Finasteride vs. minoxidil for pattern hair loss

What causes pattern hair loss

Androgenetic alopecia, the most common type of hair loss in both men and women, is driven by genetics and by dihydrotestosterone (DHT), a potent form of testosterone. In susceptible follicles, DHT gradually shrinks them, so each new hair grows thinner and shorter until the follicle produces only fine, barely visible hair.

Because the process is gradual, both medicines work best when started early, while follicles can still respond. Neither can bring back follicles that are long gone.

How each medicine works

Finasteride is a 5-alpha reductase inhibitor. It blocks the enzyme that converts testosterone into DHT in the scalp, slowing or stopping the shrinking process. It's taken as a 1 mg tablet daily for hair loss and tends to work best at the crown.

Minoxidil was first used as a blood pressure medicine. Applied to the scalp, it's thought to widen small blood vessels and prolong the growth (anagen) phase of the hair cycle. It doesn't affect hormones. Topical minoxidil is available over the counter in strengths up to 5%.

Timelines and what to expect

Patience is essential with both. Minoxidil labeling says it may take at least four months, and up to a year, to see an effect. With finasteride, improvement can take at least three months, and if there's no benefit after 12 months, further treatment is unlikely to help. Some people notice extra shedding in the first weeks of either treatment as old hairs make way for new growth.

Results last only as long as you keep using them. Most new hair from minoxidil is lost within a few months of stopping, and gains from finasteride are typically lost within about a year.

A practical tip: take a few clear photos of your hairline and crown in the same lighting before you start, then repeat every three months. Day-to-day changes are too small to notice in the mirror, and photos make it much easier for you and your clinician to judge whether treatment is working.

Side effects and cautions

Finasteride's best-known side effects are sexual: lower desire, ejaculation changes and erection problems in a small number of men. These usually improve, but rare reports describe symptoms that persist. Finasteride also lowers PSA, so tell anyone checking your prostate that you take it. It's only for men, and women who are or could become pregnant should not handle crushed or broken tablets.

Topical minoxidil commonly causes scalp itching, dryness, flaking or irritation, often from the alcohol or propylene glycol in the formula. Rarely, enough is absorbed to cause rapid heartbeat, dizziness, swelling or unexplained weight gain, which should be reported right away.

Using them together, and our combination

Because they act on different parts of the problem, combining finasteride and minoxidil often gives better results than either alone. HealifyMD offers a compounded 4-in-1 Hair Loss Treatment for $199 as a one-time purchase, which combines more than one hair-loss agent in a single product. Your clinician will review its ingredients with you before prescribing.

Compounded combinations are not FDA-approved, the FDA doesn't verify their safety, effectiveness or quality before they're sold, and combined formulas have less direct research behind them than the individual medicines. There is no FDA-approved topical finasteride.

Which might fit you

Your clinician will consider your sex, pattern and stage of hair loss, health history and preferences. These general patterns may help you prepare.

• Men with early crown or overall thinning who are comfortable with a daily pill: finasteride is often discussed, alone or with minoxidil
• Women with pattern thinning: minoxidil is the usual starting point; finasteride is not for women who could become pregnant
• You're worried about sexual side effects: minoxidil alone, or a frank discussion of finasteride's risks with your clinician
• You're trying to conceive with a partner, or have prostate concerns: tell your clinician before considering finasteride
• Sudden, patchy or rapid hair loss: get evaluated first, since thyroid disease, iron deficiency, stress or other conditions may be the cause