Finasteride vs. Minoxidil for Hair Loss: 5 Differences to Consider

Hair loss can be distressing. Thankfully, there are several treatment options available. Two popular choices are finasteride (Propecia) and minoxidil (Rogaine).

Finasteride is an oral medication that was initially approved to treat benign prostatic hyperplasia (BPH). Today, a lower dose is approved to treat hair loss in men. Minoxidil, originally developed as an oral blood pressure pill, is now widely used as a topical treatment for hair loss. Lower doses of oral minoxidil are also sometimes used off-label for this purpose.

Both finasteride and minoxidil are effective medications, but they work differently to treat hair loss. There are also differences when it comes to who can take them, dosages, and side effects. Here are five differences between finasteride and minoxidil to consider.

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1. Finasteride and minoxidil come in different dosage forms

One difference between finasteride and minoxidil is their available dosage forms. Finasteride is available as a 1 mg tablet that’s taken by mouth once a day. Minoxidil comes in a foam, spray, and solution that’s applied topically to the scalp twice a day. And as mentioned above, minoxidil pills are also sometimes prescribed for hair loss.

For topical minoxidil, the concentration and instructions vary between products. Read the product information carefully and ask your pharmacist or primary care provider if you have any questions about how to use it.

2. Finasteride and minoxidil work differently for hair loss

There are many causes of hair loss. And hair-loss treatments work in different ways. Finasteride and minoxidil target two different reasons behind hair loss.

Finasteride is a 5-alpha reductase inhibitor. It blocks an enzyme (protein) called 5-alpha reductase. This enzyme normally changes the hormone testosterone into dihydrotestosterone (DHT). Having too much DHT can shrink hair follicles and cause hair loss. Taking finasteride allows your hair to grow back by lowering DHT levels in the scalp. It can take anywhere from a few months to years to notice its full effects.

It isn’t fully clear how minoxidil works to treat hair loss. But it’s thought to open blood vessels and promote blood flow to hair follicles, which may stimulate hair growth. It may also cause hair follicles to move from a resting stage of hair growth into a more active hair-growth phase. It may take about 2 to 4 months of regular use to see results with minoxidil.

3. Finasteride is only approved for men, while minoxidil is approved for men and women

Another difference between finasteride and minoxidil is who’s approved to use them for hair loss. Both finasteride and minoxidil are approved for hair loss in men, but only minoxidil is also approved for women.

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• Hair loss treatments: Experts review which hair loss treatments are available to help you decide which may be the best option for you.

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The FDA approved finasteride in 1997 to treat male-pattern hair loss in men, but at a lower dose than what’s used for treating BPH. Finasteride isn’t approved for hair loss in women, but it’s sometimes prescribed off-label for this purpose. However, if you’re pregnant or able to get pregnant, you shouldn’t take or handle finasteride tablets. This is because finasteride can cause harm to a growing male fetus.

Unlike finasteride, minoxidil is approved for male-pattern or female-pattern hair loss. This means it helps regrow hair in people who have hair loss due to genetics. It’s also sometimes used off-label for other types of hair loss. Minoxidil comes in a 5% solution and foam for men (Rogaine for Men). For women, it comes in a 5% foam and 2% solution (Rogaine for Women).

Minoxidil also comes in an oral tablet that isn’t approved for treating hair loss. But a healthcare professional may prescribe lower doses off-label for this use.

4. Finasteride and minoxidil cause different side effects

Since finasteride is taken by mouth, it can cause more body-wide side effects compared to topical minoxidil. Most topical minoxidil side effects are usually limited to where you apply it on the scalp.

The most common finasteride side effects are sexual problems. This can include lower sex drive, erectile dysfunction, and ejaculation issues. These side effects typically go away once you stop finasteride. But in rare cases, it may take years for these problems to resolve. Other possible finasteride side effects include:

• Male breast enlargement (called gynecomastia)

• Mood changes

• Drops in blood pressure when changing positions

Topical minoxidil is applied directly to the scalp, so the side effects primarily affect where it’s applied. While uncommon, there have been some reports of sexual side effects. But it’s not clear if minoxidil was the cause. Typical minoxidil side effects can include:

• Itching

• Scaling

• Scalp irritation

• Temporary hair shedding

• Unwanted hair growth on the face, arms, or legs

Side effects are more likely with the higher concentration (5%) compared to the lower concentration (2%). Unwanted hair growth is more likely if you apply too much minoxidil. It’s reversible after stopping treatment, but it can take up to 5 months.

Taking minoxidil by mouth can cause different side effects. In addition to unwanted hair growth in other areas of the body, increased heart rate, headache, and low blood pressure are also possible.

5. Finasteride requires a prescription, while minoxidil is available OTC

Topical minoxidil does not require a prescription. If you’re looking for an over-the-counter (OTC) product for hair loss, you’ll find different minoxidil products available for both men and women. Which product you choose is based on personal preference. But finasteride is only available with a prescription. This means you’ll need to consult a healthcare professional before taking it. 

Topical minoxidil used to require a prescription. But in 1996, it switched from prescription only to OTC. Minoxidil tablets, however, still require a prescription.

Can you use finasteride and minoxidil together for hair loss?

Yes, it’s possible to use both finasteride and minoxidil at the same time. In fact, taking finasteride and minoxidil together may be more effective for treating hair loss than either alone. This is likely due to the fact that each of these medications works in a different way to treat hair loss. 

If one treatment isn’t working well for you, talk to your primary care provider. They may recommend a different treatment or combining more than one medication together.

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Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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