Hair loss can be a real emotional rollercoaster. Leading the pack on the causes of hair loss is a condition known as androgenetic alopecia. It’s a prevalent problem, affecting nearly 80% of men and half of women by age 70.¹

The good news is that you don’t have to let hair loss lower your spirits. Using finasteride and minoxidil, you may begin your hair regrowth journey. Right here, our team of experienced dermatology providers will guide you on how you may embark on your hair regrowth journey using these two powerful treatments.

How finasteride and minoxidil may trigger hair growth

All human bodies produce the hormone testosterone, which plays an important role in various aspects of our health. However, an enzyme called 5-alpha-reductase triggers the body to convert testosterone into dihydrotestosterone (DHT).² Too much DHT in the body can cause problems like hair loss, hair thinning, and changing hair texture.³ But don’t worry, there is a solution! Oral finasteride, an FDA-approved medication, can step in to stop testosterone from becoming DHT.⁴

Topical finasteride isn't FDA-approved like its oral counterpart, but it shows potential and may be a good alternative for you if you don’t want to ingest medication for hair growth.⁵

When finasteride is taken orally, it’s recommended to take it once daily at 1 mg, and it’s commonly used for treating hair loss in men.⁶ It has been found to significantly increase hair growth. After about 6 months of taking it, you might see around 12.4 more hairs per square centimeter on your scalp compared to not taking anything.⁷ By about a year, this can increase to around 16.4 more hairs per square centimeter. While finasteride is usually okay for men, it's important to be aware of the side effects, both short-term and long-term, before you decide to start the treatment, so always speak with a medical provider first.⁸ It is important to note that it is contraindicated in pregnant women or women of childbearing age.

Now, let’s talk about minoxidil medication. It was a hypertension med when it was first introduced into the market.⁹ But surprise! Clinicians observed it was doing something unexpected by triggering hair growth among balding patients, so it’s now also used as a topical medication to treat hair loss conditions like androgenetic alopecia. However, the exact science of how minoxidil does this remains unclear.¹⁰

Some studies have linked its effectiveness to:

• Opening up of blood vessels and potassium channels. More blood, nutrients, and oxygen reach the hair follicles through this.¹¹

• Prolonging the growth stage of hair follicles.¹² You see, hair follicle growth is cyclical with three phases: the anagen (growth phase), catagen (transition phase), and telogen (rest phase).¹³ Minoxidil prolongs the growth phase of the hair follicle and may even boost the size of the hair follicle itself.¹⁴ This may result in thicker, longer hair. It also shortens the rest phase.¹⁵

If you’re dealing with hair loss, there are two main types of topical minoxidil you can use:¹⁶

Minoxidil solution: This is available in two strengths: 2% and 5%. Research shows that both can help grow more hair and reduce hair loss. The 5% strength is more effective, with an average gain of about 14.90 hairs in each square centimeter of your scalp when compared to placebo, versus 8.11 hairs for the 2% strength.¹⁷ However, the stronger 5% solution may also cause more side effects, such as skin irritation.

Minoxidil foam: This was developed to help people who get skin irritation from the minoxidil solution, as it does not contain a possible irritant called propylene glycol.¹⁸ It’s available in a 5% strength and is typically easier on your skin.

How is finasteride and minoxidil administered?

Minoxidil is an over-the-counter and prescription medication. It is administered either as an oral tablet or as a topical agent.¹⁹ When using topical minoxidil, you will apply it directly onto your scalp.

Oral minoxidil is not currently approved by the FDA for treating hair loss.

Finasteride is a prescription-only medication that can also be administered as an oral or topical agent.

Remember, it is essential to consult a dermatology provider before using finasteride or minoxidil. They will offer personalized guidance to help you achieve the best results for your unique needs.

What to consider when choosing between finasteride or minoxidil

Always consider several factors before deciding what suits you best between finasteride and minoxidil. They include:

Pregnancy

Finasteride is not a drug you should consider if you are pregnant or plan to become pregnant. It can hinder the development of a male fetus as it works by inhibiting the conversion of testosterone into DHT.²⁰ Animal experimental studies have also shown that finasteride might increase the chance of preterm delivery.²¹ Animal studies have also shown it may also jeopardize the memory of an exposed offspring.²² If you realize you are pregnant while still using finasteride, it is best to chat with your healthcare provider for advice.

For safety’s sake, women should also avoid using minoxidil during pregnancy and breastfeeding.²³ While lactating, minoxidil can be excreted in breast milk.²⁴ Women in the childbearing age bracket should exercise caution when deciding whether to use finasteride or minoxidil. For a male patient trying to get a partner pregnant, discuss with your healthcare provider about the potential risks.

Efficacy

When comparing finasteride vs. minoxidil, both the oral and topical forms were effective and safe in treating mild to severe androgenetic alopecia, but some forms have been found to be more effective.²⁵ For example, in a study comparing oral finasteride and topical minoxidil, men with hair loss were split into two groups with one taking oral finasteride pills and the other using topical minoxidil. The group taking finasteride pills had better results, with about 80% of the men in that group seeing their hair get thicker and fuller. In the topical minoxidil group, about 52% saw similar results.²⁶

However, the efficacy rate is higher for patients who opt for finasteride and minoxidil combination therapy.²⁷ In a study on treatments for male hair loss, three methods were compared: finasteride alone, 5% minoxidil alone, and a combination of both. The study found that 80.5% of men who used only finasteride saw their hair condition improve.²⁸ For those using just the 5% minoxidil, 59% noticed improvement. And the group using a combination of finasteride and minoxidil saw a remarkable 94.1% of men experiencing hair improvement.²⁹

If you opt for topical minoxidil, you may also boost its efficacy by combining it with microneedling. Microneedling is a technique that involves using a device equipped with hundreds of tiny needles to gently puncture your skin.³⁰ This method is not just for skin rejuvenation; it has also shown promise in stimulating hair growth, particularly when combined with other treatments like minoxidil. Results from a study showed that 5% minoxidil twice a day plus weekly microneedling had better results compared to 5% minoxidil therapy alone.³¹

Ease of use

Compliance is crucial when using finasteride or minoxidil. Oral finasteride is typically administered in a 1 mg oral tablet once daily.³² Topical minoxidil typically requires application on the scalp twice daily.³³ Choose a treatment regimen that is easy for you to adhere to.

Diseases

People with certain health issues should reach out to their healthcare provider before starting finasteride or minoxidil. A medical provider will advise if the medication works well with your condition. Oral finasteride or minoxidil may not be right for people with the following conditions:

• People with liver conditions should exercise caution when using oral minoxidil or oral finasteride since the liver highly metabolizes the drug. Topical forms have minimal systemic absorption, however caution is still advised.³⁴

• People with kidney issues may require a dose reduction for oral minoxidil.³⁵

• Patients with severe hypotension or a high risk of heart disease should be cautious with oral minoxidil.³⁶

Side effects

When considering finasteride or minoxidil to manage androgenetic alopecia, understanding their potential side effects is fundamental.

Potential oral finasteride side effects include:

• Sexual side effects like sexual dysfunction, low libido, decreased arousal, or problems with orgasm.³⁷ Some men may also experience poor semen quality, abnormal penis curvature, decreased ejaculation volume, testicular pain and reduction.³⁸

• Finasteride may trigger neurological side effects like depression, suicidal thoughts, and difficulties in memory or thinking.³⁹ It may also trigger anxiety disorders, panic attacks, emotional detachment, and insomnia.⁴⁰

• Breast swelling/tenderness and breast cancer.⁴¹

The side effects of minoxidil may depend on whether you are using topical or oral minoxidil. Some side effects of topical minoxidil include:⁴²

• Skin irritation that could potentially cause redness, discomfort, or a slight burning sensation on the scalp

• Topical minoxidil may also lead to a condition known as hypertrichosis. Hypertrichosis is excessive hair growth in unintended areas. This condition is more likely when using a high-percentage topical minoxidil solution.

• Allergic contact dermatitis

• Excessive hair shedding at the start of the regimen due to the shortening of the telogen phase

• Itching of the scalp and increased dandruff⁴³

While side effects of oral minoxidil may include:⁴⁴

• Exacerbation of congestive heart failure

• Worsening of chest pain

• Hypotension

• Breast tenderness

• Increased hair growth (hypertrichosis)

• Weight gain

Symptoms vary from person to person. If you are experiencing any of the above symptoms, speak to your healthcare provider on how to manage them. They may help you make a few adjustments to your treatment.

Don’t let hair loss get to you—take control with Curology

Choosing the right hair loss treatment between finasteride and minoxidil depends on various factors, including your medical history, specific condition, ease of use, potential side effects, and personal preferences. Both oral and topical finasteride and minoxidil have their benefits, and you can enjoy the benefits of both by discovering the power of personalized hair care with Hair Formulaᴿˣ for hair loss* from Curology.

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Get your personalized skincare routine with Curology

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What sets Hair Formulaᴿˣ apart is its unique blend of 3 clinically proven active ingredients, each chosen for its ability to combat various causes of hair thinning. Among these potential ingredients are minoxidil and finasteride.

Hair Formulaᴿˣ was formulated by dermatologists to be more effective at regrowing hair than over-the-counter treatments.* We provide 1:1 support from a dermatology provider to ensure the best care for you.

Are you ready to embark on your journey to healthier, fuller hair? Start with our hair quiz** and let Hair Formulaᴿˣ be your partner in achieving your hair goals.

P.S. We did the homework so you don’t have to:

1. Nestor, M.S., et al. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of Cosmetic Dermatology. (December 2021).

2. Kinter, K.J., et al. Biochemistry, Dihydrotestosterone. StatPearls. (2023, July 30).

3. Fu, D., et al. Dihydrotestosterone-induced hair regrowth inhibition by activating androgen receptor in C57BL6 mice simulates androgenetic alopecia. Biomed Pharmacother. (2021, January 29).

4. Zito, P.M., et al. Finasteride. StatPearls. (2022, August 25).

5. Gupta, A.K. and Talukder, M. Topical finasteride for male and female pattern hair loss: Is it a safe and effective alternative? J Cosmet Dermatol. (May 2022).

6. Gupta, A.K., et al. Finasteride for hair loss: a review. J Dermatolog Treat. (June 2022).

7. Gupta, A.K., et al. Finasteride for hair loss: a review. J Dermatolog Treat. Ibid.

8. Gupta, A.K., et al. Finasteride for hair loss: a review. J Dermatolog Treat. Ibid.

9. Suchonwanit, P., et al. Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. (2019, August 9).

10. Suchonwanit, P., et al. Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. Ibid.

11. Rossi, A., et al. Minoxidil use in dermatology, side effects and recent patents. Recent Patents on Inflammation & Allergy Drug Discovery. (May 2012).

12. Otomo, S. Hair growth effect of minoxidil. Nihon Yakurigaku Zasshi. Folia Pharmacologica Japonica. (March 2002).

13. Hoover, E., et al. Physiology, Hair. StatPearls. (2023, July 30).

14. Messenger, A.G. and Rundegren, J. Minoxidil: mechanisms of action on hair growth. The British Journal of Dermatology. (February 2004).

15. Messenger, A.G. and Rundegren, J. Minoxidil: mechanisms of action on hair growth. The British Journal of Dermatology. Ibid.

16. Patel, P., et al. Minoxidil. StatPearls. (2024, February 4).

17. Suchonwanit, P., et al. Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. Ibid.

18. Patel, P., et al. Minoxidil. StatPearls. Ibid.

19. Patel, P., et al. Minoxidil. StatPearls. Ibid.

20. Zito, P.M., et al. Finasteride. StatPearls. Ibid.

21. Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS). Finasteride. (October 2022).

22. Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS). Finasteride. Ibid.

23. Suchonwanit, P., et al. Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. Ibid.

24. Patel, P., et al. Minoxidil. StatPearls. Ibid.

25. Arca, E., et al. An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology (Basel, Switzerland). (2004, n.d.).

26. Arca, E., et al. An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology (Basel, Switzerland). Ibid.

27. Hu, R., et al. Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and comparative study in Chinese patients. Dermatologic Therapy. (September-October 2015).

28. Hu, R., et al. Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and comparative study in Chinese patients. Dermatologic Therapy. Ibid.

29. Hu, R., et al. Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and comparative study in Chinese patients. Dermatologic Therapy. Ibid.

30. American Academy of Dermatology Association. Hair Loss: Diagnosis and Treatment. (2022, December 13).

31. American Academy of Dermatology Association. Hair Loss: Diagnosis and Treatment. Ibid.

32. Zito, P.M., et al. Finasteride. StatPearls. Ibid.

33. Patel, P., et al. Minoxidil. StatPearls. Ibid.

34. Zito, P.M., et al. Finasteride. StatPearls. Ibid.

35. Patel, P., et al. Minoxidil. StatPearls. Ibid.

36. Panchaprateep, R. and Lueangarun, S. Efficacy and Safety of Oral Minoxidil 5 mg Once Daily in the Treatment of Male Patients with Androgenetic Alopecia: An Open-Label and Global Photographic Assessment. Dermatology and Therapy. (December 2020).

37. Irwig, M.S. and Kolukula, S. Persistent sexual side effects of finasteride for male pattern hair loss. J Sex Med. (June 2011).

38. Pereira, A.F.J.R. and Coelho, T.O.A. Post-finasteride syndrome. An Bras Dermatol. (May-June 2020).

39. Sasibhushana, R.B., et al. Repeated finasteride administration induces depression-like behavior in adult male rats. Behav Brain Res. (2019, June 3).

40. Pereira, A.F.J.R. and Coelho, T.O.A. Post-finasteride syndrome. An Bras Dermatol. Ibid.

41. Al Saffar, H., et al. US Food and Drug Administration Warning Regarding Finasteride and Suicidal Ideation: What Should Urologists Know?. Eur Urol Open Sci. (June 2023).

42. Patel, P., et al. Minoxidil. StatPearls. Ibid.

43. Shadi, Z. Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia. Dermatol Ther (Heidelb). (May 2023).

44. Patel, P., et al. Minoxidil. StatPearls. Ibid.

45. American Academy of Dermatology Association. Hair Loss: Who Gets and Causes. (n.d.).

46. Bharadwaj, A.V., et al. Comparative Efficacy of Topical Finasteride (0.25%) in Combination with Minoxidil (5%) Against 5% Minoxidil or 0.25% Finasteride Alone in Male Androgenetic Alopecia: A Pilot, Randomized Open-Label Study. International Journal of Trichology. (March-April 2023).

47. Nestor, M.S., et al. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of Cosmetic Dermatology. Ibid.

48. McClellan, K.J. and Markham, A. Finasteride: a review of its use in male pattern hair loss. Drugs. (January 1999).

49. Nestor, M.S., et al. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of Cosmetic Dermatology. Ibid.

Elise Griffin is a certified physician assistant at Curology. She received her Master of Medical Science in physician assistant studies from Nova Southeastern University in Jacksonville, FL.

*Active ingredients have been studied separately. Results may vary. Restrictions apply. See website for full details and important safety information.

Active ingredients have been studied separately; minoxidil has been shown to improve hair growth within three to twelve months of use. Results may vary.

Minoxidil Disclaimer: Ingredients subject to medical consultation. Do not use if pregnant, breastfeeding, or trying to conceive.

Finasteride Disclaimer: Ingredients subject to medical consultation. Inform your medical provider of your pregnancy status. Do not handle if pregnant, breastfeeding, or any chance you may become pregnant.

**Cancel anytime. Subject to consultation. Results may vary. Restrictions apply. See website for full details and important safety information.

Written by

Curology Team

Medically reviewed by

Elise Griffin, PA-C