Finasteride and Hair Loss: The Risk-Benefit Balance for Young Men

Hair loss in young men is often due to androgenic alopecia, which is more than just a cosmetic issue. For many, it strikes at the core of their identity, confidence, and social standing. Society may tell us that appearance shouldn’t matter, but evolutionary biology suggests otherwise. In every species, from peacocks to primates, outward physical traits play a role in mating and social hierarchies. Humans are no exception, and hair is a significant part of that equation.

I’ve prescribed finasteride for decades, and I’ve taken it myself for just as long. At 68, I have a full head of hair, no prostate symptoms, and a low PSA. I can’t run my life counterfactually—I can’t know what would have happened had I not taken the drug—but the benefits, at least in my case, are tangible. I also know plenty of men who have taken finasteride without issue. Like any medical intervention, it comes with risks, but the recent media focus on worst-case scenarios, such as those highlighted in The Wall Street Journal’s recent article, doesn’t capture the full reality.

Understanding Male Pattern Hair Loss

What is Finasteride?

Finasteride is a medication specifically designed to treat male pattern hair loss and benign prostatic hyperplasia (BPH). As a 5-alpha-reductase inhibitor, finasteride works by blocking the conversion of testosterone to DHT, thereby reducing DHT levels in the body. This reduction helps to slow down hair loss and can even promote hair growth. Finasteride is available in two strengths: a 1mg dose for treating male pattern hair loss and a 5mg dose for managing BPH. By targeting the hormonal pathway responsible for hair loss, finasteride offers a scientifically-backed solution for those looking to maintain or restore their hair.

The Psychological and Social Weight of Male Pattern Hair Loss

For many young men, hair loss isn’t just about losing strands of hair—it’s about losing status. For many, to lose hair is to lose a part of their identity and social standing. Some will say that embracing baldness is a viable option, and for some men, it absolutely is. But we don’t treat obesity with an encouraging pat on the back and a suggestion to embrace the extra weight. We offer solutions because we recognize that people’s self-image affects their well-being. The same logic applies to hair loss.

There’s a reason men take care of their bodies, hit the gym, dress well, and groom themselves. It’s about confidence, social positioning, and, ultimately, attraction. Hair plays a role in this. A young man going bald in his early twenties faces a different reality than a man in his forties. He’s in the thick of dating competition, and while some men can own the bald look, most don’t want to roll those dice.

One young man I know started finasteride as part of a broader hair restoration plan. At 26, he had a receding hairline that was affecting his confidence. He was hesitant at first, worried about side effects, but ultimately chose to move forward. A year later, his hair had thickened, and he felt like he had reclaimed a part of himself that was slipping away. His dating life improved, his confidence in social settings skyrocketed, and he felt more at ease. The transformation wasn’t just physical—it was psychological. And isn’t that what most medical treatments aim to do?

The Role of FUE and Finasteride in Long-Term Hair Maintenance for Androgenetic Alopecia

Many young men undergoing hair restoration opt for follicular unit extraction (FUE), a process in which individual hair follicles are transplanted from the back of the head to the balding areas. These transplanted hairs tend to have a different growth cycle than those affected by androgenetic alopecia, and while they often take hold in their new location, they are not immune to the same hormonal forces that caused the initial hair loss.

In the first six to seven months post-transplant, these newly relocated hairs struggle to adjust to their new environment. They go through a phase of shedding, re-growth, and eventual stabilization. While the FUE procedure gives a patient a refreshed hairline, the surrounding native hair—especially near the crown—continues to thin unless properly maintained. Without finasteride, a man may find that a year or two after his transplant, he develops a stark contrast between the stable transplanted area and the newly receded zones beyond it. This can result in an effect reminiscent of a “Dominican monk” pattern—where the hairline looks strong, but a noticeable thinning forms just beyond the crest of the restored hair.

This is why many leading hair transplant surgeons strongly recommend finasteride post-transplant, especially for young men. It helps protect the native, non-transplanted hair from continued recession, ensuring a more uniform, natural appearance over time. Without it, men may find themselves needing additional transplants as their natural hairline continues to retreat, leading to a cycle of repeated procedures. If one is already committed to the investment, discomfort, and healing time of an FUE procedure, it makes sense to maximize and protect the results with a medication proven to slow hair loss. Finasteride is specifically recommended post-transplant to treat male pattern baldness, reducing dihydrotestosterone (DHT) levels in the scalp and improving hair density. “Melvin” from Hair Transplant Network posted this provocative image, but his recommended alternative was topical finasteride (over the tablets), but he acknowledged it didn’t work as well. He also stated that young people getting the hair transplant should strongly consider taking finasteride (or other 5-alpha-reductase inhibitor medication) tablets.

Finasteride Interactions and Contraindications

While finasteride is effective for many, it is important to be aware of potential interactions and contraindications. Finasteride can interact with certain medications, including alpha-blockers, which are used to treat high blood pressure and BPH, as well as some antidepressants and antifungals. Additionally, finasteride is contraindicated in women and children due to the risk of birth defects and other serious side effects. Men with a history of breast cancer or liver disease should also avoid taking finasteride. Consulting with a healthcare provider is essential to ensure that finasteride is a safe and appropriate option for your specific health profile.

Combination Therapy for Hair Loss

For those seeking to maximize their hair restoration efforts, combination therapy can be an effective approach. Finasteride is often used in conjunction with other treatments to enhance results. One common combination is finasteride and minoxidil, a topical medication applied directly to the scalp. Studies have shown that this combination is more effective than using either medication alone. Additionally, finasteride can be paired with low-level laser therapy (LLLT), a non-invasive treatment that uses low-level lasers or light-emitting diodes to stimulate hair growth. By combining these therapies, individuals can tackle hair loss from multiple angles, increasing the likelihood of achieving and maintaining a fuller head of hair.

The Risks and the Reality

The recent Wall Street Journal article “They Wanted a Quick Fix for Hair Loss. Instead, These Young Men Got Sick” highlighted extreme cases of finasteride side effects, including erectile dysfunction, particularly from young men who obtained it through telehealth services like Hims and Keeps. Their experiences are valid, and for some, the drug may indeed cause significant adverse reactions. But how common are these cases?

Clinical trials suggest that sexual side effects occur in about 3.8% of men, while placebo groups report a 2.1% occurrence. The real risk may be slightly higher or lower depending on the individual, but these numbers suggest that the overwhelming majority of men tolerate finasteride well. The problem is that those who experience no issues don’t make headlines. Instead, the focus remains on the horror stories.

It’s also important to put these risks into perspective. Exercise carries risks—pulled muscles, joint injuries, even long-term wear and tear. Yet we encourage young men to work out because the benefits far outweigh the downsides. We don’t tell them to stop lifting weights because a few people develop shoulder injuries. We tell them to be informed, lift properly, and manage risk accordingly. The same logic applies to finasteride.

The Unspoken Benefits

One aspect that often gets overlooked in discussions about finasteride is its potential long-term benefits beyond hair loss prevention. The drug was originally developed to treat benign prostatic hyperplasia (BPH), and long-term users may be reducing their risk of an enlarged prostate later in life. Some research even suggests a potential protective effect against prostate cancer, though there is a debate about the risk of high grade prostate cancer. At the very least, a man who takes finasteride is unlikely to experience significant prostate growth, which, for many men, becomes an issue with age.

Young men considering finasteride aren’t necessarily thinking about their prostate health decades down the road, but the benefit is there. In the same way that some men take creatine to improve workout performance while also gaining neuroprotective benefits, finasteride may offer more than just hair retention.

Should Finasteride Tablets Even Be Prescription-Only?

A larger discussion worth having is whether finasteride should require a prescription at all. Finasteride tablets, currently prescription-only, are used to treat male-pattern hair loss (androgenetic alopecia) and benign prostatic hyperplasia (BPH). Minoxidil, another hair loss treatment, is available over the counter. In countries like Mexico, medications like sildenafil (Viagra) are easily accessible without a doctor’s note. In the U.S., prescription requirements are as much about regulatory gatekeeping as they are about safety.

Physicians have historically expanded their professional influence through prescription rights, making it difficult for consumers to access certain medications without an intermediary. While that system has its merits in cases of serious risk, does finasteride truly require this level of oversight? The argument that it should be controlled because of potential side effects doesn’t hold up when we look at the open availability of other drugs with far more severe risks. If a man experiences side effects from finasteride, he can simply stop taking it. His hair loss will resume, but that’s a manageable consequence.

In an era where marijuana clinics are on every corner and weight-loss drugs are being prescribed at record levels, it’s worth questioning whether finasteride should remain under lock and key. Many young men feel more comfortable navigating hair loss treatments on their own, and if access were as easy as buying minoxidil at the pharmacy, we might see a more informed, balanced approach to use.

Final Thoughts

Finasteride isn’t for everyone, but it shouldn’t be demonized either. For many men, it offers a simple, effective solution to a problem that carries significant social and psychological weight by reducing DHT levels in the prostate gland. While side effects exist, they affect a minority of users, and those who experience issues can discontinue use.

The conversation around finasteride should be one of balance, not fear-mongering. Hair loss is a legitimate concern for young men, and they deserve access to solutions without being shamed for wanting to improve their appearance.

Peak Masculinity
Starts Here

By Dr. Ryan Welter

August 16, 2025

The Best Version
of You Starts Here

Schedule a consultation with Dr. Ryan Welter