Finasteride alternatives: What can I take instead of finasteride?

Compare finasteride alternatives | Rogaine | Avodart | Flomax | Rapaflo | Cialis | Natural alternatives | How to switch meds

Seeking an alternative to one of your prescription drugs can be an intimidating task, but it need not be. If you want your finasteride replaced with a different option, whether you are taking it for male pattern baldness, hair thinning, or for an enlarged prostate, the first order of business is to review what alternatives are out there. You will want to vet these other drugs in order to know their advantages and disadvantages compared to finasteride. Will the new drug avoid the side effect you are having with finasteride? Will it be faster acting or more effective? Your findings can then be taken to your healthcare provider to reach a final decision. Here, we will streamline your preparation for that appointment.

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What can I take in place of finasteride?

The plight of male pattern baldness (also known as male pattern hair loss) can afflict either gender, and better terms for the condition are androgenic alopecia and androgenetic alopecia. Androgens are sex hormones, like testosterone, which are produced by both genders but at higher levels by men. These hormones play an integral role in the development of most cases of hair loss. Finasteride’s inhibition of the 5-alpha reductase enzyme limits the conversion of testosterone to dihydrotestosterone (DHT), an androgen with major effects on hair growth. Via this mechanism, finasteride can be useful for hair regrowth. For growth factors, finasteride is available as brand name Propecia and taken as a 1 mg tablet once daily. Although alternatives are not plentiful for hair loss treatment, topical minoxidil is another viable option because it stimulates the hair follicles directly and boosts blood flow to the application site.

Treatment options are much more plentiful for treatment of symptomatic prostate enlargement. Benign prostatic hypertrophy (BPH) and benign prostatic hyperplasia are synonymous terms for noncancerous enlargement of the prostate. Finasteride is one of two 5-alpha reductase inhibitors approved by the Food and Drug Administration (FDA) for treatment of BPH. It is packaged under the brand name Proscar and given as a 5 mg daily tablet for this indication. Besides switching to the other member of this drug class, you could also change to an alpha-1 adrenergic receptor blocker instead to get relief from BPH symptoms like a weak urinary stream, frequency or hesitancy of urination, or overnight urination. The phosphodiesterase type 5 (PDE5) inhibitor drug Cialis is another option for BPH treatment. 

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Top 5 finasteride alternatives

The following are some of the most common alternatives to finasteride.

1. Rogaine

One reason you may be looking for an alternative to Propecia is the potential for sexual side effects. Topical Rogaine avoids this risk and is a FDA-approved, over-the-counter hair loss treatment. For men suffering from erectile dysfunction, loss of libido, or ejaculatory dysfunction with Propecia, the change over to Rogaine could be helpful. The trade off is that Rogaine may not be quite as effective as Propecia, according to one study. If you decide to try Rogaine but experience skin irritation from it, there is a 5% foam formulation that could be helpful and less irritating.

2. Avodart

Avodart and Proscar have a lot in common. They are both 5-alpha reductase inhibitors which gradually shrink the prostate gland by reducing DHT levels. A smaller prostate takes months to achieve, with maximal results coming six to 12 months into treatment. The result is a reduction in urinary symptoms in exchange for a slightly increased risk of sexual dysfunction. The slow onset of action means that neither of these drugs is a good choice if you need quick relief. If either of the drugs is stopped, the symptoms will slowly recur. With all of these similarities, choosing one over another may come down to price. Shop around for the best deal, check out the coupon links listed above, and show your SingleCare discount card at a local pharmacy.

You may have reservations about either of the 5-alpha reductase inhibitors. They can both suppress prostate specific antigen (PSA) levels, a blood test used for prostate cancer screening. This impact might increase the risk of high-grade prostate cancer by delaying diagnosis.

3. Flomax

The foundation of medical treatment of BPH lies in the alpha-1 adrenergic antagonist drug class. Blocking alpha-1 receptors causes the bladder outlet to relax, allowing a stronger urine stream and more complete bladder emptying. The mechanism has a quick onset of action, which is a significant advantage over Proscar. Flomax is a popular choice out of the alpha-1 blocker drug class, based on less potential for hypotension (low blood pressure) than others. You should still watch out for dizziness, runny nose, and ejaculation problems with Flomax.

If ineffectiveness is the problem with Proscar, you may also want to consider adding an alpha-1 blocker rather than changing to one. Combination therapy has proven superior in some but not all studies. Jalyn combines a member of each drug class.

4. Rapaflo

Rapaflo represents another alpha-1 adrenergic receptor blocker. Like Flomax, its effects are more selective to the prostate than the alpha blockers Cardura and terazosin, so it is less likely to cause hypotension. It also beats Proscar in terms of a rapid response to therapy for BPH. Unfortunately, like Flomax, Rapaflo may also be associated with intraoperative floppy iris syndrome, a condition which makes cataract surgery more challenging.

5. Cialis

Coexisting erectile dysfunction (ED) and BPH are not an uncommon tandem. Cialis can treat the symptoms of both with a once-daily pill. Curiously, Cialis improved BPH symptoms significantly but did not improve measured urinary flow or bladder emptying in a randomized, double-blind, placebo-controlled clinical study. It might make sense to try Cialis instead of Proscar if you are experiencing both ED and BPH. If you do, keep in mind that headache, flushing, and upset stomach are some of the potential side effects.

Natural alternatives to finasteride

Natural options are commonly sought based on the perception that they are safer. It is important to keep in mind that this is not necessarily true as there are many harmful substances in nature. Nonetheless, it is reasonable to look into these options. 

Saw palmetto has probably generated the most interest regarding natural treatment of BPH and androgenic alopecia. It is extracted from the fruit of the American dwarf palm tree and may be able to block the 5-alpha reductase enzyme and reduce DHT in a manner similar to finasteride or block alpha-1 adrenergic receptors in a way like tamsulosin. The exact mechanism of saw palmetto is unknown. 

What is perhaps most disappointing is its lack of proven effectiveness for BPH in a 2021 analysis of clinical trials and lack of high quality data to support use for male pattern baldness. Similarly, coconut oil and other cooking oils have generated interest for BPH treatment based on preliminary studies in rodents but have not proven their worth in humans.

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How to switch to a finasteride alternative

You have knowledge now to get a conversation started with the healthcare professional prescribing finasteride. Discuss your concerns, whether they are based on adverse effects or a lack of benefit. Bring up your ideas about alternatives while pursuing medical advice. Review your list of prescription drugs, over-the-counter medications, and dietary supplements, so you can seek to avoid drug interactions. A realistic goal of the appointment is that a decision is made that you are comfortable with, whether that means continuing finasteride or starting an alternative.