Key takeaways
- Finasteride slows further hair loss in about 80 to 90% of men, according to the American Academy of Dermatology, with results seen in about six months.
- Sexual side effects and mood changes are recognised. In 2025 the European Medicines Agency confirmed suicidal thoughts as a side effect of finasteride tablets, frequency unknown.
- Dutasteride is more potent but is used off-label for hair in many countries. Low-dose oral minoxidil is also off-label.
- All three work only while you take them. Hair loss returns gradually after stopping.
- These are prescription decisions after assessment. Do not buy them online or start them on a friend's advice.
How do these tablets work?
Men often walk in and say, "Doctor, just give me the tablet my friend is taking." I'm happy to talk about it. But first, have you understood what it does in your body? See, what happens is, male pattern hair loss happens when DHT (dihydrotestosterone), which an enzyme called 5-alpha reductase makes from testosterone, acts on genetically sensitive scalp follicles and shrinks them over time.
| Medicine | How it works | Status for hair loss |
|---|---|---|
| Finasteride 1 mg | Blocks the type 2 form of 5-alpha reductase, lowering DHT | Approved for male pattern hair loss in many countries |
| Dutasteride | Blocks both type 1 and type 2 forms; StatPearls describes it as about three times more potent on type 2 | Off-label for hair in many countries; often used when finasteride has not worked |
| Low-dose oral minoxidil | Helps follicles stay in the growing phase; does not affect DHT | Off-label; much lower doses than for blood pressure |
Finasteride and dutasteride work on the cause. Minoxidil supports growth. That is why doctors sometimes combine them.
What results can I realistically expect?
- Finasteride slows further hair loss in about 80 to 90% of men, per the American Academy of Dermatology, with results visible in about six months. The Indian Journal of Dermatology, Venereology and Leprology review advises assessing response at six months, noting some men only respond by twelve. StatPearls notes it tends to work better at the crown than the front.
- Combining minoxidil with finasteride was reported to be more effective than either alone in the same Indian review.
- Low-dose oral minoxidil has been shown to promote regrowth at 0.25 to 2.5 mg daily, according to The Medical Letter.
- Age matters. The Mayo Clinic notes finasteride may work less well in men over 60.
None of these brings back hair on scalp that has been bare for many years. Their real strength is protecting and thickening hair that is still there. Read will my hair grow back for why.
What are the side effects?
Please read this part slowly. Most men who take these medicines have no problems. Some do, and you should know before you start, not after.
Finasteride and dutasteride - Sexual side effects: reduced sex drive and erection problems. The American Academy of Dermatology lists these, along with breast tenderness. - Mood changes: the American Academy of Dermatology lists depression. In May 2025, the European Medicines Agency's safety committee confirmed suicidal thoughts as a side effect of finasteride tablets, mostly in men taking the 1 mg dose for hair loss, with frequency unknown. It recommended that men on finasteride 1 mg who notice mood changes stop treatment and seek medical advice, and that a patient card be included in packs. It added precautionary mood warnings for dutasteride. - Persistent symptoms: some men report symptoms that continue after stopping. The US FDA noted this in its 2025 alert on reports linked to compounded topical finasteride. - PSA test: these medicines lower PSA, a blood test used to screen for prostate cancer. StatPearls notes this can delay detection if the doctor does not know. Always tell any doctor ordering a PSA test that you take them. - Pregnancy exposure: finasteride can harm a male baby in pregnancy. Women who are or may be pregnant should not handle crushed or broken tablets.
Low-dose oral minoxidil - Unwanted hair growth on the face and body, and ankle swelling, are the most common effects, per The Medical Letter. - Less commonly: fast heartbeat, fluid around the heart and salt imbalance. - It needs a check of blood pressure, heart history and other medicines before starting.
If you have a history of depression or anxiety, sexual health concerns, or plans to start a family soon, tell me at your first consultation. That is very important to understand, because it can change which option is right for you. Nothing you say in that room is too awkward.
Is topical finasteride a safer option?
It is often marketed that way, but I would be cautious. In April 2025 the US FDA warned about compounded topical finasteride products, noting there are no FDA-approved topical finasteride products, and that it had received reports of side effects similar to the tablets, including sexual side effects, anxiety, depression and suicidal thoughts. On the other hand, the European Medicines Agency found no link between suicidal thoughts and an approved finasteride skin spray in Europe. The evidence is still evolving. So topical forms are a prescription decision too, not a risk-free shortcut.
What should I ask before I start?
- Is my hair loss definitely male pattern, or is something else contributing?
- Which medicine do you suggest for me, and why?
- What results are realistic in six and twelve months?
- Which side effects should make me call you?
- How will we review progress, and when?
- What happens if I want to stop, or if I am planning a family?
- Do I need any tests before starting?
A good doctor will be happy to answer all of these, and will also accept it if you decide tablets are not for you. Topical options, in-clinic treatments and, in suitable cases, a transplant by a qualified surgeon are alternatives. Read minoxidil explained and hair transplant or treatment first.
Why not just buy them online?
Hair tablets are very easy to order online. The problem is not only quality. Nobody checks whether the diagnosis is right, whether the medicine suits your health and your plans, or whether side effects are happening. And if you start without a diagnosis, you cannot judge whether it is working. I do not push any particular medicine. I lay out the options, and then it is your call. If you ask, I will tell you what I would do in your place.
How we approach this at Dr Tvacha
At a Rs 499 hair diagnosis at our Thane, Andheri, Bandra or Dahisar centre, my team and I confirm the diagnosis, review your health history, and explain your options and their side effects in plain language. If you choose to start a tablet, review dates are fixed from the first day. In the 5-Year Time Machine Hair Plan, home medicines are combined with monthly in-clinic sessions over four months, and the fee is given in writing. See our hair page.
Frequently asked questions
How long does finasteride take to work?
Most men need about six months to see a difference, and some need up to twelve. The first sign is usually less shedding, not new hair. Monthly photos of the crown and hairline in the same light help you judge honestly. If there is no improvement after twelve months, your doctor will review the plan with you rather than simply continuing.
Will my hair fall out if I stop finasteride?
Yes, gradually. The American Academy of Dermatology notes hair loss returns once you stop, because the medicine controls the cause rather than curing it. Over the following months, hair tends to return to the level it would have reached without treatment. If you want to stop, discuss it with your doctor so you can plan alternatives.
Can finasteride affect fertility?
Sexual side effects such as reduced sex drive or erection problems can affect family planning, so this deserves a frank conversation. If you are trying for a baby soon, tell your doctor, who may suggest a different approach or timing. Women who are or may be pregnant should not handle crushed or broken tablets, because finasteride can affect a male baby's development.
Is dutasteride stronger than finasteride?
Dutasteride blocks both forms of the enzyme that makes DHT and is more potent, which is why it is sometimes used when finasteride has not worked. It is off-label for hair in many countries. But stronger does not mean it suits everyone. It shares similar side effects, and the European Medicines Agency has added precautionary mood-change warnings, so it needs careful discussion.
Can young men in their early 20s take these medicines?
Men over 18 with confirmed male pattern hair loss can be considered, and early treatment preserves more hair. But younger men often have strong concerns about sexual side effects and mood, and those deserve a frank discussion. Topical treatments and in-clinic options are alternatives. Read my guide to losing hair in your early 20s before deciding.
Written by
Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.
Sources
- What is male pattern hair loss, and can it be treated? (American Academy of Dermatology)
- Measures to minimise risk of suicidal thoughts with finasteride and dutasteride medicines (European Medicines Agency, 2025)
- FDA alerts health care providers, compounders and consumers to potential risks associated with compounded topical finasteride products (US FDA, 2025)
- Androgenetic Alopecia (StatPearls, NCBI Bookshelf)
- Low-dose oral minoxidil for hair loss (The Medical Letter on Drugs and Therapeutics)
- Androgenetic alopecia: An update (Indian Journal of Dermatology, Venereology and Leprology)
This article is for general education and does not replace a consultation. Medicines and treatments are prescribed only after a doctor's assessment. Last reviewed 25 October 2026.