Androgenetic alopecia (pattern hair loss) is hormonal. The enzyme 5-alpha reductase converts testosterone into DHT (dihydrotestosterone), a hormone that binds to hair follicles on the scalp, causing them to miniaturize over time. Finasteride blocks 5-alpha reductase at the hair follicle, reducing scalp DHT by approximately 64% in clinical trials. When DHT stops attacking the follicles, miniaturization halts and the hair cycle normalizes.
Obsidian Genetics offers four oral options: Finasteride 1mg alone (FDA-approved monotherapy), a Minoxidil 1mg + Finasteride 1.25mg compounded combination tablet, a Premium 5-Active compounded capsule (Min 1mg / Fin 0.5mg / Caffeine / Zinc Gluconate / Folic Acid), and a Dutasteride 0.5mg mono capsule for patients seeking more potent DHT suppression than finasteride provides. Your provider matches the right formulation to your hair-loss pattern, prior response, and tolerance.
Who these are for: Men of any age, and postmenopausal women under provider review (finasteride is prescribed off-label for postmenopausal female pattern hair loss). Premenopausal women and women who could become pregnant should not take finasteride — see the Women's Hair Loss page for the four female-specific formulations (oral Min/Spiro/Biotin capsule, or three retinoid-free topicals) instead.
For topical-only options, see the Topical Hair Loss page — four compounded formulations available: Premium 10-Active (Fin+Dut+Spiro+Latanoprost+Calcipotriene), Pro 7-Active (Min/Fin/Tretinoin/Keto/Caf/Mel/Rosemary), Dutasteride 4-Active, and Finasteride 4-Active.
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Male pattern hair loss responds directly to DHT suppression. These numbers show the mechanism and efficacy of finasteride in real clinical practice.
Finasteride 1mg (Propecia) is FDA-approved for male pattern hair loss. Results vary by individual. Continued daily use is required to maintain benefit. Stopping finasteride results in reversal of effects within months. Success rates highest when started early in hair loss progression.
Finasteride specifically inhibits Type II 5-alpha reductase, the enzyme responsible for converting testosterone into DHT. This occurs at the hair follicle itself, where Type II reductase is most concentrated. By blocking this enzyme, finasteride prevents the formation of the hormone that attacks susceptible hair follicles.
The result is a reduction in scalp DHT of approximately 64 percent (Drake 1999). DHT is the critical factor in androgenic alopecia; it binds to androgen receptors in genetically susceptible follicles, triggering miniaturization. When DHT levels drop, this process stops. The follicles are no longer under hormone-driven attack.
Once DHT suppression begins, miniaturized follicles stabilize and the hair cycle normalizes. In many cases, partially miniaturized follicles recover, producing thicker, longer hairs. This is most pronounced when finasteride is started early, before follicles become completely atrophied. Continued use maintains the effect; stopping finasteride allows DHT to rise again and hair loss to resume.
Optimal timing for finasteride initiation. At early stages, follicles are miniaturized but not completely atrophied. When DHT is suppressed, recovery is most robust. Most men in this category achieve visible regrowth and sustained density improvement. The benefit is both preventive (stopping further loss) and restorative (recovering lost density).
Finasteride still provides significant benefit, though recovery is less dramatic than in earlier stages. Stabilization of existing hair is reliable; significant regrowth is less certain. Many men see slowing of loss and modest density improvement. The earlier you start, the better the outcome at this stage. Some moderate-stage patients benefit from combining finasteride with topical minoxidil.
Finasteride offers limited restoration in severe hair loss, as many follicles have become completely non-functional. However, it can stabilize remaining density and prevent further progression. Advanced-stage patients should discuss realistic expectations with their provider. The goal at this stage is halting loss and maintaining what remains, rather than reversing extensive baldness.
DHT suppression begins immediately, but the hair cycle lags behind. Some patients experience increased shedding in the first 1-2 months as resting hairs cycle out naturally. This is normal and expected; it means the medication is working. Continue your daily dose. Shedding phase typically resolves by month 3.
Hair shedding normalizes. Stabilization of existing density becomes visible. Some men notice subtle improvements in hairline or crown thickness. The foundation is being laid for recovery. Consistency is critical at this stage; results require continuous DHT suppression.
Measurable hair density improvement begins to appear. Hair count increases; hairline may show early signs of recovery. Improvements are modest but cumulative. Many patients first notice their barber or family members commenting on improved hair thickness at this stage.
Full response to finasteride is typically apparent by 12 months. Hair density improvement peaks around this timeframe. Many men see significant hairline recovery and crown density restoration. Continued daily use is required to maintain these results. Long-term success requires lifelong consistency.
Finasteride is a prescription medication. Your Obsidian Genetics provider will review your full health history before prescribing.
Sexual side effects occur in a minority of users and are typically reversible. A small percentage of men report decreased libido, erectile dysfunction, or reduced ejaculate volume. These effects affect a minority of users and typically occur within the first 1-2 months of treatment. In the majority of cases, these effects resolve after discontinuation of the medication. Your care team can discuss risk mitigation strategies if this is a concern for you.
All four oral options address the same underlying biology — DHT-driven follicle miniaturization — with different combinations of mechanisms and potencies. Your provider will confirm the right fit during intake. Here's a starting point.
FDA-Approved Monotherapy · From $90 / 3 mo
What it is: A daily 1mg finasteride tablet — the brand-name Propecia equivalent. Blocks 5α-reductase to reduce scalp DHT by ~64%.
Best for:
Why pick this: Decades of safety and efficacy data. The first-line oral choice for male pattern hair loss.
Compounded Combination Tablet · $ Coming Soon
What it is: A once-daily compounded tablet containing minoxidil 1mg + finasteride 1.25mg. DHT blockade plus systemic vasodilation in one pill.
Best for:
Why pick this: Two complementary mechanisms in one dose — DHT suppression plus follicular blood flow support. No daily topical application.
Min 1mg / Fin 0.5mg / Caffeine 0.2mg / Zinc Gluconate 25mg / Folic Acid 1mg · $ Coming Soon
What it is: A 5-active compounded capsule combining low-dose minoxidil and finasteride with three supporting cofactors: caffeine (follicular stimulant), zinc gluconate (modulates 5α-reductase activity at higher serum levels), and folic acid (methylation cofactor relevant to keratin synthesis).
Best for:
Why pick this: Lower minoxidil (1mg) and finasteride (0.5mg) doses with cofactor support — multi-mechanism approach with potentially better tolerability than higher single-active doses.
Dutasteride 0.5mg — once-daily compounded capsule · $ Coming Soon
What it is: A single-active compounded capsule of dutasteride at the FDA-approved BPH dose (off-label for AGA). Dutasteride is a dual Type I + Type II 5α-reductase inhibitor — roughly 3× more potent at suppressing scalp DHT than finasteride.
Best for:
Why pick this: Blocks both 5α-reductase isoenzymes (vs finasteride's Type II only). Same monitoring needs as finasteride (sexual side effects, PSA suppression). Not FDA-approved for hair loss in the US.
FDA Approval Status: Finasteride 1mg is FDA-approved for male pattern hair loss under the brand name Propecia. This is a standard generic medication manufactured to FDA standards. Obsidian Genetics prescribes the established, proven formulation approved for this indication. This is not a compounded or off-label preparation.
Women and Pregnancy: Finasteride is absolutely contraindicated in women of childbearing potential. The drug can cause abnormalities of external genitalia in male fetuses. Women must not handle crushed or broken tablets. If you are a woman of childbearing age, this medication is not for you. Men using finasteride do not expose partners to risk through sexual contact; however, pregnant women must not be exposed to the medication.
PSA and Prostate Screening: Finasteride lowers PSA levels by approximately 50 percent. Inform your primary care provider that you are taking finasteride before any prostate cancer screening or PSA testing. Your physician must account for this drug effect when interpreting results. This is a critical disclosure to your non-telehealth providers.
Not Medical Advice: The content on this page is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Consult a qualified healthcare provider before starting any new treatment. All Obsidian Genetics prescriptions are issued following a clinical review by a licensed provider.
Citations & Evidence: Scalp DHT reduction with finasteride 1mg: Drake L et al., J Am Acad Dermatol. 1999;41(4):550-554; PMID 10495374. Median scalp DHT decreased 64% on 1mg/day vs 13% on placebo. Systemic 5α-reductase inhibition and serum DHT reduction (BPH context): Gormley GJ et al., N Engl J Med. 1992;327(17):1185-1191 — landmark trial establishing finasteride's mechanism. Clinical efficacy in male pattern hair loss: Kaufman KD et al., J Am Acad Dermatol. 1998;39(4 Pt 1):578-589; PMID 9777765 — Phase III 2-year RCT (n=1,553) showed significant scalp hair count gains; ~83% of finasteride-treated men had no further hair loss at 2 years. Long-term follow-up: PMID 18573712 — 5-year data showing 93% relative decrease vs placebo in further visible hair loss. Timeline and dosing: FDA approval summary and clinical practice guidelines.
Dutasteride: Dutasteride is FDA-approved for benign prostatic hyperplasia (Avodart) and used off-label for androgenetic alopecia. The same monitoring considerations as finasteride apply (sexual side effects, PSA suppression), with potentially higher incidence given more potent dual 5α-reductase inhibition.