10 Ways to Reduce the Side Effects of Finasteride

Article Summary

Finasteride is one of the most effective treatments for male pattern hair loss, but side effects can happen. This evidence-based guide outlines 10 practical strategies to reduce or manage finasteride side effects, from dose and formulation adjustments to lifestyle considerations, while emphasizing when to stop and consult a clinician.

Full Article

Finasteride is one of the most effective and widely studied treatments for androgenic alopecia (AGA). It works by lowering dihydrotestosterone (DHT) levels at the scalp to slow or halt androgen-driven hair follicle miniaturization. While most men tolerate finasteride well and experience meaningful, long-term hair preservation, side effects can occur in a minority of users and are a legitimate concern for anyone considering or already using the medication.

Importantly, tolerance to finasteride varies from person to person. Factors such as baseline hormone levels, genetics, lifestyle, and overall health can influence how an individual responds. The goal of this article is to outline practical, evidence-informed strategies to help manage or reduce side effects, enabling thoughtful, safe decisions about finasteride use with appropriate medical guidance.

Common Finasteride Side Effects

Sexual side effects, such as decreased libido, erectile dysfunction, and ejaculation disorders, occur in a small minority of users. They are most commonly reported early in treatment and often improve or resolve on their own.^[1]Hirshburg, J. M., Kelsey, P. A., Therrien, C. A., Gavino, A. C., & Reichenberg, J. S. (2016). Adverse effects and safety of 5-alpha reductase inhibitors (finasteride, dutasteride): a systematic … Continue reading

Breast tenderness and enlargement (gynecomastia) are sometimes reported. Gynecomastia in particular is well-documented and can persist in a minority of cases even after stopping the drug.^[2]Kaplan, S. A., Chung, D. E., Lee, R. K., Scofield, S., & Te, A. E. (2012). A 5-year retrospective analysis of 5α-reductase inhibitors in men with benign prostatic hyperplasia: finasteride has … Continue reading

Some men report cognitive symptoms while taking finasteride, most commonly described as “brain fog” or reduced mental clarity, but these complaints have not been observed at meaningful rates in controlled clinical trials. If such effects occur, they are likely subtle and gradual, which may make them difficult to quantify or consistently attribute to the medication

There is a small number of cases where sexual, cognitive, or mood-related symptoms have persisted, leading to the development of the term post-finasteride syndrome (PFS). 

PFS remains controversial: some clinicians consider it a genuine but extremely rare drug-related condition, while others argue that existing evidence is low quality and heavily confounded by psychological factors, reporting bias, and the high baseline prevalence of sexual dysfunction in men.^[3]Traish, A. M. (2020). Post-finasteride syndrome: a surmountable challenge for clinicians. *Fertility and Sterility.* 113(1). 21–50. Available at: https://doi.org/10.1016/j.fertnstert.2019.11.030,^[4]Trüeb, R. M., Régnier, A., Rezende, H. D., & Dias, M. F. R. G. (2019). Post-finasteride syndrome: an induced delusional disorder with the potential of a mass psychogenic illness?. *Skin … Continue reading

How common are side effects? 

It’s important to remember that the majority of men who use finasteride experience no noticeable side effects, 

In the original large, randomized, placebo-controlled trial that led to FDA approval for AGA, sexual side effects were reported in about 4.2% of men taking finasteride versus 2.2% on placebo in the first year. This suggests a small absolute risk, and participants in the study who stopped taking finasteride due to side effects reported that they did not persist after the medication was discontinued.^[5]Kaufman, K. D., Olsen, E. A., Whiting, D., Savin, R., DeVillez, R., Bergfeld, W., Price, V. H., et al. (1998). Finasteride in the treatment of men with androgenetic alopecia. *Journal of the American … Continue reading 

In other trials, rates vary widely across studies depending on study design, definitions, and participant expectations.

Higher rates seen in some studies appear to be strongly influenced by the nocebo effect, where awareness of potential side effects increases reporting. More conservative analyses estimate that up to 10-15% of users may experience some form of sexual symptoms, most of which are mild, transient, and reversible.^[6]Traish, A. M., Hassani, J., Guay, A. T., Zitzmann, M., & Hansen, M. L. (2011). Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and … Continue reading

The Most Important Rule: Speak to a Physician

If you get severe side effects, stop and speak to your primary care physician.

Early evaluation helps rule out other medical, hormonal, or psychological contributors, establishes whether symptoms are plausibly related to finasteride, and prevents unnecessary continuation of treatment when modification or discontinuation is appropriate.

Prompt medical guidance also ensures that side effects are documented and managed correctly, rather than being compounded by anxiety, misinformation, or unsupervised dose changes. The strategies outlined below apply only to mild or moderate symptoms, should be considered only under clinician supervision, and are not appropriate for severe, rapidly worsening, or distressing effects, which warrant immediate medical review.

With that in mind, we can now look at ways to reduce the side effects of finasteride.

1. Continue Treatment and Allow Time for Adaptation (When Symptoms Are Mild)

One of the most consistently observed patterns with finasteride and other 5α-Reductase (5AR) inhibitors is that many reported side effects improve or resolve with continued use, particularly when they are mild and occur early in treatment. 

Clinical trials and follow-up data also suggest the side effects are most common in the first 12 months. This pattern supports the idea that early side effects often reflect a transient adjustment phase rather than a permanent intolerance.^[7]Lowe, F. C., McConnell, J. D., Hudson, P. B., Romas, N. A., Boake, R., Lieber, M., Elhilali, M., et al. (2003). Long-term 6-year experience with finasteride in patients with benign prostatic … Continue reading,^[8]Hudson, P. B., Boake, R., Trachtenberg, J., Romas, N. A., Rosenblatt, S., Narayan, P., Geller, J., et al. (1999). Efficacy of finasteride is maintained in patients with benign prostatic hyperplasia … Continue reading

Several biological mechanisms may explain this improvement. Androgen receptors and downstream hormone signaling can adapt to reduced DHT levels, central nervous system sensitivity to hormonal shifts may normalize, and early symptoms may be amplified by anxiety or expectancy effects that lessen with reassurance and time.

2. Reduce the Daily Dose

The standard dose of finasteride for AGA is 1 mg once daily, a regimen supported by large randomized controlled trials showing clear improvements in hair count, hair shaft thickness, and global photographic assessments. 

However, a key pharmacologic feature of finasteride is its non-linear (logarithmic) dose–response curve, meaning that most of its DHT–lowering effect occurs at relatively low doses.

By the time a daily dose of 1 mg is reached, inhibition of 5AR is already near maximal. As a result, lower doses, such as 0.2–0.5 mg daily, can still meaningfully suppress serum and scalp DHT, often preserving much of finasteride’s hair-protective benefit. ^[9]Drake, L., Hordinsky, M., Fiedler, V., Swinehart, J., Unger, W. P., Cotterill, P. C., Thiboutot, D. M., et al. (1999). The effects of finasteride on scalp skin and serum androgen levels in men with … Continue reading

Increasing the dose beyond 1 mg does not produce proportionally greater hair regrowth, but instead primarily increases systemic exposure, which may raise the likelihood of side effects without additional cosmetic gain.

From a practical standpoint, this dose–response relationship allows for flexibility in real-world use. Because finasteride side effects tend to be dose-sensitive rather than all-or-nothing, reducing the daily dose is often an effective first adjustment for improving tolerability while maintaining therapeutic efficacy.

3. Reduce Dosing Frequency

Finasteride’s pharmacology also allows for flexibility in dosing frequency. The drug binds tightly to 5AR, and suppression of DHT persists well beyond the drug’s short plasma half-life.^[10]National Center for Biotechnology Information. (n.d.). Finasteride. *NCBI Bookshelf.* Available at: https://www.ncbi.nlm.nih.gov/books/NBK513329/ (Accessed: November 2025),^[11]Steiner, J. F. (1996). Clinical pharmacokinetics and pharmacodynamics of finasteride. *Clinical Pharmacokinetics.* 30(1). 16–27. Available at: https://doi.org/10.2165/00003088-199630010-00002 In practical terms, this means that daily dosing is not strictly required to maintain meaningful inhibition of scalp DHT once steady-state suppression has been achieved.

Common clinician-guided intermittent regimens include 1 mg three times per week or 0.5 mg every other day, both of which can significantly reduce cumulative drug exposure while preserving much of finasteride’s therapeutic effect. Because DHT levels recover gradually rather than immediately, these schedules often maintain adequate androgen suppression for hair stabilization.

Intermittent dosing may be especially helpful for men who develop mild side effects on daily therapy, those who are particularly sensitive to hormonal changes, or individuals transitioning into a long-term maintenance phase after initial hair loss control.

If you want to understand more about finasteride dosing, you can read our in-depth article here.

4. Switch to Topical Finasteride

Topical finasteride is designed to reduce DHT locally within the scalp while limiting systemic exposure, making it an attractive option for men who experience side effects with oral therapy. By delivering the drug directly to the scalp, topical formulations aim to suppress DHT activity in hair follicles without relying on sustained systemic circulation.

Randomized trials comparing topical and oral finasteride show that topical treatment can produce similar improvements in target-area hair counts and other hair growth parameters, while generally causing less suppression of serum DHT and lower measured systemic drug levels.^[13]Hajheydari, Z., Akbari, J., Saeedi, M., & Shokoohi, L. (2009). Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. *Indian Journal of … Continue reading

One trial demonstrated that topical finasteride reduced DHT in the blood by 34.5%, compared to 55.6% with oral finasteride. They also found that sexual side effects were more associated with oral treatment.^[14]Piraccini, B. M., Blume-Peytavi, U., Scarci, F., Jansat, J. M., Falqués, M., Otero, R., Tamarit, M. L., et al. (2022). Efficacy and safety of topical finasteride spray solution for male androgenetic … Continue reading

That said, finasteride’s highly sensitive, logarithmic dose–response curve means that even small amounts entering the bloodstream can suppress DHT. Total systemic exposure depends not only on concentration, but also on application volume, frequency, treated surface area, and formulation vehicle. 

As such, topical treatments also require care when applying, and success with topical finasteride depends on consistent, measured application and adherence to the prescribed regimen.

When used thoughtfully, topical finasteride can preserve much of the hair benefit of oral therapy while reducing the risk of systemic side effects for many men.

Find out more about topical finasteride in our article.

5. Use Ultra–Low-Dose Topical Finasteride

As we’ve already seen, even low doses of finasteride can have a significant impact on hair growth. For men who are particularly sensitive to finasteride or who experience side effects even with standard topical formulations, ultra–low-dose topical finasteride may offer a further risk-reduction strategy.

These formulations typically use very low concentrations (e.g., 0.005%), aiming to provide localized scalp DHT suppression while minimizing systemic exposure as much as possible. Supporting this strategy, a small clinical study of 0.005% alcohol-based topical finasteride found appreciable changes in serum DHT levels, indicating little-to-no systemic absorption. Despite minimal systemic exposure, participants still experienced meaningful hair growth outcomes, suggesting that even ultra-low topical doses can be effective at the scalp level.^[15]Mazzarella, G. F., Loconsole, G. F., Cammisa, G. A., Mastrolonardo, G. M., & Vena, G. A. (1997). Topical finasteride in the treatment of androgenic alopecia: preliminary evaluations after a … Continue reading

Ultra–low-dose topical finasteride has not been studied extensively in large randomized controlled trials. Observationally, many users report improved tolerability and stable hair outcomes, but responses are variable, and efficacy may be more modest than with higher doses.

6. Use PDE5 Inhibitors to Address Sexual Side Effects

For men who develop erectile dysfunction while using finasteride, PDE5 inhibitors (such as sildenafil or tadalafil) can be an effective symptom-management option. These medications are well studied in urology, including in men treated with 5AR inhibitors for benign prostatic hyperplasia (BPH).^[16]Casabé, A., Roehrborn, C. G., Da Pozzo, L. F., Zepeda, S., Henderson, R. J., Sorsaburu, S., Henneges, C., Wong, D. G., & Viktrup, L. (2014). Efficacy and safety of the coadministration of … Continue reading

In that setting, PDE5 inhibitors have consistently been shown to improve erectile performance and sexual confidence, even when the underlying hormonal environment is altered.

It’s important to be clear about what this strategy does (and doesn’t) do. PDE5 inhibitors do not reverse DHT suppression or directly address libido changes or ejaculatory volume in the same way they may improve erectile rigidity. However, for many men, symptom relief can meaningfully reduce distress and help prevent performance anxiety from amplifying the problem.

Because PDE5 inhibitors are prescription medications with cardiovascular considerations and potential drug interactions, they should be used only under clinician supervision, particularly in men with heart disease, low blood pressure, or those taking nitrates or certain alpha-blockers.^[17]Lui, J. L., Shaw, N. M., Abbasi, B., Hakam, N., & Breyer, B. N. (2023). Adverse reactions of PDE5 inhibitors: an analysis of the World Health Organization pharmacovigilance database. *Andrology.* … Continue reading

7. Optimize Testosterone

Testosterone plays a vital role in sexual health and, like finasteride, is associated with a wide range of symptoms. Reduced libido, erectile changes, fatigue, or low mood overlap significantly with those of hypogonadism, thyroid dysfunction, or other hormonal imbalances.^[18]National Center for Biotechnology Information. (n.d.). Dutasteride. *NCBI Bookshelf.* Available at: https://www.ncbi.nlm.nih.gov/books/NBK532933/ (Accessed: November 2025)

Improving total and free testosterone levels through lifestyle changes or medical treatment when indicated can therefore restore androgen balance and reduce the relative impact of DHT suppression in sensitive individuals.

In select cases, testosterone replacement therapy (TRT) may be considered, but only with careful specialist oversight. TRT can improve sexual function, energy, and quality of life, yet it may also accelerate AGA unless combined thoughtfully with hair-loss treatments.^[19]Zhang, Y., Xu, J., Jing, J., Wu, X., & Lv, Z. (2018). Serum levels of androgen-associated hormones are correlated with curative effect in androgenic alopecia in young men. *Medical Science … Continue reading For these reasons, TRT should never be initiated solely to counter finasteride side effects without a clear medical diagnosis and a comprehensive discussion of risks, benefits, and long-term goals.

8. Review Diet, Lifestyle, and Environmental Factors

While lifestyle changes cannot reverse finasteride’s pharmacologic action on DHT, they can meaningfully improve erectile function, mood, energy levels, sleep quality, and overall androgen balance, all of which overlap with the most commonly reported finasteride-related complaints.

A wide body of evidence shows that diet, exercise, and weight management play a significant role in sexual function. Randomized trials demonstrate that intensive lifestyle programs can significantly improve erectile function, with a meaningful proportion of men regaining normal erectile performance over time.^[20]Esposito, K., Giugliano, F., Di Palo, C., Giugliano, G., Marfella, R., D’Andrea, F., D’Armiento, M., & Giugliano, D. (2004). Effect of lifestyle changes on erectile dysfunction in obese men: … Continue reading,^[21]Hehemann, M. C., & Kashanian, J. A. (2016). Can lifestyle modification affect men’s erectile function?. *Translational Andrology and Urology.* 5(2). 187. Available at: … Continue reading

Environmental and behavioral factors can also be reviewed. Excessive heat exposure (such as frequent sauna use), high alcohol intake, cannabis use, and certain medications (including antidepressants) can independently impair sexual function or mood and may confound the interpretation of finasteride-related symptoms.

Although no studies have looked specifically at lifestyle programs for finasteride side effects, strong evidence shows that improving fitness, diet, sleep, and stress can enhance the same areas (erectile function, mood, energy, and hormone balance) that many men find most affected.

9. Consider Experimental or Adjunctive Supplements (With Caution)

Some men explore supplements marketed for testosterone support or sexual function, such as tongkat ali, in an effort to counter finasteride-related symptoms. Small studies suggest that tongkat ali may modestly increase testosterone or improve libido in certain populations, but the evidence is limited, inconsistent, and highly variable between individuals.^[22]Leisegang, K., Finelli, R., Sikka, S. C., & Selvam, M. K. P. (2022). Eurycoma longifolia (jack) improves serum total testosterone in men: a systematic review and meta-analysis of clinical trials. … Continue reading

It’s critical to remember these supplements are experimental, not first-line solutions. Product quality, dosing, and purity can vary widely, and robust data on long-term safety or interactions with finasteride are lacking. While some individuals report subjective benefit, others notice no effect at all.

For these reasons, supplements should only be considered after established strategies have been explored and ideally discussed with a clinician, rather than relied upon as a primary way to manage side effects.

10. Switch Treatments or Change Strategy Entirely

If side effects persist despite adjustments to dose, frequency, or formulation, it may be appropriate to change strategies altogether. Hair loss treatment is not all-or-nothing, and finasteride, while highly effective, is not the only option.

Many men choose to rely on non-hormonal treatments entirely. Options such as topical or oral minoxidil, microneedling, low-level laser therapy devices, platelet-rich plasma (PRP), or hair transplantation can provide meaningful benefits without altering androgen pathways.

You can read more about alternative treatments in our guides and in-depth articles on minoxidil, microneedling, low-level laser therapy devices, and platelet-rich plasma (PRP).

While these approaches may not match finasteride’s disease-modifying effect on DHT, they can still preserve or improve cosmetic density for many users.

If you’re using topical finasteride, you might consider switching to low-dose topical dutasteride. offer better scalp localization at very low application frequencies due to dutasteride’s stronger and longer-lasting binding to 5AR. When used carefully and infrequently, some patients tolerate topical dutasteride well while maintaining hair stabilization.

Final Thoughts

Finasteride side effects are often manageable with thoughtful adjustments to dose, dosing schedule, formulation, and supporting lifestyle factors. There is no single correct way to use finasteride. Personalization is key, and the right approach depends on individual biology, risk tolerance, and treatment goals.

Health should always come first. Any side effects warrant open discussion with a clinician, and treatment decisions should be made collaboratively rather than in isolation. With informed, flexible planning, many men are able to find a balance that protects both their hair and their overall well-being.