Oral Finasteride Before and After: Real Case Studies

Article Summary

Oral finasteride remains the gold-standard treatment for male pattern hair loss, with decades of data showing consistent improvement in density and prevention of further thinning. However, dramatic online regrowth photos can lead to unrealistic expectations. In your regrowth journey, it’s important to know what realistic before-and-after results look like, how long regrowth typically takes, and how to set achievable expectations for lasting, evidence-based results.

Full Article

Oral finasteride remains the most clinically validated medication for androgenic alopecia (AGA). Over 20 years of trials and follow-up data show consistent, predictable outcomes in slowing miniaturization and restoring density, particularly in the vertex and mid-scalp.

Yet, despite this wealth of data, online forums and “miracle” before-and-after photos often distort expectations. These transformations represent the upper end of the response curve, while most users experience more moderate, steady results that unfold over months to years.

This article explores what realistic regrowth looks like with oral finasteride, how to interpret finasteride before and after photos critically, and what to expect when used correctly and consistently. 

What is Oral Finasteride?

Oral finasteride is a type II 5ɑ-reductase inhibitor that reduces the conversion of testosterone to dihydrotestosterone (DHT), the key androgen responsible for hair follicle miniaturization in AGA. 

Originally approved by the FDA at a dose of 1 mg for male pattern hair loss, oral finasteride has since become widely known as the gold-standard treatment for hair loss. Its primary mechanism is systemic DHT suppression, lowering circulating levels by roughly 60-70% and scalp DHT by up to 65%.^[1]Caserini, M., Radicioni, M., Leuratti, C., Terragni, E., Iorizzo, M., Palmieri, R. (2016). Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men … Continue reading

Mechanism of Action

As mentioned above, finasteride is a competitive inhibitor of the 5ɑ-reductase enzyme, specifically targeting the type II (and to a lesser extent, type III) isoenzymes.^[2]Zito, P.M., Bistas, K.G., Patel, P., Syed, K. (2024). Finasteride. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513329/

Treatment with finasteride leads to a significant decrease in both scalp and serum DHT concentrations. This effect is dose-dependent and has been observed as early as 28 days after starting treatment.^[3]Dallob, A.L., Sadick, N.S., Unger, W., Lipert, S., Geissler, L.A., Gregoire, S.L., Nguyen, H.H., Moore, E.C., Tanaka, W.K. (1994). The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp … Continue reading Lower DHT levels in the scalp prevent androgen-dependent miniaturization of hair follicles, promoting the maintenance and improvement of hair follicle size and number in the anagen (growth) phase.

Unlike topical formulations, oral finasteride exerts a systemic effect. More comprehensive, but also more likely to cause side effects in sensitive individuals.

Adverse Effects

The most commonly reported adverse effects of oral finasteride are sexual in nature, including decreased libido, erectile dysfunction, and reduced ejaculatory volume. These occur in a range of users depending on the study and determination of what a side effect is (<1% to 25%).^[4]Traish, A.M., Hassani, J., Guay, A.T., Zitzmann, M., Hansen, M.L. (2011). Adverse side effects of 5ɑ-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and … Continue reading 

Other potential side effects include psychological and neuropsychiatric effects and post-finasteride syndrome (PFS). PFS refers to persistent sexual, neurological, and physical symptoms that continue after stopping finasteride. However, the existence and prevalence of PFS are debated, with some studies suggesting a possible genetic predisposition.^[5]Gupta, A.K., Talukder, M., Keene, S.A., Bamimore, M.A. (2025). Is the safety of finasteride correlated with its route of administration: topical versus oral? A pharmacovigilance study with data from … Continue reading 

You can read in more depth about the potential side effects in our oral finasteride ultimate guide.

Why Expectation Setting Matters

Finasteride is powerful and predictable, but even the best data can get lost when you see incredible results online. Online before-and-after posts tend to showcase outliers, individuals who happen to respond at the extreme high end of the efficacy curve. 

Meanwhile, clinical averages show that:

• Most men stop or reverse their hair loss progression.
• Around 65-80% experience visible thickening after 12-24 months.
• Only a small subset achieves “complete restoration”.

Unrealistic expectations can lead to disappointment, early discontinuation, or cycling through treatments unnecessarily. Grounding expectations in clinical probabilities rather than forum anecdotes helps users stay consistent long enough to see results. 

What’s Possible ≠ What’s Probable

While oral finasteride can produce impressive regrowth, most users experience gradual thickening and stabilization rather than dramatic restoration. 

Treatment outcomes typically follow a distribution pattern:

• A minority are “hyper responders”, achieving rapid and substantial visible improvement.
• The majority notice moderate, progressive gains, such as fuller density or slowed shedding.
• A smaller subset experience arrest of hair loss but remain unsatisfied with new hair growth.^[6]Dhurat, R., Mathapati, S. (2015). Response to Microneedling Treatment in Men with Androgenetic Alopecia Who Failed to Respond to Conventional Therapy. Indian Journal of Dermatology. 60(3). 260-263. … Continue reading 

Factors influencing response:

• Age and duration of hair loss: Finasteride efficacy is higher in younger patients and those with less advanced disease at treatment initiation.^[7]Camacho, F.M., Garcia-Hernandez, M.J., Fernandez-Crehuet, J.L. (2008). Value of hormonal levels in patients with male androgenetic alopecia treated with finasteride: better response in patients under … Continue reading Starting treatment at age 40 or higher is an independent risk factor for insufficient efficacy.^[8]Yoshitake, T., Takeda, A., Ohki, K., Inoue, Y., Yamawaki, T., Otsuka, S., Akimoto, M., Nemoto, M., Shimakura, Y., Sato, A. (2015). Five-year efficacy of finasteride in 801 Japanese men with … Continue reading 

• Consistency: Missing doses or cycling off can interrupt the stabilization of hair loss.

• Adjunct therapies: Combining finasteride with other therapies like topical minoxidil can improve results.^[9]Hu, R., Xu, F., Sheng, Y., Qi, S., Han, Y., Miao, Y., Rui, W., Yang, Q. (2015). Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and … Continue reading 
• Genetics: Variations in the androgen receptor (AR) gene sensitivity affect responsiveness.^[10]Keene, S., Goren A. (2011). Therapeutic hotline. Genetic variations in the androgen receptor gene and finasteride response in women with androgenetic alopecia mediated by epigenetics. Dermatologic … Continue reading 

Strong Evidence = Predictable Results

Unlike many newer (and even potentially stronger acting treatments), oral finasteride benefits from decades of standardized data, making outcomes highly predictable. A good example of this is comparing finasteride to dutasteride. Finasteride is extremely well-studied; therefore, we can usually predict the type of results we will see. Dutasteride, on the other hand, has studies showing it can outperform even the likes of finasteride in terms of hair regrowth. But the number of clinical studies is lacking, meaning that it is more difficult to predict a consistent outcome.

This predictability helps clinicians set clear, realistic expectations and provides users with confidence that consistency will lead to steady results.

Real Case Studies: Oral Finasteride Before and After

The examples below help see what’s possible and do not represent what every user should expect. They are purely anecdotal and not independently verified by us or any qualified third party.

Case Summary #1: Male (23), 3 Months on Oral Finasteride 1 mg (then every other day) + Topical Minoxidil Foam (twice daily)

This 23-year-old male took oral finasteride 1 mg daily for 2 months before titrating down to 1 mg every other day due to side effects. He also applied topical minoxidil foam twice daily, initially to the whole scalp but later exclusively to the hairline. He noted an initial shedding phase and early side effects on finasteride in the first month of treatment. In the second month, he described visible thickening while still on 1 mg daily. By month 3, he reduced finasteride to every other day and continued with minoxidil to maintain the progress. He reported marked improvement in hairline and density over the 3 months. 

The user also described early transient effects, including testicular ache (first week), watery semen, heightened libido, and less intense orgasm, which resolved after dialing the finasteride down to every other day. 

Case Summary #2: Male (25), 1-Year Course of Finasteride (1 mg) + Topical Minoxidil (1–2x Daily) + Monthly Dermarolling

This male Redditor started treatment at age 24 after severe crown thinning since he was about 18. His one-year course consisted of finasteride 1 mg daily (generic), topical liquid minoxidil 1–2/day, and dermarolling roughly monthly (post-shower, before nightly minoxidil). He supplemented with vitamin D and occasional biotin, and he regularly used argan oil after showers to limit flaking.

The patient noted a strong early response, but felt his results peaked roughly halfway into treatment. He stopped minoxidil for 1 month and missed some doses in the months leading up to the post. His photos indicated a significant improvement in density compared to baseline, particularly at the hairline and the top. He noted more coverage at the crown but felt it was still noticeably weaker than desired. The patient reported no sexual side effects or skin issues.

Case Summary #3: Male (24), 6 Months on Oral Finasteride 1 mg Daily + Oral Minoxidil 2.5 mg Daily

This 24-year-old male’s intervention consisted of oral finasteride 1 mg once daily and oral minoxidil 2.5 mg once daily. The user noted the emergence of small baby hairs at the hairline and temples at month 2 of treatment. By months 4-5, he reported noticeable thickening, with longer eyelashes and denser eyebrows. By month 6, the user showed clear improvement, as evidenced by his wet-hair photos and day-to-day density. He reported visible density gains at the hairline with better coverage under bright light, with his crown improved from baseline, though not fully closed. He reported no side effects, apart from brief mild erectile difficulty early on that resolved. 

Case Summary #4: Male (25), 3 Months on Oral Finasteride 1 mg Daily + Oral Minoxidil 2.5 mg Daily (added at month 2) + Ketoconazole Shampoo 3x/week + Microneedling 1.5 mm Weekly 

This 24-year-old male’s intervention was oral finasteride 1 mg daily for 3 months, oral minoxidil 2.5 mg daily (added 2 weeks before the 3-month update), ketoconazole shampoo (Nizoral) about three times weekly, and dermaroller 1.5 mm once weekly over the whole scalp.

The user described gradual thickening over the 3-month finasteride course, with minoxidil introduced at month 2.5. He reported a noticeable improvement in density at the hairline and mid-scalp compared with baseline. He described a possible mild libido reduction on finasteride and thinning of the eyebrows thinned on finasteride, which appeared fuller after starting minoxidil. He reported no other significant effects. 

Case Summary #5: Male (38), 7 Months on Oral Finasteride + Topical Finasteride + Topical Minoxidil + Weekly Microneedling

This 38-year-old male started the current treatment with oral finasteride 1 mg daily and topical minoxidil (strength/frequency not specified). He added topical finasteride (concentration not specified) and weekly microneedling at 0.25 mm in month 5. The patient reported a slight but noticeable improvement vs. baseline at month 5 and, at month 7, likewise described his progress as modest. In the 7 months, he achieved stabilization with modest density improvement, most visible anteriorly, with the crown remaining limited. He reported no side effects from finasteride and minoxidil. 

Case Summary #6: Male (28), 10 Years on Oral Finasteride + 4–5 Months on Oral Minoxidil 

This 28-year-old male reported on his 10-year treatment progress on oral finasteride 1 mg daily, before adding oral minoxidil 2.5 mg twice daily 4-5 months before the progress report. He confirmed no dermarolling or topical agent application. The patient reported that, between the ages of 18 and 27, he was on finasteride monotherapy, achieving significant regrowth and strong maintenance. Towards the end of that period, he reported subtle renewed thinning, prompting him to add oral minoxidil. Within 4 months thereafter, his hair density and thickness nearly doubled. 

He reported good tolerance to finasteride with no noticeable side effects. He added that oral minoxidil caused mild generalized hypertrichosis (slightly darker chest/back hair, fuller beard, higher cheek/temple hairs), but was otherwise tolerated. 

Case Summary #7: Male (28), 2–3 Months on Oral Finasteride 1 mg Monotherapy

This 28-year-old male’s intervention included oral finasteride 1 mg daily, weekly microneedling with dermastamp 1.0–1.5 mm, and supplementation with vitamin D3 + K2, zinc, folate, magnesium glycinate, and ketoconazole 2% shampoo. Additionally, he made lifestyle adjustments, including going to the gym 2x/week and starting a higher-protein diet.

He noted a mild shedding phase in the first month of treatment. By month 2, he described the first visible tiny regrowth after a buzz cut, by which point the shedding had reduced. Overall, the patient described early regrowth at the hairline and thinning zones. He reported no side effects on finasteride 1 mg daily, stating that libido and energy have remained unchanged or improved.

Case Summary #8: Male (unspecified age), 3 Years on Oral Finasteride 1 mg Daily + Topical Minoxidil

This male Redditor’s intervention over 3 years was oral finasteride 1 mg daily and topical minoxidil (strength not specified).

In the first year, he noted steady cosmetic improvement, followed by continued thickening and maintenance of gains over years 2-3. Overall, the user reported substantial density gain, with perceived improvement in the hairline and temples over time. He mentioned no significant side effects and confirmed his sex drive had remained unchanged throughout treatment. He noted that the minoxidil sometimes caused dandruff and that on finasteride, he required greater mental focus to push weight-lifting sets to failure. 

Case Summary #9: Male (early 30s), 3.5 Months on Oral Finasteride 1.25 mg Daily

This male, in his early 30s, opted for a treatment consisting of oral finasteride monotherapy at 1.25 mg daily (5 mg tablets quartered). He described a mild daily shedding phase within the first month of treatment. By month 2.5, he reported his first visible thickening. At the 3.5-month progress report, the user achieved a fuller crown with reduced scalp show-through. He reported no side effects. 

Case Summary #10: Male (25), 5.5 Months on Oral Finasteride 1.25 mg Daily + Oral Minoxidil 5 mg Daily

This 25-year-old South Asian male’s intervention was oral finasteride 1.25 mg daily (5 mg tablets quartered) and oral minoxidil, starting at 2.5 mg daily, titrated to 5 mg after 3 months. He described a substantial shedding phase, particularly in the first 3 weeks of month 3. The following month, he reported progressive thickening and density gains with improved coverage. As of month 5.5, he is still improving and continuing both agents unchanged. Overall, he reported a marked increase in density, with a thicker texture, and the crown and hairline both looked fuller than baseline. He reported no side effects on either dose level for finasteride or oral minoxidil. 

Probable Regrowth Timeline

Based on the available research (which you can take a look at with our research tables here), we have created a probable hair regrowth timeline.

Months 0-3: Adjustment Phase

In the first three months, most users experience minimal visible change. Finasteride actively lowers scalp and serum DHT levels, initiating follicle recovery. Some users notice a temporary increase in shedding as older hairs are shed to make way for new growth, while others observe subtle stabilization of hair loss.

Months 3-6: Reduction in Shedding

By this stage, a clear reduction in hair shedding often becomes noticeable. Although visible thickening remains limited for many, the treatment is beginning to normalize hair cycling. Early responders may report small areas of improved density, particularly in the crown or vertex.

Months 6-12: Early Cosmetic Improvements

Between 6 and 12 months, most responders start to see visible regrowth. Hair density gradually improves, strands appear thicker, and areas of thinning begin to fill in. The crown region typically shows improvement sooner than the frontal hairline, which tends to respond more slowly. Continued adherence is essential during this phase to sustain progress.

Months 12-24: Peak Response Period

During the second year, responders generally achieve their maximum results. Hair density, coverage, and stabilization reach their highest levels, with further visible gains possible in some individuals. Those starting with more advanced thinning usually experience consolidation rather than full growth.

Months 24+: Maintenance and Long-Term Stability

After two years, most users reach a plateau in visible improvement. Continued daily use of finasteride is needed to preserve these gains, as stopping the medication often results in gradual hair loss returning to baseline within 6-12 months. Some people combine treatments at this point to achieve further outcomes.

For most users, oral finasteride provides progressive, steady improvements over time, with long-term commitment being the key to maintaining results.

Setting Realistic Expectations

It’s important to set realistic expectations when starting any treatment. Finasteride primarily stabilizes hair loss during the early months, with noticeable growth typically developing later in the treatment course. True cosmetic improvement usually unfolds gradually over 12 to 24 months rather than weeks, reflecting the natural pace of the hair growth cycle. 

Clinical trials suggest that most men experience visible thickening and halting of progression rather than full restoration, effectively “turning back the clock” by two to five years in terms of density and coverage.^[11]Kaufman, K.D., Olson, E.A., Whiting, D., Savin, R., DeVillez, R., Bergfeld, W., Price, V.H., Van Neste, D., Roberts, J.L., Hordinsky, M., Shapiro, J., Binkowitz, B., Gormley, G.J. (1998). Finasteride … Continue reading,^[12]Price, V.H., Roberts, J.L., Hordinsky, M., Olsen, E.A., Savin, R., Bergfeld, W., Fiedler, V., Lucky, A., Whiting, D.A., Pappas, F., Culbertson, J., Kotey, P., Meehan, A., Waldstreicher, J. (2000). … Continue reading,^[13]Rossi, A., Mari, E., Scarno, M., Garelli, V., Maxia, C., Scali, E., Iorio, A., Carlesimo, M. (2012). Comparative effectiveness of finasteride vs Serenoa repens in male androgenetic alopecia: a … Continue reading 

Consistent photographic tracking using identical lighting and angles can help visualize these incremental gains. Long-term adherence is crucial, as discontinuation typically leads to renewed miniaturization and hair loss within several months of stopping treatment.

Practical Takeaways

• Oral finasteride remains the most effective DHT blocker for male AGA
• Decades of clinical data make results highly predictable and durable
• The safety profile is well-established, with sexual side effects uncommon and often reversible
• Combining treatments can improve outcomes, especially for advanced loss.

Final Thoughts

Oral finasteride remains the most extensively studied and clinically validated treatment for androgenic alopecia, offering predictable outcomes for most users through gradual thickening, stabilization of shedding, and preservation of existing hair rather than dramatic restoration. While newer options like oral minoxidil are gaining popularity, they remain off-label despite growing supportive evidence and should be used under medical supervision. 

The key to achieving and maintaining meaningful results lies in consistency, patience, and realistic expectations, recognizing that hair regrowth is a slow, cumulative process measured over months and years. By grounding expectations in clinical evidence rather than anecdotal extremes, patients can make informed, balanced decisions and stay committed to a long-term plan that maximizes both safety and effectiveness.