About 40% of men start losing hair by age 35, and many wonder whether a prescription pill is the only fix. Finasteride, sold as Propecia, dominates the market, but a dozen other options promise similar or even better results. This guide breaks down Propecia side‑by‑side with the most common alternatives, so you can pick the right path for your scalp without guessing.
Propecia is a prescription tablet containing 1mg of finasteride, approved for treating male pattern hair loss (androgenetic alopecia) in men. It works by inhibiting the enzyme 5‑alpha‑reductase typeII, which converts testosterone into dihydrotestosterone (DHT), the hormone that shrinks hair follicles.
Understanding how Propecia stacks up against alternatives starts with the core questions most readers ask:
Option | Mechanism | Approval Status (UK) | Typical Dose | Hair‑Regrowth Efficacy* | Common Side Effects | Annual Cost (GBP) | Suitable For |
---|---|---|---|---|---|---|---|
Propecia (Finasteride) | 5‑α‑reductase II inhibitor (reduces DHT) | MHRA‑approved prescription | 1mg daily | ≈30%patients see visible regrowth | Sexual dysfunction, mood changes, rare breast tenderness | £210-£300 | Men≥18y, early‑stage loss |
Minoxidil | Vasodilator (prolongs anagen phase) | OTC (2% and 5% solutions) | 2ml twice daily (solution) or 5mg tablet | ≈45%patients maintain or regrow | Scalp irritation, unwanted facial hair | £25-£80 | Men & women, any stage |
Dutasteride | 5‑α‑reductase I&II inhibitor (stronger DHT cut) | Off‑label for hair loss (prescribed) | 0.5mg daily | ≈55%patients see regrowth | Higher rates of sexual side effects, decreased PSA | £250-£350 | Men with moderate‑to‑advanced loss |
Low‑Level Laser Therapy (LLLT) | Photobiomodulation (stimulates follicles) | Medical‑device clearance (CE marked) | 10‑min sessions, 3‑4times/week | ≈30%patients report density increase | Eye strain (if not shielded), mild headache | £300-£900 (device) | Men & women, early‑ to mid‑stage |
Platelet‑Rich Plasma (PRP) | Autologous growth‑factor injection | Experimental, widely offered in clinics | 3sessions, 4‑6weeks apart | ≈40%patients see thickness gain | Temporary soreness, scalp swelling | £1,200-£2,500 (full course) | Men & women, thinning, not complete baldness |
Hair Transplant | Follicular unit extraction (FUE) or strip (FUT) | Clinical procedure, no drug approval needed | One‑time surgery (grafts≈2,500‑4,000) | Permanent restoration, 80‑90% graft survival | Scalp numbness, shock loss, cost barrier | £4,000-£12,000 (depends on graft count) | Men & women with stable loss, sufficient donor hair |
Saw Palmetto | Natural DHT‑blocking extract (weak inhibition) | Dietary supplement (no formal approval) | 320mg daily (standardized) | ≈10‑15% modest improvement (limited data) | Digestive upset, possible hormone interaction | £15-£30 | Men seeking mild, low‑risk option |
Finasteride blocks the enzyme that turns testosterone into DHT, the hormone that tells hair follicles to shrink. Less DHT means the follicles stay larger for longer, slowing loss and allowing existing hairs to thicken. Clinical trials in the UK consistently show a 25‑30% regrowth rate after12months of daily 1mg dosing.
Minoxidil started life as a blood‑pressure drug, but researchers noticed patients grew extra hair on their faces. Today it’s sold as a 2% solution for women and 5% for men. It works by widening blood vessels around the scalp, delivering more oxygen and nutrients to dormant follicles.
Because it’s topical, systemic side effects are rare, but you must apply it consistently-missing days can reverse progress within weeks.
Dutasteride blocks both typeI and typeII 5‑α‑reductase enzymes, cutting DHT levels up to 90% versus about 70% with finasteride. That extra potency translates into higher regrowth numbers in studies, but the trade‑off is a bumpier side‑effect profile, especially concerning sexual function and a possible impact on PSA testing for prostate health.
Urologists sometimes prescribe it off‑label for hair loss, and it’s available in the UK as a 0.5mg tablet.
Low‑Level Laser Therapy (LLLT) uses red light (around 650nm) to stimulate mitochondria inside hair‑follicle cells. The result is a modest boost in cell metabolism, prolonging the growth phase (anagen). Home‑use devices such as laser combs or caps have become popular because they’re drug‑free and easy to incorporate into a morning routine.
Evidence suggests about a third of users see a 10‑15% increase in hair density after six months, but the effect plateaus, so many combine LLLT with medication.
Platelet‑Rich Plasma (PRP) is drawn from your own blood, spun to concentrate platelets, then re‑injected into the scalp. Growth factors released by platelets can awaken dormant follicles. Clinics in the UK typically offer three sessions spaced a month apart, followed by maintenance every 6‑12months.
PRP is safe (autologous) but pricey, and results vary widely. It works best for patients with early thinning rather than full bald patches.
Hair Transplant moves healthy hair follicles from a donor zone (usually the back of the scalp) to the balding area. Modern techniques like Follicular Unit Extraction (FUE) leave tiny dots instead of linear scars, and graft survival rates exceed 90% when performed by experienced surgeons.
The downside is cost and the need for a stable donor supply. It’s a permanent solution, but you’ll still need medication or lasers to protect existing hair from further loss.
Saw Palmetto is a plant extract marketed as a natural DHT blocker. Its potency is far lower than finasteride, and clinical data are mixed. Some users report a slight thickening after three months, but it’s not a reliable stand‑alone therapy.
It’s safe for most men, but because it can interact with hormonal medications, you should check with a GP before adding it to your regimen.
Prescription drugs like finasteride and dutasteride are covered by the NHS in some cases, but most men pay privately. A typical 12‑month supply of finasteride from a private pharmacy runs £210‑£300, while dutasteride sits a bit higher. Minoxidil is readily available at supermarkets for as little as £25 a year.
Device costs (LLLT caps) vary from £300 to £900, and clinics charge £1,200‑£2,500 for a full PRP course. Hair transplant prices depend heavily on graft count and surgeon reputation, ranging from £4,000 for a modest restoration to over £12,000 for extensive coverage.
Finasteride’s most debated risk is persistent sexual dysfunction, reported by a small subset (<2%) of long‑term users. The FDA added a label warning in 2018; British dermatologists advise regular follow‑up.
Dutasteride shares these risks, plus a greater impact on PSA, which could mask early prostate cancer detection. Minoxidil’s main issue is local irritation; people with sensitive skin may prefer a foam formulation.
LLLT and PRP have negligible systemic risks, but improper laser use can cause eye injury-always wear the provided goggles.
If you’re comfortable with a daily pill and want proven DHT suppression, finasteride remains the go‑to. Pair it with minoxidil for a synergistic boost if you have moderate thinning. For men who can’t tolerate finasteride’s sexual side‑effects, dutasteride or a low‑dose finasteride‑plus‑LLLT combo may work better. Women and those avoiding pills should start with minoxidil or explore PRP and LLLT, while hair transplant delivers a permanent fix for those with sufficient donor hair and budget.
Finasteride is not licensed for women in the UK because of potential birth‑defect risks. Post‑menopausal women sometimes receive it off‑label, but the evidence is limited. Women should stick to minoxidil or discuss PRP with a dermatologist.
Most men notice a slowdown of shedding within three months and visible regrowth between six and twelve months. Patience is key-stopping the drug will usually reverse gains within a year.
Yes. The two act via different pathways (hormonal vs vascular) and many dermatologists prescribe them together for additive effect. Monitor skin irritation from minoxidil and any sexual side‑effects from finasteride.
While dutasteride cuts DHT more aggressively, it also raises the likelihood of sexual dysfunction and can lower PSA levels, complicating prostate screening. Discuss these trade‑offs with your GP or urologist.
Clinical studies show modest density gains (10‑15%) in about a third of users when used consistently for six months. They’re most effective as an adjunct to medication, not as a solo cure.
A typical regimen includes three initial sessions one month apart, then maintenance every 6‑12 months depending on response. Results tend to plateau after two years.
Because its DHT‑blocking power is weak, saw palmetto may only offer a subtle benefit for mild thinning. If budget allows, combine it with minoxidil, but don’t rely on it as a primary treatment.
Roshin Ramakrishnan
5 October, 2025 . 19:20 PM
Hey folks, thanks for sharing this deep dive, it’s super helpful, especially for anyone who’s just starting to navigate the hair‑loss maze, you’ve covered the basics and the nuances, and the side‑effect sections are honestly a lifesaver, I’d add that keeping a simple diary of any changes can really pinpoint what works for you, and don’t forget to check if your GP can cover any of the prescription costs under the NHS, it can make a big difference in the long run.