Finasteride for women: Risks, Safety Issues, and Alternatives

Key Takeaways:

• What is finasteride used to treat? Finasteride is a medication approved for pattern hair loss in men
  
• Can women be prescribed finasteride for hair loss? It is sometimes also prescribed off-label to women for female pattern hair loss
  
• How strong is the evidence for using finasteride in women? Evidence for its use in women is currently uncertain; more research is required.
  
• Can finasteride be used during pregnancy? It must not be used during pregnancy because it risks harming the development of the male foetus.
  
• Which medication is usually tried before finasteride in women? Topical minoxidil is the most commonly used medication for female pattern hair loss used first-line before finasteride.

You may have heard about finasteride as a medication to treat hair loss. It is most often recommended for use in men. This article discusses the evidence for its use in women, side effects, and alternatives.

What is Finasteride?

Finasteride is a medication that reduces a potent testosterone-related hormone called dihydrotestosterone(DHT)

It is this hormone, DHT, which is responsible for causing the thinning and shortening of hair commonly seen in pattern hair loss. 

The effects of reducing hair loss in susceptible hair follicles are brought about by lowering the amount of this hormone in your body. 

Is Finasteride Approved For Women?

Finasteride is not approved for use in female pattern hair loss. However, some doctors may prescribe finasteride to you for this purpose off-label.^* This is usually after you have completed menopause but can be prescribed before then, if you meet the criteria.¹

*This means prescribing a medication outside of its official licence when a doctor believes the potential benefits outweigh the risk.

When might a specialist consider it?

It may be suitable for you to take finasteride as a woman when all of the following apply:

• You have been diagnosed with female pattern hair loss
• You have already tried minoxidil, but it has proven ineffective or unsuitable
• You have completed menopause
• You understand that the benefits are uncertain and the treatment is an off-label prescription in women.¹

Occasionally, you may be able to get finasteride on prescription if you are premenopausal, have severe or androgen-related hair loss, and can reliably avoid pregnancy.

“I tend to recommend my female patients speak with a Dermatologist before starting Finasteride. It requires careful counselling and monitoring with specialist care to ensure they aren’t putting themselves or any potential child in their womb at risk” 

Dr Roshan Vara, Co-Founder and Surgeon at The Treatment Rooms London

What is the Difference Between Oral and Topical Finasteride?

• Oral finasteride is ingested in tablet form, meaning it has more of an effect over the whole body.
  
• Topical finasteride, as it is applied locally to the scalp, is believed to impact more locally, closer to the area where it is applied, and less systemically.

Does Finasteride Work for Women’s Hair Loss?

It remains to be seen whether finasteride is of major benefit in female pattern hair loss. Most of the evidence we have has been studied in men. This does not necessarily translate to women, where female pattern hair loss is not as directly linked to androgens (male hormones).

What Does the Research Show?

In one study of women, it was found that 2.5mg a day of finasteride showed improvement in hair appearance, using photographs of the change as evidence.² Another previous study at 1 mg a day showed no difference when compared to a placebo. 

Most of these studies were carried out in postmenopausal women. It is deemed too risky to perform such studies in women of childbearing age due to the impact it can have on the foetus.³ Overall, more research needs to be carried out in women before it is conclusively proven to show benefit. 

There is emerging evidence that looks promising for topical finasteride. It has been shown to reduce hair loss and improve hair growth. The effect is more limited to the scalp and avoids a lot of the systemic side effects, which is particularly relevant in women; however, again, more research needs to be done to decide how beneficial it is compared to other medical options.^4,5

How strong is the evidence?

The evidence for Finasteride’s use is limited in women, compared to that established in men.

Is Finasteride Safe for Women?

Finasteride is NOT to be taken by women who are pregnant or planning pregnancy.

The main concern around using finasteride in pregnant women is its effect on a growing foetus. It has been shown to cause abnormalities of the genitalia in male foetuses; this is because of its effect on blocking testosterone from changing to the more potent dihydrotestosterone(DHT), a hormone responsible for the development of male sexual organs.⁶

What if a woman could become pregnant?

Any off-label use in women of childbearing age will require a discussion about reliable contraception and future pregnancy plans. This is to ensure a woman taking Finasteride who could become pregnant takes strict precautions against conceiving. 

What about trying to conceive, IVF, or breastfeeding?

Finasteride should not be used while pregnant or trying to conceive. During breastfeeding, the safety of finasteride has not been established. If you are undergoing fertility treatment or have any other concerns, discuss them with your doctor, who will be able to work through options, including alternative hair loss treatments, with you.

Can pregnant women handle finasteride tablets?

If you are pregnant or may become pregnant, you should not handle crushed or broken finasteride tablets. You may come into contact with, and end up absorbing, the active ingredients.

What Are The Possible Side Effects Of Finasteride In Women?

The rate and occurrence of female-specific side effects are uncertain because there have not been many studies carried out in women. The side effects reported in people so far are as follows:

Sexual and reproductive effects

• Reduced libido or other sexual symptoms.
  
• Reported menstrual changes.

Breast symptoms

• Breast tenderness or enlargement.

Mood effects

Mood effects such as depressed mood and, less frequently, suicidal ideation have been reported in people being treated with finasteride 1mg. ^6,7

Other reported effects include:

• Headache, dizziness, and allergic reactions.
  
• Irritation of the scalp (with topical preparations).

What Are The Alternatives To Finasteride For Women?

There are alternatives to finasteride when looking to treat your hair loss. These include:

Topical minoxidil

• This is the most common first-line medication for female pattern hair loss.  It currently has more established evidence behind it than finasteride.

Low-dose oral minoxidil

• This is prescribed off-label like finasteride. It avoids the difficulties experienced with applying topical minoxidil. You may, however, experience hair growth in undesirable parts of your body such as your face.

Non-drug and procedural alternatives

• Low level laser therapy (LLT)
  
• Artificial cosmetic options such as wigs, hair fibres or scalp micropigmentation
  
• Hair transplant: a possible option for selected women with stable hair loss and adequate donor hair, but may also benefit from continued use of medicines alongside.²

Conclusion

In conclusion, finasteride is a treatment option in certain women that is being studied further. It currently has limited evidence for its use and should be avoided in women of childbearing age.

The topical form is promising, and it manages to avoid whole-body side effects. Speak to your doctor about any concerns you have and whether this is the right option for your individual circumstances.

References:

1. National Institute for Health and Care Excellence. Female pattern hair loss (female androgenetic alopecia): Management. NICE Clinical Knowledge Summaries. Accessed 31 July 2026. NICE CKS management page 
   
2. Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, Lobo RA, Olsen EA. Female pattern hair loss and androgen excess: a report from the multidisciplinary Androgen Excess and PCOS Committee. J Clin Endocrinol Metab. 2019;104(7):2875–2891. doi:10.1210/jc.2018-02548.
   
3. Price VH, Roberts JL, Hordinsky M, Olsen EA, Savin R, Bergfeld W, Fiedler V, Lucky A, Whiting DA, Pappas F, Culbertson J, Kotey P, Meehan A, Waldstreicher J. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. J Am Acad Dermatol. 2000;43(5 Pt 1):768–776. 
   
4. Nobari NN, Roohaninasab M, Sadeghzadeh-Bazargan A, Goodarzi A, Behrangi E, Nikkhah F, et al. A systematic review of clinical trials using single or combination therapy of oral or topical finasteride for women in reproductive age and postmenopausal women with hormonal and nonhormonal androgenetic alopecia. Adv Clin Exp Med. 2023;32(7):813–823. doi:10.17219/acem/157990. 
   
5. Lee SW, Juhasz M, Mobasher P, Ekelem C, Mesinkovska NA. A systematic review of topical finasteride in the treatment of androgenetic alopecia in men and women. J Drugs Dermatol. 2018;17(4):457–463. PMID: 29601622; PMCID: PMC6609098. Available from: PubMed. 
   
6. Organon Pharma (UK) Limited. Propecia 1 mg film-coated tablets: Summary of Product Characteristics. Electronic Medicines Compendium. Updated 14 July 2026. Available from: https://www.medicines.org.uk/emc/product/2194/smpc
   
7. Medicines and Healthcare products Regulatory Agency. Finasteride and dutasteride: updated safety warnings for psychiatric side effects and sexual dysfunction. Drug Safety Update. 2026;19(10):1. Published 11 May 2026. Available from: GOV.UK.