Proscar (Finasteride) vs Alternatives: What Actually Works for Hair Loss and Enlarged Prostate

Finasteride is one of the most prescribed medications for two very different conditions: male pattern hair loss and benign prostatic hyperplasia (BPH), or an enlarged prostate. It’s sold under the brand name Proscar for prostate issues and Propecia for hair loss, but the active ingredient is the same. Many men start with Proscar because it’s been around for decades and has solid data behind it. But it’s not the only option. Side effects like lowered libido, erectile dysfunction, and mood changes push some men to look for alternatives. So what actually works as well-or better-without the same risks?

How Finasteride Works

Finasteride blocks an enzyme called 5-alpha-reductase, which turns testosterone into dihydrotestosterone (DHT). DHT is the hormone that shrinks hair follicles over time, leading to thinning and balding. It also causes the prostate to swell. By lowering DHT levels by up to 70%, finasteride slows or reverses both processes. Studies show that after one year of daily use, about 65% of men with hair loss see some regrowth. For prostate enlargement, it reduces prostate size by around 20-30% and improves urinary flow in most men within six months.

But here’s the catch: you have to take it every day, forever. Stop taking it, and DHT levels bounce back. Hair loss resumes within 6-12 months. Prostate symptoms return, too. That’s why many men explore alternatives-either to reduce side effects, avoid daily pills, or find something more natural.

Top Alternatives to Proscar

There are three main categories of alternatives: other prescription drugs, natural supplements, and non-pill treatments. Each has different levels of evidence, effectiveness, and risk.

1. Dutasteride (Avodart)

Dutasteride is the closest thing to finasteride, but stronger. It blocks both types of 5-alpha-reductase enzymes (Type I and Type II), while finasteride only blocks Type II. That means dutasteride cuts DHT by about 90%-not 70%. A 2017 study in the Journal of the American Academy of Dermatology found dutasteride led to significantly more hair regrowth than finasteride after two years.

But stronger doesn’t always mean better. The side effect profile is nearly identical: low libido, erectile dysfunction, and decreased semen volume. Some men report worse mood changes. It’s also not approved for hair loss in Australia, so it’s only prescribed off-label. That means no PBS subsidy, so it costs more-around $120 a month without insurance. If you’ve tried finasteride and didn’t get results, dutasteride might help. But if you had side effects with finasteride, you’ll likely get them again-maybe worse.

2. Minoxidil (Rogaine)

Minoxidil is the only FDA-approved topical treatment for hair loss that works without touching DHT. It’s a vasodilator-it opens up blood vessels in the scalp, boosting nutrient flow to follicles. It’s available as a 5% foam or liquid, applied twice daily. It doesn’t stop hair loss at the hormonal level, but it can stimulate new growth in about 40% of men after four to six months.

The big advantage? No systemic side effects. You won’t get sexual side effects because it doesn’t enter your bloodstream in meaningful amounts. The downside? You need to use it for life. Miss a day or two, and you’ll notice shedding. It also doesn’t help with prostate issues at all. Many men use minoxidil alongside finasteride for a double punch. If you’re only worried about hair and want to avoid pills, minoxidil is the safest bet.

3. Saw Palmetto

Saw palmetto is a berry extract used in herbal medicine for centuries. It’s marketed as a natural alternative to finasteride. Some studies suggest it mildly inhibits 5-alpha-reductase, but not nearly as effectively. A 2012 meta-analysis in Phytotherapy Research found saw palmetto improved urinary symptoms in men with BPH, but the effect was about half that of finasteride. For hair loss, evidence is weak-most trials show no real regrowth.

It’s generally safe. Side effects are mild: stomach upset, headache, or dizziness in a small number of users. It’s also cheap-around $15-$25 a month. But if you’re looking for results that match Proscar, saw palmetto won’t deliver. It’s better as a maintenance option for men with mild symptoms or those who want to avoid pharmaceuticals entirely.

4. Low-Level Laser Therapy (LLLT)

Devices like the Capillus laser cap or iRestore helmet use red light to stimulate hair follicles. The theory is that light energy boosts cellular activity in the scalp, encouraging growth. Multiple clinical trials, including one published in The American Journal of Clinical Dermatology in 2019, show LLLT can increase hair density by 15-20% over six months.

It’s non-invasive, has zero known side effects, and can be used with other treatments. But it’s expensive-$300 to $1,000 upfront for a home device. You need to use it 3-5 times a week for at least 20 minutes each session. If you’re tech-savvy and willing to stick to a routine, LLLT is a solid option. It won’t shrink your prostate, though.

5. Spironolactone (for women only)

Spironolactone is a diuretic that also blocks androgen receptors. It’s commonly prescribed for female pattern hair loss and acne in women. But it’s not suitable for men. In men, it can cause breast enlargement, sexual dysfunction, and even feminizing effects. Some men try it off-label, but the risks far outweigh the benefits. Avoid this one unless you’re a woman under a doctor’s care.

What About Newer Options?

There’s growing interest in topical finasteride and oral peptides like BPC-157 or Epitalon, but these are still experimental. Topical finasteride-applied as a solution instead of swallowed-shows promise in early studies for reducing scalp DHT with less systemic exposure. A 2023 pilot study in Journal of Clinical and Aesthetic Dermatology found it was just as effective as oral finasteride for hair loss but caused fewer sexual side effects in 80% of users.

However, it’s not FDA or TGA approved. You can’t buy it legally in Australia without a compounding pharmacy prescription. And long-term safety data doesn’t exist yet. Same goes for peptides. They’re not regulated, and many are sold online with no quality control. Don’t risk your health on unproven options.

Side Effects Comparison

Here’s how the main options stack up in terms of sexual and psychological side effects, based on patient reports and clinical trials:

Notice something? The only treatments with zero sexual side effects are minoxidil, saw palmetto, and LLLT. If your priority is preserving sexual health, those are your best bets. Finasteride and dutasteride carry real, documented risks-even if they’re statistically low, they can be devastating for the individuals affected.

Who Should Choose What?

There’s no one-size-fits-all. Your choice depends on your goals and tolerance for risk.

• Choose finasteride if you want maximum hair regrowth and have no history of sexual dysfunction or depression. You’re okay with daily pills and potential side effects.
• Choose dutasteride if finasteride didn’t work after 12 months and you’re willing to pay more and accept higher side effect risk.
• Choose minoxidil if you want a safe, non-pill option for hair loss. Use it alone or with finasteride for better results.
• Choose saw palmetto if you have mild prostate symptoms and want a natural, low-cost option. Don’t expect dramatic results.
• Choose LLLT if you’re tech-savvy, can afford the upfront cost, and want a zero-side-effect solution for hair.
• Avoid spironolactone if you’re male. It’s not safe for you.

What If You’ve Already Tried Proscar?

If you’ve been on Proscar for six months and didn’t see results, don’t give up. It can take up to 12 months to see full benefits. If you’re experiencing side effects, talk to your doctor. Some men find that lowering the dose to 0.5 mg per day reduces side effects while still maintaining results. Others switch to topical finasteride or combine minoxidil with a lower oral dose.

Never stop abruptly. Tapering off slowly can help reduce the risk of sudden shedding. Keep in mind: if you’ve had persistent sexual or mental health issues after stopping finasteride, you may be experiencing Post-Finasteride Syndrome (PFS). It’s rare, but real. Document your symptoms and seek a specialist in hormonal or sexual health.

Final Thoughts

Proscar works. But it’s not the only option-and for many men, it’s not the best. If your main goal is to keep your hair without risking your sex life, minoxidil and LLLT are safer and just as effective over time. If you’re dealing with prostate issues and need strong results, finasteride or dutasteride still have their place. But don’t accept side effects as inevitable. There are alternatives that work without the same trade-offs.

The key is matching the treatment to your priorities. Hair loss isn’t just cosmetic-it affects confidence and mental health. Prostate issues aren’t just inconvenient-they affect sleep, relationships, and quality of life. Choose wisely. Talk to your doctor. And don’t let fear of side effects stop you from trying something safer.