What if you can’t take finasteride (Brand name: Propecia)? Many men are very concerned about the risk of possible sexual side effects, and understandably so, given that in the clinical trials approximately 2% of men did have some decrease in either sexual desire, sexual performance, or sperm count. Now, even though we know that these symptoms do resolve upon discontinuation of the drug, and because it has a very short half-life, it’s actually out of your system in less than a week, there are still a lot of men who just don’t want take it. So, what are your options? One is to suggest the oral version of minoxidil. Now, minoxidil has been around since the ’80s, under the trade name Loniten, as a blood pressure medication. When researchers found that it grew hair Johnson & Johnson said, “let’s do clinical trials,” and that was the birth of Rogaine.

Many men don’t want use topical minoxidil because of the film and feeling of their hair. So, if you can’t or won’t take oral finasteride, sometimes oral minoxidil is a great alternative. It comes as a 2.5 mg pill, and we generally start off with about one-half pill daily, and then we let patients increase to either one pill or two pills as tolerated. Some patients who have a little bit of high blood pressure may benefit from the blood pressure lowering effects of oral minoxidil. The second option is to use a topical version of finasteride, and there was data published recently in the Journal of Drugs in Dermatology showing that at a 0.25% solution, it can help block the production of dihydrotestosterone (DHT).

Unfortunately, is not commercially available, you have to get it compounded through your local pharmacy, and it isn’t something you can get at a big box pharmacy, you have to find your local mom-and-pop compounding pharmacy. The third option is to do a plant-based version of finasteride. And there are several available. The one that has been first described is saw palmetto, and we have one small study investigating the use of oral 320 mg daily, and it showed about a 30-40% increase in hair regrowth. Unfortunately, it was not as significant as was seen in the finasteride group, but at least it is something, and it is an alternative. The other option is to do what’s called pumpkin seed oil. Pumpkin seed oil is another plant-based five-alpha reductase inhibitor. And if you don’t want to buy each of these individually, you can actually purchase a prostate supplement that has both saw palmetto and pumpkin seed oil. However, you do need to read the ingredients carefully and make sure that they contain what you’re looking for.