Minoxidil vs Finasteride: Which Is Better?
Both are proven hair loss treatments, but they work completely differently. Here's how to decide which one—or both—is right for you.
Quick Comparison
Finasteride
- How it works: Blocks DHT (the hormone causing hair loss)
- Format: Daily pill (1mg)
- Effectiveness: ~80% see improvement
- Best for: Stopping hair loss at the source
- Prescription: Required
Minoxidil
- How it works: Stimulates hair growth directly
- Format: Topical (2x daily) or oral pill
- Effectiveness: ~60% see improvement
- Best for: Stimulating new growth
- Prescription: OTC (topical) or Rx (oral)
The Fundamental Difference
Finasteride and minoxidil are the two main FDA-approved treatments for male pattern baldness, but they attack the problem from completely different angles:
Finasteride: Defense
Finasteride is a 5-alpha reductase inhibitor. It blocks your body from converting testosterone into DHT (dihydrotestosterone)—the hormone that causes hair follicles to shrink and eventually stop producing hair.
Think of it as: Stopping the attack on your hair follicles.
Minoxidil: Offense
Minoxidil is a vasodilator that increases blood flow to hair follicles. It also extends the growth phase of the hair cycle and may enlarge follicles, leading to thicker, longer hairs.
Think of it as: Actively stimulating new hair growth.
Key Insight
Because they work through different mechanisms, finasteride and minoxidil can be used together for a "defense + offense" approach. Research shows combination therapy is more effective than either treatment alone.
Effectiveness Comparison
Both treatments are clinically proven, but finasteride tends to show stronger results in head-to-head studies:
| Metric | Finasteride | Minoxidil (Topical) |
|---|---|---|
| Improvement rate | ~80% | ~52-60% |
| Stops further loss | Yes (primary effect) | Partially |
| Regrows hair | Yes (secondary effect) | Yes (primary effect) |
| Best area | Crown and mid-scalp | Crown (vertex) |
| Time to results | 3-6 months | 3-6 months |
A year-long study found that 80% of men treated with oral finasteride saw hair improvement, compared to 52% with 5% topical minoxidil. However, it's worth noting that minoxidil works well for many people, and individual responses vary significantly.
Side Effects Comparison
This is often the deciding factor for many men. The side effect profiles are very different:
Finasteride Side Effects
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•
Sexual side effects (2-4%)
Decreased libido, erectile dysfunction, reduced ejaculate volume. Usually resolve after stopping.
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•
Depression/anxiety (rare)
Some reports of mood changes, though causation is debated.
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•
Breast tenderness (rare)
Gynecomastia in <1% of users.
Most side effects resolve upon discontinuation. "Post-finasteride syndrome" is controversial and not universally accepted.
Minoxidil Side Effects
Topical:
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•
Scalp irritation
Dryness, itching, flaking—especially with alcohol-based formulas.
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•
Initial shedding
Temporary increase in hair fall before regrowth.
Oral:
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•
Body hair growth
Most common with oral form. Hair may grow on face, arms, etc.
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•
Low blood pressure
Dizziness, lightheadedness possible with oral form.
The Sexual Side Effect Question
Finasteride's potential sexual side effects are often the main concern. While they occur in a small percentage of users, they're significant enough that some men prefer to avoid finasteride entirely. If you're concerned about sexual side effects, minoxidil (or oral minoxidil) may be a better starting point.
Full Comparison Table
| Feature | Finasteride | Minoxidil (Topical) | Minoxidil (Oral) |
|---|---|---|---|
| How taken | 1mg pill daily | Applied to scalp 2x/day | Pill daily |
| Prescription | Required | OTC available | Required (off-label) |
| Mechanism | Blocks DHT | Increases blood flow | Increases blood flow |
| Primary benefit | Stops hair loss | Stimulates growth | Stimulates growth |
| Sexual side effects | Possible (2-4%) | No | No |
| Body hair growth | No | Minimal | Common |
| Scalp irritation | No | Common | No |
| Convenience | High | Low | High |
| Typical cost | $10-30/mo | $15-50/mo | $15-40/mo |
Using Both Together
Research consistently shows that combining finasteride and minoxidil produces better results than either treatment alone. A 2024 study of over 500 men found that 92.4% achieved stable or improved outcomes after 12 months of combined oral finasteride and minoxidil therapy.
Why Combination Works
- ✓ Synergistic mechanisms: Finasteride stops the hormonal damage while minoxidil actively promotes new growth.
- ✓ Better coverage: Finasteride works best on crown/mid-scalp; minoxidil can help the hairline too.
- ✓ Insurance policy: If one doesn't work well for you, you're still getting benefit from the other.
Many dermatologists recommend starting with both if you're serious about stopping hair loss and regrowing what you've lost.
Which Should You Choose?
Choose Finasteride If:
- • You want the most effective single treatment for stopping hair loss
- • Convenience is important (once-daily pill vs. twice-daily topical)
- • You're not concerned about potential sexual side effects
- • You're losing hair primarily in the crown and mid-scalp areas
- • You want to address the root hormonal cause of hair loss
Choose Minoxidil If:
- • You want to avoid any risk of sexual side effects
- • You prefer an over-the-counter option (topical)
- • You're focused more on regrowth than preventing loss
- • You're female (finasteride isn't approved for women)
- • You want to try something before committing to prescription meds
Choose Both If:
- • You want the best possible results
- • You're willing to manage two treatments
- • You have moderate to advanced hair loss
- • One treatment alone hasn't produced satisfactory results
Getting Started
Both treatments are available through telehealth platforms, making it easy to get started:
For Finasteride
Requires a prescription. Telehealth consultations are typically free, and generic finasteride costs $10-30/month.
Get Finasteride Online →For Minoxidil
Topical is OTC (Rogaine, generics). Oral requires a prescription for off-label use.
Get Minoxidil Online →Ready to Treat Your Hair Loss?
Start with a free online consultation to discuss which treatment—or combination—is right for you.
Get StartedThe Bottom Line
Finasteride is generally more effective at stopping hair loss (80% improvement rate vs. ~60% for topical minoxidil), but it comes with a small risk of sexual side effects that minoxidil doesn't have. Minoxidil is better at stimulating new growth and is available without a prescription (in topical form). For the best results, research shows that using both together produces superior outcomes to either treatment alone. Your choice should depend on your priorities: maximum effectiveness (finasteride or both), avoiding sexual side effect risk (minoxidil), or convenience (oral options).