Finasteride Cost vs. Alternatives: A Full Clinical Comparison

Forms and products

Finasteride is available as an oral prescription tablet; Drugs@FDA lists no FDA-approved topical or injectable finasteride product [1][2].

One drug, two products

Propecia, the 1 mg tablet, is indicated for male pattern hair loss in men only; efficacy in bitemporal recession has not been established [1][3]. Proscar, the 5 mg tablet, is indicated for symptomatic BPH in men with an enlarged prostate, to improve symptoms and reduce the risk of acute urinary retention and of surgery [2][4]. The 5 mg dose is five times the hair-loss dose [3].

The labels state that adverse-reaction rates from the clinical trials of one drug cannot be directly compared with rates from another drug's trials. In three 12-month trials of 1 mg (945 men on drug, 934 on placebo), drug-related decreased libido was 1.8% vs 1.3%, erectile dysfunction 1.3% vs 0.7% and ejaculation disorder 1.2% vs 0.7%; 3.8% vs 2.1% reported one or more of these (p=0.04) [3].

PSA handling also differs. In men 18 to 41 on 1 mg, mean PSA fell from 0.7 to 0.5 ng/mL at month 12 [3]. The Proscar label reports an approximately 50% PSA reduction within six months and says PSA values should be interpreted using a new baseline after six months; for an isolated PSA value after six months, the label describes doubling it for comparison with ranges in untreated men [4].

Dutasteride

A 2019 meta-analysis of 15 placebo-controlled trials in 4,495 men with androgenetic alopecia found a relative risk of sexual dysfunction of 1.66 (95% CI 1.20 to 2.30) for finasteride 1 mg and 1.37 (0.81 to 2.32, not significant) for dutasteride 0.5 mg [5]. In a 24-week randomized trial of 416 men aged 21 to 45, dutasteride increased hair counts versus placebo in a dose-dependent fashion, and dutasteride 2.5 mg was superior to finasteride 5 mg at 12 and 24 weeks [8]. The finasteride labels also report that Gleason 8 to 10 prostate cancer occurred in 1% of dutasteride users vs 0.5% on placebo in a 4-year trial [3][4].

Minoxidil and ketoconazole

In a 12-month randomized study of 450 Chinese men with male pattern hair loss, 80.5% of those on finasteride 1 mg, 59% of those on 5% topical minoxidil and 94.1% of those on both showed improvement [9]. A 2002 open randomized study of 100 men compared finasteride 1 mg alone (30 men), finasteride plus 2% minoxidil (36), 2% minoxidil alone (24) and finasteride plus 2% ketoconazole shampoo (10) over one year: hair growth occurred in every group, results were best with finasteride plus minoxidil, and the finasteride-containing groups improved significantly more than minoxidil alone (p<0.05) [10].

Time on treatment and reported risk

The label says daily use for three months or more is usually needed before benefit is seen, that continued use sustains it, and that withdrawal leads to reversal of effect within 12 months [3]. In two 1-year trials of 1 mg in 1,553 men aged 18 to 41, hair count in a 1-inch circle of vertex scalp (baseline 876 hairs) was 107 hairs higher than placebo at 1 year and 138 higher at 2 years (P<0.001) [6].

The Propecia postmarketing section lists sexual dysfunction that continued after discontinuation [3]. Since August 2022 it also lists depression, suicidal ideation and behavior, and states these reports are voluntary, from a population of uncertain size, with a causal relationship that cannot reliably be established [3][7]. Neither Propecia nor Proscar carries a boxed warning [3][4]. Finasteride is contraindicated in pregnancy [3].