Hair loss is a common problem that can affect men and women. In fact, 2 out of 3 men will experience some form of male pattern baldness by 35 years old. Androgenetic alopecia, or male pattern baldness (MPB), is caused by DHT, a hormone that affects hair follicles. In men's tendency for hair loss, excess of DHT causes the hair follicles at the hairline and crown to shrink. This process starts early and can be found in 20% of men in their 20s and 30% in their 30s.
Two common treatments are clinically proven to help hair loss; Finasteride and Minoxidil. With regular use, both of these products can help slow down male pattern hair loss (also known as androgenetic alopecia) and help promote hair regrowth. Although both of these products achieve the same goal, they work differently. Let's break down the differences between Finasteride and Minoxidil.
What is male pattern balding?
Male pattern baldness, also known as androgenetic alopecia, is men's most common type of hair loss. One cause of this condition is genetics; if there is a family history of baldness, especially on the mother's side, you are more susceptible to it.
Research has found that male pattern baldness is connected to male sex hormones called androgens. These androgens can affect many things within the body, including regulating hair growth and loss.
Male pattern baldness can begin as early as the teenage years, but it's more commonly found in adult men. Some men find their hair loss starts at the temple or crown of the head, while others notice it in a single spot or a receding hairline in the form of an "M" shape.
What is the difference between minoxidil and finasteride?
Minoxidil and finasteride are two of the most researched and well-known hair loss treatments available. Both are approved by the Food and Drug Administration (FDA) and backed with scientific research, though significant differences exist between the two.
What is minoxidil?
Minoxidil is a vasodilator that is an over-the-counter topical medication available in liquid or foam form. When applied to the affected areas of the scalp, it helps to widen the blood vessels, encouraging the flow of blood to the hair follicles. The increased blood flow delivers more essential nutrients and oxygen to the area, promoting hair growth.
What is finasteride?
Finasteride is an oral medication initially developed to treat prostate enlargement and cancer. Finasteride is typically used for male hair loss. However, it is not approved for use in women due to the possibility of congenital disorders. Side effects may include dizziness, headache, gastrointestinal discomfort, excessive facial and/or body hair growth, and sexual dysfunction.
How does minoxidil work?
Minoxidil works by widening the blood vessels in the head and increasing blood flow to the area. It stimulates hair growth by lengthening the hair cycle's anagen phase (growth phase) to encourage healthier, thicker growth.
Technically, topical minoxidil does not stop hair loss. Instead, it promotes growth by triggering hairs in the resting phase (telogen phase) to shed so they can be replaced with new hairs that may start to take on a healthier, thicker appearance.
Are there side effects of minoxidil?
Since minoxidil disrupts your hair's growth cycle, users may find that they shed more during the first few months of growth. This is a normal side effect that will pass with time. Other common side effects include dryness, itching, flaking, and slight scalp irritation.
How does finasteride work?
Finasteride is categorized into a class of medications called 5-alpha-reductase inhibitors. It works by blocking the effects of 5-alpha-reductase, which converts testosterone into DHT within the body. As mentioned, DHT is the primary hormone responsible for causing male pattern baldness.
You can think of finasteride as a shield that protects the follicles from being exposed to DHT in the first place. Finasteride is praised for its ability to prevent male pattern baldness from worsening while protecting the existing hair.
Are there side effects of finasteride?
Finasteride may cause many side effects, including loss of interest in sex, erectile dysfunction, and mood changes. Other possible side effects are trouble having an orgasm, abnormal ejaculation, swelling in the hands and feet, tenderness or lumps in the breasts, dizziness, weakness, headache, runny nose, and skin rashes. The sexual side effects of finasteride may continue after stopping taking this medicine. Consult with your local physician if you have concerns about these side effects.
In rare cases, finasteride can cause serious side effects that require immediate medical attention. Those are severe allergic reactions that can cause trouble breathing, swelling of your throat or tongue, or hives.
A recent study of 3,282 users of finasteride used VigiBase, the World Health Organization's global database of individual case safety reports, and found a disproportional prevalence of suicidality, depression, and anxiety associated with finasteride use for alopecia in patients younger than 45 years. No such signs were related to medications with different mechanisms of action but similar indications or medications with similar mechanisms and adverse effect profiles.
Finasteride should not be used by people with liver disease or prostate cancer. Finasteride is metabolized in the liver. In people with liver disease, the body processes the medication more slowly, increasing the medication levels in the body and causing more side effects. Finasteride can also increase the risk of faster-growing or more aggressive forms of prostate cancer. If you have or have had prostate cancer, you should not take finasteride.
Is finasteride spray safe?
Finasteride spray is not approved by the FDA to treat hair loss. Some websites mix it with minoxidil and sell it off-label. Adding finasteride to the minoxidil can be associated with more side effects than when using the minoxidil solution. The finasteride spray is safer but can cause the same side effects as oral finasteride, including sexual dysfunction, headaches, etc.
The FDA does not approve finasteride spray to treat hair loss. Some websites mix it with minoxidil and sell it off-label. Adding finasteride to the minoxidil can be associated with more side effects than using the minoxidil solution. The finasteride spray is safer but can cause the same side effects as oral finasteride, including sexual dysfunction, headaches, etc.
Beware that topical finasteride is not safe for pregnant women or trying to become pregnant. If you live with a pregnant woman or trying to conceive, they should not touch your hair or share your towel or pillow.
Should I use finasteride or minoxidil to treat male hair loss?
As with every other medical treatment, using a topical treatment like minoxidil should be the first step. Minoxidil is safer and does not require taking oral medication. Males who do not see a significant reduction in hair loss after six months of minoxidil can consider adding oral finasteride to their routine.
Can I use finasteride and minoxidil together?
Studies have shown that oral finasteride and minoxidil are safe to take together. One study published in the journal Dermatologic Therapy looked at the effects of taking the two treatments together and found that 94.1% of men showed significant improvements compared to the 59% and 80.5% of men treated with minoxidil or finasteride alone, respectively.
Can women use finasteride (Propecia)?
The FDA does not approve finasteride for women's hair loss, and women should not use finasteride. Finasteride can cause significant birth defects and has been shown to cause the feminization of male fetuses. In women, it was shown to cause depression, headaches, nausea, and hot flashes. Women who are pregnant or may become pregnant should not use finasteride or handle crushed or broken tablets. Finasteride can be absorbed through the skin and cause birth defects in male babies. If a woman does come in contact with this medication, the affected area should be washed right away with soap and water.
- Minoxidil - StatPearls - NCBI Bookshelf
- Long-term (10-year) efficacy of finasteride in 523 Japanese men with androgenetic alopecia
- Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: a randomized and comparative study in Chinese patients
- Androgenetic alopecia
- Finasteride and sexual side effects
- Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride
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