Finasteride vs Minoxidil: Which Should You Try First?
Finasteride vs minoxidil — how each works, side effects, timelines, and which one you should start with based on your hair loss type.
Two treatments dominate the hair loss world: finasteride and minoxidil. Both are clinically proven. Both are cheap. But they work completely differently — and which one you should start with depends on your situation.
Here’s the real breakdown.
How Finasteride Works
Finasteride is a DHT blocker. DHT (dihydrotestosterone) is the androgen hormone responsible for shrinking hair follicles in men genetically predisposed to male pattern baldness. Finasteride inhibits the enzyme (5-alpha reductase) that converts testosterone into DHT, reducing DHT levels by about 70%.
Less DHT = follicles stop shrinking = hair loss slows or stops.
It doesn’t directly stimulate new growth — it removes the signal telling your follicles to miniaturise. In many men, once that signal is blocked, follicles that were still partially alive can recover and produce thicker hair again.
Key stat: In clinical trials, finasteride stopped hair loss progression in ~85% of men and produced visible regrowth in ~65% over two years.
How Minoxidil Works
Minoxidil is a vasodilator. Originally developed as a blood pressure drug, it was noticed to cause hair growth as a side effect. Applied topically (or taken orally at low doses), it increases blood flow and nutrients to hair follicles and extends the anagen (growth) phase of the hair cycle.
It doesn’t address DHT. It doesn’t fix the underlying cause of androgenetic alopecia. What it does is create a better environment for follicles to stay in their growth phase longer.
Think of finasteride as fixing the root problem and minoxidil as boosting the environment around it.
Key stat: Topical 5% minoxidil showed meaningful regrowth in 40–60% of men in studies. Oral minoxidil (0.25–1.25mg) is emerging as more effective than topical for some men.
Side Effects: The Honest Picture
Finasteride Side Effects
The one that worries men most: sexual side effects. In clinical trials, ~2–3% of men on finasteride reported reduced libido, erectile dysfunction, or ejaculation issues. These typically resolve within weeks of stopping the drug.
Post-finasteride syndrome (PFS) — where side effects persist after stopping — is real but rare. The estimated prevalence is under 1%, though it’s contested. If you have a history of depression or anxiety, discuss with a doctor before starting.
Other side effects are uncommon: gynecomastia (breast tissue growth) affects under 1%.
Bottom line on fin side effects: Most men take it for years with zero issues. The 2–3% stat is worth knowing, not obsessing over.
Minoxidil Side Effects
Topical minoxidil’s main nuisance: scalp irritation, dryness, or flaking — especially with the solution (liquid) formula. The foam version tends to be gentler.
Initial shedding is common in weeks 2–6. This freaks people out. It’s not hair loss — it’s follicles cycling through telogen phase before entering a new growth phase. Push through it.
Oral minoxidil side effects include fluid retention, low blood pressure, and increased body hair in a minority of users. At the doses used for hair loss (0.25–1.25mg), serious cardiovascular effects are rare but worth flagging to a doctor.
Timeline Comparison
| Milestone | Finasteride | Minoxidil |
|---|---|---|
| Initial shedding | Months 1–3 | Weeks 2–6 |
| Stabilisation | Month 3–6 | Month 2–4 |
| Visible improvement | Month 6–12 | Month 4–8 |
| Full results | 12–24 months | 12 months |
Finasteride takes longer to show its hand. Minoxidil tends to produce visible changes a bit sooner, but they plateau earlier too.
Where Each Works Best
Finasteride: Better for Frontal/Hairline Recession
DHT-driven hair loss starts at the temples and crown. Because finasteride targets the hormonal cause, it’s effective across the scalp — including the hairline, where minoxidil historically underperforms.
Minoxidil: Better for Crown/Vertex
The crown has better blood supply and responds well to vasodilation. Minoxidil consistently performs better on the top/crown than on the temples.
The Combo: Strongest Evidence
Using both together produces better results than either alone. The studies on combination therapy consistently show additive benefit. This is why most hair loss protocols stack both.
Who Each Is Best For
Start with Finasteride if:
- You have obvious hairline recession or temple thinning
- You’re in early-to-mid stages (Norwood 2–4)
- You have no contraindications (not planning a pregnancy, no liver issues)
- You want to address the root cause, not just symptoms
Start with Minoxidil if:
- You’re primarily losing hair on the crown
- You want to avoid prescription drugs to start
- You have concerns about finasteride’s side effects and want to ease in
- You’re female (finasteride is generally not prescribed to women of childbearing age)
Use Both if:
- You’re serious about results
- You’re Norwood 3+ and want maximum effect
- You’ve been on one for 6+ months without enough response
Oral vs Topical Minoxidil
This is worth a quick mention because oral minoxidil is increasingly popular.
Topical 5%: Applied once or twice daily. Effective. Messy. Some men hate the routine.
Oral 0.5–1.25mg: One tiny pill daily. Easier. Emerging evidence suggests it may outperform topical — a 2022 study in JAAD showed oral 5mg outperformed topical 5% for women; smaller studies in men are encouraging. Side effects at low doses are manageable for most.
If you’re frustrated with topical minoxidil’s results or compliance, oral is worth asking your doctor about.
Topical Finasteride: The Middle Ground
Brands like Hims and Happy Head now offer topical finasteride (often combined with minoxidil). The idea: lower systemic absorption means lower side effect risk, while still delivering DHT-blocking activity to the scalp.
Evidence is limited compared to oral finasteride, but early data is promising. Good option for men who want finasteride’s mechanism without the systemic exposure.
See also: Hims Hair Loss Review 2026 — they offer the topical combo as their flagship product.
Cost Comparison
| Treatment | Monthly Cost (approx.) |
|---|---|
| Generic finasteride (oral) | $15–35 |
| Topical minoxidil 5% | $10–25 |
| Oral minoxidil (off-label) | $20–40 |
| Topical finasteride + minoxidil combo | $50–80 |
Generic finasteride is absurdly cheap — often $15–20/month through telehealth platforms like Hims or Keeps, or even less with a GoodRx coupon at a local pharmacy.
The Clear Recommendation
If you have male pattern baldness and one choice to make: start with finasteride.
It addresses the actual cause of androgenetic alopecia. Minoxidil is excellent, but it’s working around the problem rather than fixing it. If you can only do one, target DHT.
If you can do both: do both. The evidence for combination therapy is the strongest in the field.
If side effects from finasteride worry you: try topical finasteride (less systemic exposure) or start with minoxidil alone while you gather more information. Don’t let fear of a 2–3% side effect stat stop you from treating a condition that compounds over time.
The worst outcome in hair loss is doing nothing for 5 years and then wishing you’d started in year one.
Bottom Line
Finasteride targets the cause. Minoxidil boosts the environment. Both work. The combo works best.
Start early. Give it 12 months before judging. Don’t switch or quit because of the initial shed.
The men who get the best results aren’t the ones who found a secret — they’re the ones who started early, stayed consistent, and had realistic expectations.
