minoxidil + LLLT combos. Others are trying Dutasteride under supervision.

One key point: no alternative works as well as Finasteride for DHT suppression. But that doesn’t mean you have to take it. If side effects are a dealbreaker, there are other paths. The goal isn’t to find the "best" drug-it’s to find the best fit for your life.

What Not to Do

Don’t buy Finasteride or Dutasteride from online pharmacies without a prescription. Many sell counterfeit or contaminated versions. In 2023, Irish health authorities warned about fake Finasteride pills containing steroids or toxic fillers.

Don’t assume natural = safe. Saw palmetto can interact with blood thinners. LLLT devices can damage eyes if misused. Always check with a pharmacist or doctor before combining treatments.

And don’t wait too long. Hair follicles die after 3-5 years of inactivity. The earlier you act, the more you can save.

Next Steps: What to Do Today

If you’re on Finasteride and happy with results, keep going. Don’t stop without a plan.

If you’re experiencing side effects, talk to your GP or a dermatologist. Don’t just quit. Ask about switching to Minoxidil or LLLT. Ask if Dutasteride is an option.

If you haven’t started treatment yet, take a photo of your scalp now. Track changes monthly. Start with Minoxidil-it’s safe, affordable, and has minimal risk. If you don’t see progress in 6 months, consider adding Finasteride.

There’s no single best option. But there is a best option for you. The key is starting early, staying consistent, and choosing based on your body-not just your hopes.