Look for information about treating and preventing male pattern baldness and you'll see two medications mentioned frequently: minoxidil (the active ingredient in Rogaine®) and finasteride (the active ingredient in Propecia®).
Both drugs have been around for decades and are often used to treat male-pattern hair loss, or androgenetic alopecia.
But do they really work? If so, which is the most effective choice for preventing hair loss and allowing hair to grow back?
Below, we've explained how minoxidil and finasteride work and how effective each option is for treating baldness and stimulating hair growth.
We've also talked about how to use minoxidil and finasteride, separately or at the same time, to stop hair loss and grow a fuller, thicker head of hair.
Minoxidil vs. Finasteride: What's the difference?
Before going into the specific details of how minoxidil and finasteride works, we will first discuss the main differences between these two drugs.
Minoxidil and finasteride are both approved by the EMA for the treatment of male baldness. Both drugs are supported by a considerable amount of research, although there are a few major differences in how they stop hair loss and promote hair growth.
The main difference between minoxidil and finasteride is the dosage form of each medication.
Minoxidil is a topical medicine in liquid or foam form. It is formulated for use directly on your scalp (more specifically, areas of your scalp with visible hair loss) and works primarily by promoting local hair growth.
Finasteride, on the other hand, comes as an oral tablet. Instead of acting locally to help your hair grow, it has a systemic effect throughout your body by lowering levels of the hormone responsible for male pattern baldness.
You can see minoxidil and finasteride as hair loss treatments from different angles. Minoxidil is a topical treatment that works as a fertilizer that provides your hair with the nutrients it needs to grow optimally.
Finasteride, on the other hand, is more like a shield that protects your hair follicles from damage caused by certain hormones.
Below, we'll dive deeper into each drug and how to use minoxidil and finasteride together for optimal results.
How Minoxidil works
Minoxidil is a type of medication called a hair growth stimulator. It works by widening the blood vessels in your scalp, which can help promote blood flow to your hair follicles -- the tiny organs in your scalp from which your hair grows.
In addition to increasing blood flow, experts believe minoxidil extends the anagen phase of your hair's natural growth cycle.
What does this mean exactly? Every hair on your scalp and body grows as part of a multi-phase cycle called the hair growth cycle. This cycle consists of three to four main phases: anagen, catagen, telogen, and exogenous.
During the anagen phase, your hair follicle produces a hair fibre. This fiber slowly grows to its full length over a few years, resulting in the steady hair growth that most of us see regularly.
After the hair has stopped growing, it enters a transition phase called the catagen phase, where it shrinks in diameter. The hair then passes into the telogen phase of the growth cycle, where it rests and is replaced by a new hair, which grows from the same follicle.
Eventually, the old hair comes off and new hair takes its place—a phase called the exogenous phase.
Minoxidil works by increasing the duration of the anagen phase, allowing your hair to grow longer before it falls out. It also brings dormant hair, such as those in the telogen phase, into the anagen phase to stimulate hair growth.
This can lead to increased hair growth, even in areas of your scalp affected by male pattern baldness.
Because minoxidil interrupts your hair growth cycle, you may lose slightly more hair during the first few months of use.
This is a normal side effect that usually goes away over time. As telogen hairs are replaced by new anagen hairs, your hair will generally look thicker and denser.
So, does minoxidil work? Since it first came on the market in the 90s, several studies have investigated the effectiveness of minoxidil, with most showing very positive results.
For example, a double-blind, randomized, placebo-controlled trial published in the Journal of the American Academy of Dermatology in 2002 found that both 2% and 5% minoxidil provided improvements in hair growth in men with androgenic hair loss.
Another study, published in 2015 in the journal Dermatologic Therapy, found that 59 percent of men with pattern hair loss showed improvements after one year of treatment with minoxidil. An important point to understand is that minoxidil does not affect the production of androgen hormones, which means that it does not prevent hair loss at the follicular level.
We explain this in more detail below. In general, minoxidil is best viewed as a means of stimulating hair growth and maximizing the hair you already have, not as a medicine to protect your hair from the long-term effects of baldness.
Interested in using minoxidil? We offer minoxidil solution and minoxidil foam, both of which are available without a prescription.
How finasteride works
Finasteride stops the production of dihydrotestosterone (DHT), a hormone that causes baldness.
DHT is a hormone that is produced as a by-product of testosterone. It's important in early life and adolescence, where it plays an important role in the development of your genitals and secondary sexual characteristics, such as facial and body hair.
As an adult, DHT can attach to receptors in your scalp and cause your hair follicles to gradually shrink. Over time, this can affect your hair's natural growth cycle and ultimately cause no hair to grow at all.
DHT normally attacks the hair follicles near your hairline and crown first, resulting in the classic receding hairline that often develops in the early stages of male-pattern baldness.
Our guide to DHT and hair loss in men delves deeper into the effects of DHT and the steps you can take to prevent it from affecting your hair follicles.
Finasteride works by inhibiting the activity of the enzyme 5-alpha reductase, which is involved in converting testosterone into DHT.
By preventing testosterone from being converted to DHT, finasteride significantly lowers DHT levels throughout your body. Research shows that a normal dose of finasteride can eliminate as much as 70 percent of serum DHT.
This reduction in DHT levels helps protect your hair follicles from damage, preventing hair loss from getting worse. For many men, it also results in hair regrowth in the areas of your scalp that are already affected by male baldness.
Like minoxidil, finasteride is supported by numerous large-scale studies showing improvements in men with baldness.
For example, a study involving more than 1,500 men published in the Journal of the American Academy of Dermatology found that treatment with finasteride caused a significant increase in the number of hairs in the vertex scalp (an area commonly affected by pattern hair loss) after two years.
Another study, published in the journal Dermatologic Therapy, comparing finasteride and minoxidil, also found that 94.1 percent of men who used finasteride over a year showed improvements.
We offer finasteride online, after an online consultation with a doctor who will determine if a prescription is appropriate.
Are Minoxidil and Finasteride Effective?
Simply put, yes. Minoxidil and finasteride are both supported by a large body of research showing that using them offers real benefits, especially if you're just starting to notice hair loss.
Minoxidil and finasteride are often seen as the gold standard for male hair loss treatments, both by dermatologists and the general public.
Both short- and long-term studies demonstrate the efficacy of minoxidil and finasteride, with longer-term use generally associated with more significant benefits.
For example, a five-year finasteride study published in the European Journal of Dermatology found that men with pattern hair loss who used finasteride had improvements in hair growth and reduced hair loss.
An even longer 10-year study conducted in Japan found that daily use of finasteride prevented hair loss from becoming more severe in more than 99 percent of men and caused improvements in hair growth in more than 91 percent of the participants.
There are also several renowned studies that show that topical minoxidil is effective in preventing hair loss and promoting hair growth.
In a 12-month study in Germany, researchers found that 97.1 percent of balding men who used minoxidil experienced an improvement in hair growth or no further worsening of their hair loss.
Of the more than 900 men who participated in the study, 84.3 percent rated minoxidil as “highly effective,” “effective,” or “moderately effective” as a hair loss treatment.
A review of minoxidil published in the journal Drug Design, Development and Therapy analyzed several studies on minoxidil and concluded that it offers “remarkable benefits” to people who suffer from hair disorders.
In short, like finasteride, minoxidil is supported by real, reputable scientific studies that show that it is effective.
Is it safe to take Minoxidil and Finasteride together?
Minoxidil and finasteride are generally safe and effective medications when used separately to treat hair loss. Research also shows that they can be used safely together.
Many studies have looked at the potential benefits of using both minoxidil and finasteride to treat hair loss, often with promising results.
A 2015 study published in the Indian Dermatology Online Journal found that regular use of both finasteride and minoxidil together helped maintain good hair density.
Interestingly, this study used a topical version of finasteride, rather than the more common oral finasteride tablets.
A larger study published in the journal Dermatologic Therapy looked at the effects of finasteride and minoxidil used simultaneously to treat male baldness.
After 12 months of treatment, 94.1% of men taking finasteride and minoxidil at the same time showed improvements, compared to 80.5% and 59% of men taking finasteride or minoxidil alone, respectively.
Finasteride and minoxidil work through different mechanisms to treat pattern hair loss -- minoxidil by bringing the hair into the anagen phase of the growth cycle and stimulating local blood flow, and finasteride by lowering DHT levels throughout the body.
Because they work in different parts of the body, it is not risky to use them together. In fact, as the research above shows, you're likely to get better results using both finasteride and minoxidil together than using just one medication to treat hair loss.
That said, although minoxidil and finasteride don't interact, it's important to check for possible interactions between medications before starting a hair loss medication, including minoxidil or finasteride.
Before you start taking any of these medications, tell your healthcare provider about all medications you are taking or have recently taken and any dietary supplements you are taking.
They can let you know if you need to make changes to safely use minoxidil and/or finasteride to treat your hair loss.
Minoxidil vs. Finasteride dosage
Minoxidil and finasteride come in very different dosage forms, with one being an external medication and the other being an oral tablet.
To get the best results from minoxidil or finasteride (or both medications together), it's important to use your medication in the correct dosage.
A normal dose of minoxidil is 1 ml of liquid solution applied directly to the scalp twice a day, usually in the morning and evening. Our minoxidil application guide explains how to use minoxidil for optimal results.
A normal dose of finasteride for male pattern baldness is 1 mg daily, with or without food. You can take finasteride at any time of the day, although it's important to take it around the same time daily.
If you forget to take finasteride, skip the missed dose and continue taking your medication as usual. You should not take a double dose of finasteride to make up for a missed dose.
Side effects of Minoxidil vs. Finasteride
Minoxidil and finasteride are both safe, effective medications for most people. Both medications have been extensively studied, with clinical trials showing that side effects are usually mild, transient, and rarely serious.
However, like other medications, both minoxidil and finasteride can cause side effects, including some that can be bothersome.
Common minoxidil side effects include:
Skin irritation
unease
Burning sensation
Aggravation of seborrheic eczema
Hypertrichosis (excessive hair growth)
Isolated pruritus (dry, itchy skin)
Allergic contact dermatitis
Minoxidil may also cause a form of temporary hair loss called telogen effluvium, where hairs leave the telogen phase of the hair growth cycle prematurely.
While the idea of a hair loss treatment that causes hair loss may seem unusual, this is a common problem among people who use minoxidil. It happens because minoxidil can affect the hair's natural growth cycle when it brings follicles into the anagen phase.
In the short term, this can lead to a shortening of the telogen phase, resulting in a certain degree of hair loss.
This hair loss is only temporary. Over the course of a few months, minoxidil significantly improves hair growth and hair thickness in most men.
Although not common, finasteride can cause side effects, including sexual side effects that may affect your sexual function or pleasure.
Possible side effects of finasteride include:
Erectile Dysfunction (ED)
Changes in ejaculation volume
Gynecomastia (increased mammary gland tissue)
Decreased libido
While these forms of sexual dysfunction sound disturbing, they are not common, and research shows that they almost always stop after stopping treatment.
For example, FDA clinical trial data claims that 1.3 percent of men who take finasteride at a dose of 1 mg per day (the normal dose used to treat male baldness) experience erectile dysfunction, compared to 0.7 percent of men in a placebo group.
In other words, while these side effects may occur, they only affect a very small percentage of men who use finasteride.
Our guide to finasteride side effects explains these problems and their prevalence among finasteride users in more detail.
If you start having side effects from minoxidil, finasteride, or both medications, it's important to tell your healthcare provider. He or she may suggest making changes to how you use your medication to reduce the severity of the side effects.
Minoxidil vs. Finasteride: Who is it for?
Minoxidil and finasteride are both for anyone starting to see thinning hair, a receding hairline, or other signs of male-pattern baldness.
You don't need to have a minimum level of hair loss to use minoxidil or finasteride. However, it's important to understand that if you already have advanced hair loss, you may not be able to get all of your hair back by starting treatment with one of these medications.
Simply put, it's important to have realistic expectations about what minoxidil and finasteride can do for you.
Most men who take minoxidil, finasteride, or both medications notice improvements. However, it may take a few months before you notice that your hair loss has slowed or that you have a denser and more complete hairline than before.
Not sure if you need finasteride? If you only have a mild form of hair loss, you may want to try minoxidil first before taking other medications. As an over-the-counter medicine, minoxidil is easy to add to your hair loss prevention routine without seeing a doctor.
Minoxidil vs. Finasteride: Which Is Better?
Minoxidil and finasteride are different medications for very different purposes. One is a topical vasodilator that works by increasing blood flow to your scalp and bringing hair follicles into the anagen phase of the hair growth cycle.
The other is a DHT blocker that protects your hair follicles from the damage that baldness causes.
Research shows that minoxidil and finasteride work best when used together to treat hair loss from multiple angles. That's why it's best to see these drugs as partners rather than competitors.
We offer both minoxidil and finasteride as part of our full range of male hair loss treatments, but also both medications together. We also offer a Topical Finasteride & Minoxidil Spray that you can use to apply both medications at the same time.
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