Finasteride vs. Minoxidil: Pros, Cons, and Which Is Right for You

Hair loss, including androgenetic alopecia, is a common concern among adults. According to the National Institutes of Health, this condition affects an estimated 50 million men and 30 million women in the United States. Two FDA-approved treatments for androgenetic alopecia are minoxidil and finasteride. Let’s explore how they work and which option may be best suited for your needs.

We strive to use gender-inclusive language to promote equality and avoid discrimination. However, we may use specific terms such as 'man' or 'woman' to accurately reflect the terminology used in referenced sources. In these cases, 'woman' refers to individuals assigned female at birth (AFAB) and 'man' refers to those assigned male at birth (AMAB).

What causes hair loss?

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Alopecia is the loss of hair in areas where it is generally present. It can be localized or widespread and affects individuals of any age. There are several causes of hair loss, and some common causes include hormonal hair loss after pregnancy, thyroid disease, and iron deficiency anemia.

Androgenetic alopecia (pattern hair loss) is one of the most common forms of hair loss. It is a hereditary condition, or it is caused by increased levels of dihydrotestosterone (DHT), typically after puberty. Excessive amounts of DHT lead to shrunken hair follicles, which can shorten the hair and make it thinner. In people assigned male at birth, this hair loss generally starts around the temples and eventually progresses to the hairline, causing it to recede. In people assigned female at birth, hair typically becomes thinner at the top of the head and spreads.

Hair loss can be very stressful and adversely impact a person’s quality of life. It is best to start treating hair loss early to prevent further hair thinning. Additionally, treatments like minoxidil are most beneficial in the early stages of hair loss as they cannot restore a full head of hair.

What is finasteride?

Finasteride is a medication approved by the FDA to treat several conditions, including androgenetic alopecia in men. It is a 5-alpha-reductase inhibitor (DHT blocker) that decreases the amount of DHT in the body, slowing hair loss and helping promote hair growth.

Finasteride side effects

Several side effects are important for individuals to know before starting treatment with finasteride. Some of the significant side effects include:

  • erectile dysfunction
  • decreased libido
  • mood changes and depression
  • testicular pain
  • gynecomastia (enlargement of male breasts)
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Who should use finasteride?

Since oral finasteride is FDA-approved to treat androgenetic alopecia in men, it should not be used by women. It is also not recommended for treating hair loss in children.

What is minoxidil?

Minoxidil is a topical medication available over the counter, and it is also FDA-approved for the treatment of androgenetic alopecia. It is available as a minoxidil solution and foam and is thought to stimulate new hair growth by increasing blood flow to the scalp. It also helps to slow hair thinning by shortening the resting phase of hair growth and prolonging the growth phase to help improve hair thickness.

Minoxidil side effects

Since minoxidil is applied topically, most side effects are related to skin and scalp irritation. Common side effects include:

  • itchy scalp
  • dryness
  • flaking
  • burning

Who should use minoxidil?

Minoxidil was initially approved for the treatment of hair loss only in men. However, it is now FDA-approved for use in adult individuals for the treatment of androgenetic alopecia. It should also be noted that minoxidil is not recommended for use in pregnant or breast-feeding people. Minoxidil may also make skin more sensitive to sunlight. Wearing protective clothing and sunscreen when using minoxidil is suggested.

Finasteride and minoxidil may potentially cause other serious side effects, such as a rash, difficulty breathing, or swelling of the face and hands. If you experience any of these side effects, seek medical attention immediately.

Finasteride vs. minoxidil: key differences

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When considering which medication to help manage your hair loss, there are some important differences to know. The table below lists those key differences.

Oral finasterideTopical minoxidil
How it worksDecreases the production and synthesis of dihydrotestosterone (DHT)Vasodilator that increases blood flow to the scalp which helps to promote hair growth
Formulations and dosages for hair loss 1 mg oral tablet5% foam, 5% solution, 2% solution
Usage and applicationFinasteride dosage: One 1mg tablet by mouth once dailyMinoxidil application: Topical hair loss treatments are applied directly to the scalp twice daily. *Women using the 5% foam should only apply it once daily.
Availability and FDA approvalAvailable by prescription only and FDA approved only for male pattern baldness Available over the counter and FDA approved for pattern baldness in both males and females
EffectivenessBest used for hair loss due to increased DHT Best for improving blood flow for hair growth stimulation

Can you use finasteride and minoxidil together?

Yes, you can use finasteride and minoxidil together. In fact, using topical minoxidil in conjunction with finasteride is common. As the medications work differently, using them together may be more effective at slowing hair loss than using each alone.

Long-term results and maintenance

To see results, each product should be used consistently as directed. With minoxidil, you can expect to start seeing results after four months. However, it may take up to a year before noticing a difference. On the other hand, you may notice a difference with finasteride after three months of therapy. Similarly to minoxidil, it may take up to a year to see noticeable results. Continued use of both products is required to maintain results. If you stop using either product, you may again experience hair loss.

How to choose the best treatment for you

Several factors should be considered when picking the best product. If you are a female, minoxidil is the only treatment of the two approved by the FDA for androgenetic alopecia. It can help stimulate hair growth and slow hair loss. Additionally, if you are pregnant, plan to become pregnant, or are breastfeeding, you should speak with your doctor before starting minoxidil.

Alternatively, finasteride is approved for use in men and is effective at reducing the levels of DHT, which will help to slow hair loss. Not only is finasteride to be used only in men, but pregnant individuals should also not take tablets of finasteride as they may be harmful to their babies.

Additionally, your preference will play a role in deciding which treatment to use. For instance, minoxidil may be a more suitable option if you prefer using a topical product. Before using minoxidil or finasteride, you should speak with your doctor and tell them about any other medications, vitamins, or supplements you are taking, as they may interact with finasteride or minoxidil.

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Androgenetic alopecia can be a distressing condition, and although there are limited treatment options, finasteride and minoxidil are two effective options to help slow hair loss. Consult with your doctor about the best treatment for you.

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