What’s the Best Dose of Finasteride for Hair Loss?

Article Summary

The best daily dose of finasteride should strike the balance between minimizing drug exposure (and thereby side effect risks) while maximizing drug efficacy (and thereby hair regrowth). While the FDA has approved 1 mg daily doses of finasteride for androgenic alopecia, there’s also evidence that doses as low as 0.2 mg daily reduce dihydrotestosterone just as effectively, and also improve hair counts. But are those improvements as robust as the 1.0 mg daily dosage? This article explores the evidence in search of a balance between safety and efficacy.

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In terms of hair regrowth, the “best” dose for medication is typically the one that maximizes improvements and minimizes the risk of adverse events.

In the case of finasteride, 1mg daily has the most clinical support befitting a “best” dose given the risk-benefit ratio of hair improvements. However, there’s also evidence that finasteride doses as low as 0.2 mg daily may produce similar degrees of hair regrowth and reduce the risk of side effects.

Finasteride Doses: Is 1 mg The Only Dose That Works?

Is 1 mg the best dose of finasteride for hair loss? After all, oral finasteride is prescribed at 1 mg daily for androgenic alopecia and 5 mg daily for benign prostate hyperplasia. For most people, these dosages are tolerable and produce a relatively excellent safety profile. But for those interested in cutting down on a lifetime of finasteride consumption, there may be ways to reduce drug exposure by 80% without sacrificing much (or any) hair gains.

Clinical studies have demonstrated a steep, dose-dependent, logarithmic response curve for finasteride’s effects on DHT levels. That just means that a little bit of finasteride reduces almost as much DHT as a lot of finasteride. See this chart:

As such, 0.2 mg daily reduces DHT levels by nearly the same as 5 mg. This is why, in some countries, it’s common to prescribe 0.2 mg of finasteride for androgenic alopecia rather than the full 1 mg dose.

Does Clinical Data Support a 0.2mg Daily Dose of Finasteride?

Yes. According to a review on finasteride:^[1]https://escholarship.org/content/qt24k8q743/qt24k8q743.pdf

“In a 48-week randomized, double-blind study of finasteride treatment of androgenetic alopecia, the efficacy of 1mg and 0.2mg finasteride were compared in 414 men. The incidence of decreased libido was 2.9%, 1.5%, and 2.2% for finasteride 1mg, 0.2mg, and placebo, respectively [31]. Most of these cases resolved during the course of therapy, and there were no discontinuations of the study related to the adverse drug effects [31].”

That specific study also mentioned that:^[2]europepmc.org/article/med/15319158

“All efficacy endpoints showed significant improvement with finasteride therapy by 12 weeks (p < 0.05 versus placebo). At 48 weeks, 58%, 54%, and 6% of men in the finasteride 1 mg, finasteride 0.2 mg, and placebo groups, respectively, had improved based on assessments of global photographs. All efficacy endpoints were numerically superior for the 1 mg dose over the 0.2 mg dose at 48 weeks.“

The authors did not find that the hair regrowth from 0.2 mg daily of finasteride was statistically significantly different (i.e., better or worse) than 1.0 mg daily of finasteride. So, it’s unclear whether these results regarding slightly lower efficacy (and risks of side effects) for the 0.2 mg versus 1.0 mg doses of finasteride are statistically or clinically significant.

Another 12-month study compared finasteride doses of 1 mg, 0.2 mg, and 0.01 mg daily versus placebo.^[3]https://pubmed.ncbi.nlm.nih.gov/10495375/

Interestingly this study found directionally stronger hair count improvements for finasteride at 1-5 mg versus 0.2 mg. The researchers also noted that, unlike the other aformentioned study, adverse events were directionally higher in the 0.2 mg group – albeit not statistically different across groups.

For these reasons, the investigators concluded that 1 mg daily of finasteride is the optimal dose for androgenic alopecia (AGA).

Which Dose Of Finasteride Should I Try?

When it comes to efficacy vs. safety considerations, the evidence on dose titration of finasteride is mixed. On the one hand, some studies show directionally lower risks of side effects on 0.2 mg versus 1.0 mg daily of finasteride – albeit at the expense of slightly lower hair counts. On the other hand, other studies show no statistical risk in adverse events at 0.2 mg versus 1.0 daily of finasteride – and thus recommend the 1.0 mg dose.

What doesn’t get measured in these studies is the magnitude of each side effect. In other words, “How bad is this side effect? And does it get better on a 10-point scale when I titrate down my finasteride dose?”

In our experience working with hair loss sufferers, we routinely see a lowered magnitude of side effects when individuals go from 1.0 mg to 0.2 mg daily of finasteride. While this may come at the expense of a little more hair growth, this might be appropriate for people who are experiencing finasteride-induced side effects or who just want to take as much risk off the table, while still getting some benefit from the drug.

For others with more moderate side effects, it’s likely that topical finasteride is more appropriate.

How Can We Achieve A Dose Of 0.2 mg Daily?

To achieve a finasteride dose of 0.2 mg daily, consider the following:

• Get a prescription for 1mg of finasteride daily, then use a pill cutter to quarter the pills (so that each daily dose is now 0.25mg versus 1.0mg). This will effectively net patients the same drug exposure as 0.2mg daily.
• Get a prescription for 1mg of finasteride daily, cut the pills in half (so you have 0.5mg per daily dose), and then take one half-pill each Monday, Wednesday, and Friday. This will net patients 1.5 mg of weekly exposure, whereas 0.2mg daily would net 1.4mg weekly – so they’re more or less the same.

We hope this information helps.