Finasteride, dutasteride and oral minoxidil for hair loss
These drugs treat pattern hair loss (androgenetic alopecia). A licensed clinician reviews your intake and photos, prescribes what fits and a pharmacy ships it. Finasteride, dutasteride, oral minoxidil and ketoconazole shampoo, all generic.
The headline result: in the pivotal trials, finasteride 1 mg maintained or improved hair count in 80 to 90 percent of men over one to two years. The headline risk: sexual side effects ran in the low single digits, a couple of points above placebo, and a subset of men reports symptoms that persist after stopping. The full numbers and sources are below.
What you get
Commercial generics only. We do not sell compounded topical finasteride; the evidence section explains why.
- Finasteride 1 mg, once dailyoral
- Inhibits type II 5-alpha-reductase, dropping scalp DHT by roughly 70 percent. In the Kaufman 1998 trials, 80 to 90 percent of men maintained or improved hair count over one to two years. Visible results take three to six months. The benefit holds only while you take it; stop and gains reverse within 6 to 12 months.
- Dutasteride 0.5 mg, once dailyoff-label
- Blocks both type I and type II 5-alpha-reductase, suppressing DHT by roughly 90 percent. Stronger suppression, a half-life of weeks and a smaller evidence base than finasteride. We offer it as a step-up after an adequate finasteride trial or with clear rationale, with extra consent.
- Oral minoxidil 0.625 to 5 mg, once dailyoff-label
- A vasodilator that prolongs the hair growth phase. We start low and step up only if tolerated: 0.625, 1.25, 2.5, then 5 mg for men (2.5 mg is the usual female maximum). The most common side effect is extra body and facial hair, and it is dose-related. It also causes fluid retention and can raise heart rate.
- Ketoconazole 2% shampoo, two to three times a weektopical
- A low-risk add-on with modest evidence, used alongside the above. Not a primary therapy on its own.
What the evidence says
- [1]
Finasteride efficacy. Kaufman et al. (J Am Acad Dermatol 1998): 1 mg/day maintained or improved hair count in roughly 80 to 90 percent of men over one to two years.
- [2]
Dutasteride versus finasteride. Olsen et al. 2006 and Gubelin Harcha et al. (J Am Acad Dermatol 2014): dutasteride 0.5 mg/day produced greater hair-count improvement than finasteride 1 mg over 24 weeks. The evidence base is smaller, and US use for hair is off-label.
- [3]
The 2025 regulatory picture on mood and sexual effects. The FDA added depression (2011) and suicidality language (2022) to oral finasteride labeling. In 2025 the European Medicines Agency concluded suicidal ideation is a recognized side effect and directed prescribers to counsel patients to stop and seek help if mood symptoms occur. We counsel on this and document it.
- [4]
Why we do not sell compounded topical finasteride. In 2025 the FDA issued an alert on compounded topical finasteride reporting systemic adverse events: erectile dysfunction, anxiety, suicidal ideation, brain fog, depression and libido loss. It lacks the safety dossier of the oral product, so we do not sell it.
- [5]
Oral minoxidil. A 2022 to 2025 literature, including systematic reviews and randomized comparisons, supports low-dose oral minoxidil for androgenetic alopecia, with a dose-dependent response and extra hair growth as the leading reason people stop. Serious cardiac events are uncommon at low doses.
Who qualifies
- Age 18 or older.
- A pattern consistent with androgenetic alopecia: gradual thinning, a receding hairline or crown thinning in men, a widening central part in women.
- Clear photos submitted.
- None of the conditions in the risks section for the drug you want.
Known risks and who should not use this
Finasteride and dutasteride: in the pivotal trials, decreased libido, erectile dysfunction and ejaculation problems each ran in the low single digits, a couple of points above placebo. For most men they resolve after stopping. A subset of men reports sexual or mood symptoms that persist after stopping. The FDA added depression language to the finasteride label in 2011 and suicidality language in 2022, and in 2025 the EMA concluded suicidal ideation is a recognized side effect. If mood symptoms appear, stop the drug and contact us.
Oral minoxidil: extra body and facial hair is the most common side effect and is dose-related. It also causes fluid retention and can raise heart rate. Serious cardiac events are uncommon at low doses.
The conditions below end the intake for the drug in question.
Finasteride and dutasteride:
- Pregnancy, any chance of pregnancy or trying to conceive. These drugs are teratogenic and can cause genital abnormalities in a male fetus. For premenopausal women, our default is a hard stop on both. Spironolactone is the usual antiandrogen route for premenopausal female pattern loss; ask us about it.
- A prior bad reaction to finasteride or dutasteride.
- Pregnant or breastfeeding people must not even handle crushed or broken tablets.
Oral minoxidil:
- Pheochromocytoma or an adrenaline-producing adrenal tumor. Contraindicated.
- Heart failure, a recent heart attack, serious rhythm problems, uncontrolled chest pain or any history of fluid around the heart (pericardial effusion). A pericardial effusion history is a hard stop. The rest routes to a clinician.
- Pregnancy or breastfeeding.
A few things flag for review rather than block: a PHQ-2 score of three or more, which routes to a full PHQ-9 before any 5-alpha-reductase inhibitor; a low baseline IIEF-5, which sharpens the counseling; men over 45 wanting finasteride without a PSA discussion; and borderline blood pressure or swelling history for oral minoxidil.
A note for men over 45: finasteride and dutasteride lower your PSA by about half after six to twelve months. If you get a prostate test, tell the clinician and lab so the number can be doubled before it is compared to normal ranges. A PSA that rises while you are on the drug, even within the normal range, should be looked at.
How it works here
You answer an intake and upload photos. You describe your loss, upload top-down, hairline and part-line photos, and complete two short baseline screens: the IIEF-5 for sexual function and the PHQ-2 for mood. The screens give the side-effect conversation a starting point and catch a mood flag early.
A licensed clinician reviews it. A clinician licensed in your state reads your intake and photos. Pattern loss qualifies. Patchy, scarring or sudden diffuse shedding does not; that routes to dermatology, because it is a different problem.
The pharmacy ships. Your medication ships to your door. We reassess at three months with progress photos and repeat the screens.
Price
| Clinical visit and prescription | $39 |
|---|---|
| Finasteride 1 mg (90-day supply) | $27 |
| Dutasteride 0.5 mg (90-day supply) | $45 |
| Oral minoxidil (90-day supply) | $33 |
| Ketoconazole 2% shampoo | $18 |
Generic, FDA-approved oral medications. If a pharmacy copay beats our price, we will tell you.
FAQ
What are the real sexual side-effect rates on finasteride?
In the pivotal one-year trials, 3.8 percent of men on finasteride reported a drug-related sexual side effect versus 2.1 percent on placebo. Decreased libido ran 1.8 versus 1.3 percent, erectile dysfunction 1.3 versus 0.7 percent. For most men they resolve after stopping. A subset reports persistent symptoms, which is the contested post-finasteride syndrome. We require you to acknowledge this before we prescribe.
Is post-finasteride syndrome real?
It is reported consistently and it is not fully understood. The mechanism is contested and the reports vary in severity. It exists, it is not proven common and it is not proven impossible. We ask you to stop and contact us if symptoms appear, and we screen your mood at baseline.
Should I take finasteride or dutasteride first?
Finasteride first, in almost every case. Dutasteride suppresses DHT more strongly and stays in your body for weeks after stopping, with a smaller evidence base. We offer it as a step-up after an adequate finasteride trial or with clear rationale, and with extra consent.
Why won't you sell compounded topical finasteride?
In 2025 the FDA flagged systemic adverse events from it, and it lacks the safety record of the oral pill. We do not sell products that outrun their evidence.
Will I have to take this forever?
To keep the benefit, yes. Finasteride's effect lasts only while you take it, and gains reverse within 6 to 12 months of stopping. Dutasteride washes out more slowly given its long half-life.
What about my PSA test?
Finasteride and dutasteride cut PSA by about half after six to twelve months. Tell any clinician and lab you are taking it so the result is doubled before comparison. A PSA that rises on the drug, even within normal limits, should be evaluated.
Is oral minoxidil going to grow hair on my face?
It can. Extra body and facial hair is the most common side effect and is dose-related. It is the leading reason people, especially women, stop. We start low and step up only if you tolerate it.
Can women take any of these?
Postmenopausal women can use finasteride or dutasteride off-label, oral minoxidil up to 2.5 mg and ketoconazole shampoo. For premenopausal women, finasteride and dutasteride are a default hard stop because of the risk to a fetus; spironolactone is the usual route instead.
How long until I see results?
Three to six months for finasteride and dutasteride, with a fuller read at twelve. Oral minoxidil is assessed around six months. Send progress photos at your follow-ups so we can track it.
Do I need bloodwork?
No routine labs to start finasteride in a healthy adult. Oral minoxidil needs a baseline blood pressure and heart rate, rechecked at dose steps. We add a PSA discussion for men over 45.
The rest of the catalog
The same rules apply to every medication we carry: a structured intake, a licensed clinician on every review, flat prices and FDA-approved generics only.
From the catalog · Hair
Start your intake
Answer the intake, upload your photos and get a clinician's decision, usually within one business day.
Clinical content reviewed by [Reviewer name], MD. Last clinically reviewed 2026-06-10.