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There are many approaches to fighting and preventing hair loss; some of them focus on hair care products (like the type of shampoo you use), while others examine your everyday habits (like eating healthy, getting lots of sleep and staying hydrated). But few hair loss products and tactics can compare to the prescription-grade stuff: minoxidil and finasteride.
There are many hair loss myths out there (like, does traction alopecia cause hair loss?), but few things are as evident as finasteride and minoxidil reviving dormant follicles, fortifying existing ones and defending those follicles against hormones byproducts that threaten their very existence.
These two medicines are the core offering of the best men’s hair loss subscriptions, like Keeps, Roman and Hims, and for good reason. You might know minoxidil and finasteride by their initial brand names (Rogaine and Propecia, respectively), but those patents have long expired and now the generics of both medicines are readily available, competitively priced, and, in the case of minoxidil, even available over the counter.
So, which of these two hair loss solutions is better for you — if at all? We compare their use cases below, with the help of Board Certified Dermatologist Dr. Yoram Harth, medical director of MDhair. Learn more about how hair loss and hair regrowth work in relation to these solutions, as well as some very specific precautions to take before you embark on medicinal solutions.
When Is It Too Late to Regrow Lost Hair?
Before discussing the pros and cons of finasteride and minoxidil, it’s important to know if your hair regrowth efforts are worth your effort or entirely futile.
“Early treatment of hair loss is key,” says Harth. “If a follicle has been dormant for 20 years, it will be harder to revive.” That being said, the sweet spot is someplace in the first couple of years of loss. So as soon as you notice significant change — since it can sneak up on you — it’s worth taking action. Doing so will also help retain your hair in its current state.
Genetic male-pattern hair loss primarily happens because of dihydrotestosterone, or DHT, which is a byproduct of testosterone. DHT gathers at the root of the hair and effectively suffocates and shrinks the follicle. This inhibits hair growth and, when the follicle is subdued long enough, it becomes too shriveled to reproduce a new hair, even with remedies like minoxidil and finasteride.
Malnourishment is another way that hair loss occurs. If your follicles aren’t nourished, then they’re far weaker in their defense against genetic hair loss. Efforts like proper hydration, minimal alcohol intake, no smoking, healthy dieting and adequate rest are imperative for proper hair follicle health — and for ensuring healthy full-body nourishment and circulation, which helps fuel the follicles.
When you begin a hair loss remedy like finasteride and minoxidil, you need to set your expectations properly: Whatever your hair density was a couple of years prior… that level of density is the best-case scenario. “If treatment is used consistently for at least nine to 12 months, most people can see 20% to 30% hair regrowth,” says Harth. (So take what you’ve got up top, and add 20-30% to its volume. Again, that’s the best-case scenario.)
Moreover, you’ll drastically slow hair loss from continuing, Harth adds. “From my experience, further loss can be reduced in 60–70% of people with male- and female-pattern hair loss,” he says.
With all the above in mind, it’s also important to understand the different patterns of hair loss that occur, and how treatments can impact these—only then can you and your board-certified dermatologist understand the best approach to treatment.
Read More: Why Good Scalp Care Is the Key to Great Hair
Crown Thinning vs. Hairline Recession
You’ve probably noticed that hair loss only occurs on top of your head. The hairs on the sides of your head aren’t susceptible to DHT and genetic loss, which is why many bald guys have a “donut” of hair forming around the sides despite dolphin smoothness up top.
As for the upper dome, you will either experience thinning on the dome or recession at the hairline. The thinning can refer to general thinning or patchiness all around the crown (including individual thinning of each follicle/strand, which greatly impacts overall density), or defined bald spots, like at the back of the crown. Recession can be uniform, too, or can more greatly affect the temples. In short, all of these patterns of loss differ from one guy to the next based on his genetics.
It tends to be true, though, that recessed hair is more difficult to revive than crown thinning. It isn’t widely known why; some experts think this is because the crown recession happens so gradually that it’s simply too late to revive the follicles by the time we notice anything. Harth has a more direct explanation, plus a little bit of hope for recessed hairlines: “Every skin area has a different density of hair follicles and different sensitivity to DHT,” he says. “Recessed hair can also be improved, but less than the crown area.”
And if you want to treat hair loss with finasteride and minoxidil, then your type of loss is what typically dictates the prescription.
Minoxidil: Details and Risks
Minoxidil (the generic for Rogaine) is most commonly a topical serum or foam treatment. It comes in strengths of 2% and 5%. Women are typically prescribed the 2% and men the 5% (unless you have low blood pressure, says Harth, in which case you’d be prescribed the 2%). It is applied directly to the scalp by parting the hair and massaging it into the skin. Typically, recommended use is morning and night, on a clean, dry scalp. And you don’t need to target the entire scalp to be effective. By uniformly applying it across and around the crown, you will receive its benefits.
This is because minoxidil is a vasodilator, meaning it broadens blood vessels and allows more oxygen to reach the hair follicles. And when follicles are better nourished, they grow thicker and stronger and stay anchored longer. Minoxidil also shortens the amount of time that your hair spends “resting” during its growth cycle. Typically, about 6-8% of your hairs are in this resting phase (having naturally fallen out), and they can spend as many as 100 days dormant before regrowth without minoxidil. With the drug, they regrow much sooner and fall out much less frequently.
It is also important to note that, with minoxidil, you may notice a slight increase in shedding in the first weeks of use. Don’t be alarmed — this is a sign that it’s working, and those hairs will grow back stronger than before.
In the big picture, minoxidil has far less severe side effects than finasteride. It can cause mild itching or irritation, and sometimes even eczema or acne. Minoxidil can lower blood pressure, particularly if paired with other blood pressure drugs. It’s important to have your use monitored if you have low blood pressure, especially since the drug is now available over the counter and requires no supervision.
Who Should Use Minoxidil
Minoxidil is more commonly “prescribed” (air quotes since it’s over-the-counter) for crown thinning, mild to moderate loss and ongoing retention. However, Harth adds that in his experience, minoxidil can also help with hairline recession. (It’s less common, though, and typically finasteride will target hairline recession.)
Minoxidil is the obvious choice for people who are reticent of finasteride’s sexual side effects (keep reading for more on that). Some people will even use it on patchy beards, under the assumption that it helps coach shy follicles into production mode there, too. But don’t get your hopes up: If there’s no hair to be grown, it won’t appear out of nowhere.
Foam Minoxidil vs Minoxidil Solution
If you can choose between the minoxidil foam and the serum solution, Dr. Harth endorses the latter. “Minoxidil foam sticks to the hair, and thus, the amount that reaches the scalp is significantly smaller compared to minoxidil solution,” he says. “For most people, the minoxidil solution is a better choice. That said, using the foam can be more convenient for people who experience itching with the solution or have very sparse hair.”
The New Kid in Town: Oral Minoxidil
Oral minoxidil is becoming more readily available. Since some people complain that topical minoxidil can dry out their hair or compromise styling, the oral option becomes an attractive alternative.
Proceed only with a doctor’s tailored advice, though. “There is some new research on using oral minoxidil in small doses,” Harth says. “For women, it’s a bad idea because that grows more hair on the body. For men who are OK with taking tablets, finasteride is more effective and thus a better option.”
Finasteride: Details and Risks
Finasteride is the generic for Propecia. It was originally prescribed in 5mg doses as a remedy for an enlarged prostate, but its 1mg cosmetic dose is used to inhibit the conversion of testosterone into follicle-shrinking DHT. It is commonly an oral medicine, although topical solutions are becoming more common, especially given the drug’s notorious side effects.
A small percentage of finasteride users will experience sexual side effects. The numbers on this vary largely from one study or brand to the next but know that studies tend to conclude that roughly 1-2% of men experience side effects, and as many may manifest similar symptoms because of this awareness. The side effects can range from mild to severe. Some patients experience irreversible loss of sex drive or the ability to get an erection, while others experience temporary forms of these problems (which can stop when use of the drug ceases) or mild versions of both. For these reasons, it makes sense why finasteride remains a prescription-based remedy for hair loss, and why it must be monitored quarterly by a board-certified dermatologist (and even more closely in the first few months of use).
Who Should Use Finasteride
Finasteride can help reverse and prevent hair loss across the entire crown, as indicated by the FDA. But as Harth notes, it is particularly effective at slowing hairline recession as well. So if one’s hair loss is primarily hairline related, this person will likely be recommended finasteride.
If you experience severe itching or burning from minoxidil, then you might also consider taking finasteride as your primary defense against hair loss.
The New Kid in Town: Topical Finasteride
Just as oral minoxidil grows in popularity, so too does topical finasteride. It is largely believed that topical versions of the drug carry lowered risks of sexual side effects. The jury is still out on this but it is worth trying this option first, to see if it works for you. If so, then there’s no need to switch to the oral option. Some brands, like Hims, even offer a minoxidil + finasteride combination solution.
Where to Get Finasteride
You must get a prescription for finasteride from a board-certified dermatologist. Non-branded options are available from your pharmacy, while telemedicine companies like Hims, Keeps, and Roman all connect you with a dermatologist to receive meds by mail and quarterly check-ins.
When to Expect Results
When you embark on a hair regrowth journey, you should wait three to four months before seeing initial regrowth, says Harth. That could be the amount of time it takes for dormant follicles to wake up and start producing new hairs. You should notice a more drastic density by six months.
Can You Take Minoxidil and Finasteride Together?
It is perfectly fine to take both drugs for a double-down defense against hair loss. However, Harth suggests starting with one of the two drugs for the first six months — particularly depending on your hair loss patterns (finasteride for hairline recession, ideally). If you notice results after six months, you may not want to take more than one drug for the loss. But many men do take both, and with a high success rate at that.
Or you can start with a combined minoxidil-finasteride combo solution, like the new topical hair-loss spray offered by Hims.