Finasteride vs. Minoxidil: How To Decide Which Is Best for You
A survey of men aged 18 to 49 found that 42% had moderate-to-severe hair loss.1 About half of all men over 50 have hair loss, as do many post-menopausal women. This equates to an estimated 50 million men and 30 million women in the U.S. 2 Finasteride and minoxidil are long-standing and effective hair-loss treatment options. Both medications have clinical studies showing their safety and efficacy, are Food and Drug Administration-approved, and since they work by different mechanisms, they can be used together.
Table of Contents
What Is Finasteride?
Androgenetic alopecia is due to an increased sensitivity to the androgen dihydrotestosterone (DHT) at the hair follicle. Finasteride inhibits Type II 5α-reductase, the enzyme that converts testosterone to DHT. Finasteride decreases DHT levels by up to two-thirds and slightly increases testosterone levels.3
What Is Minoxidil?
Minoxidil is a vasodilator that increases blood flow to the hair follicle, allowing more oxygen and nutrients to enter. Minoxidil also binds to ion channels in the hair follicles. It stimulates the production of endothelial growth factors, which may help to enlarge hair follicles and promote growth.4 Minoxidil reduces the length of the telogen phase of the hair growth cycle. However, the exact mechanism by which minoxidil works is unknown.
What Are the Side Effects of Finasteride?
Like most medications, finasteride has side effects, including the following:
- An inability to have or maintain an erection
- Breast enlargement or tenderness
- Chills or cold sweats
- Decreased sex drive
- Difficulty breathing or swallowing
- Lightheadedness or dizziness when standing
- Pain in the testicles
- Problems with ejaculation
- Skin rashes
- Swelling of the lips and face
- Swelling or bloating
- Weight loss
When taking finasteride, it is important to consider its potential impact on your sexual health. If you experience sexual side effects, talk to your doctor about a medication dosage change or other treatment options.
What Are the Side Effects of Minoxidil?
The common side effects associated with minoxidil include scalp itching, scalp scaling, excessive hair growth, and changes in hair color and texture.
The following minoxidil side effects are rare but more serious:
- Severe scalp irritation
- Unwanted excessive facial hair growth
- Chest pain
- Fast heartbeat
- Swelling in the hands and feet
- Rapid weight gain from fluid retention
- Vision changes
How Well Do Finasteride and Minoxidil Work?
Both finasteride and minoxidil have clinical studies supporting their safety and efficacy.
About one-third of men with male-pattern baldness and two-thirds of women with female-pattern hair loss rated minoxidil as effective.4,5 The 5% solution works better than the 2% solution when treating male-pattern baldness. At 48 weeks, users of the more concentrated solution experienced 45% more hair regrowth. Men who used the 5% minoxidil solution also had an earlier treatment response than men who used the 2% solution.6
In another study, almost two-thirds of participants reported that their treated area became smaller and that hair regrowth was rated as very effective or effective.7
In clinical studies of women aged 18 to 45 with mild-to-moderate hair loss, about 40% reported minimal hair regrowth after eight months, and 19% reported moderate hair regrowth. Another study showed that people using 2% minoxidil had eight more hairs per square centimeter, and those using the 5% solution had 12.4 more hairs per square centimeter than people using a placebo. A 5-year follow-up study showed peak hair regrowth occurred at one year.8
Finasteride is effective for people who are genetically predisposed to DHT sensitivity. It is not suitable for everyone. Hair regrowth with finasteride is expected in up to two-thirds of men with mild-to-moderate hair loss, and it prevents future hair loss in approximately 91% of men.9
In two clinical trials, 1,553 men between the ages of 18 and 41 were given either oral finasteride or a placebo for one year, and 1,215 men continued treatment for another year. The men’s hair count increased, hair loss slowed, hair growth increased, and hair appearance improved.10
What Forms of Finasteride and Minoxidil Are Available?
Finasteride is only available in pill form. It is dosed at 1 mg daily by mouth to treat androgenetic alopecia in men.
Minoxidil is available in a foam and liquid form as well as a pill. Each of these options has benefits and drawbacks.
Is It Safe to Take Finasteride and Minoxidil Together?
Finasteride and minoxidil are commonly prescribed together because they work through different mechanisms. In a small study, 85% of patients reported maintaining good hair density when taking a combination of finasteride and minoxidil.11 In another study, 80% of men treated with finasteride had improved hair growth, as did 59% of men using minoxidil 5% and 94% of men using a combination of finasteride and 5% minoxidil.
Talk to an Invigor treatment specialist to learn more about the benefits of finasteride and minoxidil and to develop a good hair loss treatment plan, an essential part of your overall age management plan.
- Rhodes T, Girman CJ, Savin RC, et al. Prevalence of male pattern hair loss in 18-49 year old men. Dermatol Surg. Dec 1998;24(12):1330-2. doi:10.1111/j.1524-4725.1998.tb00009.x
- DeVillez RL. The therapeutic use of topical minoxidil. Dermatol Clin. Apr 1990;8(2):367-75.
- Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. Journal of the American Academy of Dermatology. 2002;47(3):377-385. doi:10.1067/mjd.2002.124088
- Rundegren, J. A one-year observational study with minoxidil 5% solution in Germany: results of independent efficacy evaluation by physicians and patients. Journal of the American Academy of Dermatology, Volume 50, Issue 3, P91
- Suchonwanit P, Thammarucha S, Leerunyakul K. Minoxidil and its use in hair disorders: a review. Drug Des Devel Ther. 2019;13:2777-2786. doi:10.2147/dddt.S214907
- Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. Oct 1998;39(4 Pt 1):578-89. doi:10.1016/s0190-9622(98)70007-6
- Chandrashekar BS, Nandhini T, Vasanth V, Sriram R, Navale S. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. Indian Dermatol Online J. 2015 Jan-Feb;6(1):17-20. doi: 10.4103/2229-5178.148925. PMID: 25657911; PMCID: PMC4314881.