The Short Answer
The best finasteride alternative is oral minoxidil — it's the most effective non-hormonal option. Topical finasteride is also worth considering if you want finasteride's benefits with potentially fewer systemic effects.
Why Look for Alternatives?
Finasteride works by blocking DHT, the hormone that causes male pattern baldness. It's highly effective, but 2-4% of men experience side effects (decreased libido, erectile changes). For these men, alternatives are needed.
The 5 Best Alternatives
1. Oral Minoxidil
Oral minoxidil is the biggest advancement in hair loss treatment. It works differently than finasteride (increases blood flow to follicles, not DHT-related) and is effective even for finasteride non-responders.
- Effectiveness: High (24% better than topical in studies)
- Cost: $20-35/month
- Side effects: Possible body hair growth, water retention
2. Topical Finasteride
Same active ingredient, applied to scalp instead of taken orally. May reduce systemic absorption and side effects while maintaining effectiveness.
- Effectiveness: Similar to oral (early research)
- Cost: $30-50/month
- Available at: Hims, Happy Head
3. Topical Minoxidil (Rogaine)
The classic OTC option. Works for many men, but 30-40% are "non-responders" due to an enzyme issue that oral minoxidil bypasses.
- Effectiveness: Moderate (works for 60-70%)
- Cost: $15-25/month
- Downside: Twice daily application, greasy
4. Ketoconazole Shampoo
Anti-fungal shampoo that may have mild anti-DHT effects. Best used alongside other treatments, not as a standalone.
- Effectiveness: Low-moderate (supportive)
- Cost: $10-20/month
- Available: Nizoral (OTC) or prescription strength
5. Low-Level Laser Therapy (LLLT)
FDA-cleared devices (caps, combs) that use red light to stimulate follicles. Modest results in studies.
- Effectiveness: Low-moderate
- Cost: $200-700 one-time
- Examples: Capillus, iRestore
Our Recommendation
If you can't take finasteride, oral minoxidil is your best bet. It's the most effective non-DHT-blocking option and works even if topical minoxidil failed for you.
Get Oral Minoxidil at Hims →