The Choice Between Minoxidil and Finasteride

Male pattern hair loss, or androgenic alopecia, is a genetic condition that unfortunately affects up to 50% of the male population. Currently, topical minoxidil and oral finasteride are the only two medications that are FDA-approved to treat this type of hair loss. There are many benefits in choosing minoxidil vs finasteride, so be sure to explore the effectiveness of each option.

What Is the Role of DHT in Hair Loss?

There are many causes for hair loss in both men and women. The main culprit in androgenic alopecia in particular is dihydrotestosterone, or DHT. Generally, increased activation of androgen receptors shortens the growth phase of hair follicles in the normal hair growth cycle. Because the growth phase is shortened, hair follicles become thinner and shorter. Weaker hair follicles may not even rise above the skin's surface, causing the physical effect or look of balding.

Men affected with this type of hair loss may have an increased production of DHT due to an increased amount of 5 alpha-reductase, which is the enzyme that converts testosterone to DHT. DHT has a much higher affinity for androgen receptors than testosterone. Not only are the levels of DHT high as a result, but these men also have a higher concentration of androgen receptors. This perfect storm equates to an abnormally increased activation of androgen receptors, causing stunted hair growth.

How Does Minoxidil Help With Hair Growth?

Minoxidil’s claim to fame is its ability to possibly promote hair growth by widening blood vessels, allowing more oxygen, blood, and nutrients to be available to hair follicles. Although the exact mechanism is unknown, this increased nourishment stimulates dormant hairs to be replaced with actively growing hairs. While minoxidil does not prevent hair loss, topical minoxidil has been safely used by millions of men to regrow hair.

How Does Finasteride Help With Hair Growth?

Finasteride is a 5 alpha-reductase type 2 inhibitor. Because finasteride dampens the effects of this pesky enzyme, less DHT is produced. Remember that this enzyme plays a major role in converting testosterone into DHT. Research has shown that finasteride reduces DHT levels in the blood by more than 70%. With less DHT circulating in the bloodstream, fewer androgen receptors are activated, freeing hair follicles from having a shortened anagen, or growth, phase.

Do They Really Work?

Minoxidil is readily available over the counter in topical formulations of varying strengths. Clinical studies have shown that minoxidil 5% is more effective than minoxidil 2% with continued use. Moreover, minoxidil has shown more clinical potency or effectiveness when used within five years after the first signs of balding occur. This can be attributed to fewer hair follicles being cycled into the telogen, or resting, phase.

Finasteride is available in multiple prescription strengths. For treating androgenic alopecia, finasteride 1 milligram is prescribed. In clinical studies, finasteride has been shown to be associated with an overall increase in both hair count and hair growth. Furthermore, in clinical studies lasting greater than five years, patients treated with finasteride have reported a slower progression of hair loss versus patients treated with placebo.

How Are They Properly Used?

Both of these medications are not a one-time deal. A four- to six-month trial period of continued use of minoxidil and/or finasteride is recommended to see if they are effective for you. If you see improvement after this period, the long-term use of both minoxidil and finasteride must be continued in order for results to be maintained.

Earlier treatment is always better. It’s much easier to maintain the hair that you already have rather than aiming to regrow hair that you no longer have. Stronger clinical potency has been shown with minoxidil when used within five years of noticing signs of hair loss.

For best results, minoxidil should be applied twice daily to the area of hair loss. One-milligram tablets of finasteride must be taken by mouth once daily to maintain hair regrowth and slow the progression of hair loss. Adherence is key to achieving results.

Is Minoxidil Safe? Is Finasteride Safe?

Starting any type of treatment can be daunting at first. The good news is that finasteride and minoxidil are generally well tolerated and have been around for some time. However, you should be aware of possible side effects.

Side effects that have been reported with minoxidil include:

• Skin irritation: Redness, burning, or mild pain can occur at the site of application.
• Localized or generalized hypertrichosis: Increased hair growth in patches or all over the body can occur. This effect is attributed to minoxidil's prolongation of the anagen phase.
• Minoxidil-induced telogen effluvium: Because minoxidil shortens the telogen phase, hair shedding can occur when treatment starts.
• Scaly scalp skin: Minoxidil can worsen seborrheic dermatitis.
• Isolated pruritus: Itchiness can occur around or far from the application site.
• Allergic contact dermatitis: An itchy, red, eczema-like skin reaction can occur. Minoxidil patch testing is recommended to see if this can affect you.

Side effects that have been reported with finasteride include:

• Sexual dysfunction: Finasteride has been associated with erectile dysfunction (2% to 4% of patients), loss of libido, and decreased ejaculation.
• Orthostatic hypotension: Decreased blood pressure can occur when rising from either a prone or sitting position. Those who are taking blood pressure medications in addition to finasteride may have a more marked drop in blood pressure.
• Possible infertility effects: There is currently no evidence to suggest that the daily use of 1 milligram of finasteride is associated with permanent infertility issues. More studies need to be performed.
• Decreased prostate-specific antigen, PSA, levels: Decreased PSA levels correlate with increased risk of prostate cancer. Speak with your prescriber regarding your baseline PSA levels before starting this medication.
• Dizziness and weakness: These effects may be due to finasteride's effect on blood pressure.
• Difficulty breathing, runny nose, and skin rash have also been reported.

Who Should Avoid Finasteride or Minoxidil?

While the approved uses of minoxidil and finasteride in male pattern hair loss are the focus here, it is important to note that both treatments should be avoided by pregnant or breastfeeding women. You should also avoid these medications if you have shown or start to develop allergic symptoms while using them.

If you’re currently taking blood pressure medications or have a family history of prostate cancer, consult with your physician before starting finasteride. If you have a sensitivity to propylene glycol, it is best to avoid minoxidil, as this is an ingredient in many formulations.

Which Option Should You Choose?

There are many ways to approach hair loss, from lifestyle changes to medication regimens. No matter how you decide to start your hair regrowth process, it’s important to note that minoxidil and finasteride are the only two medications approved by the FDA to treat androgenic alopecia. If you feel that this condition is the main cause of your hair loss, these options are strong contenders for a solution. Shapiro MD carries them both in affordable kits designed for your hair condition.

At Shapiro MD, we believe in a personalized, multi-pronged regimen to treating hair loss. Begin a free physician consultation to see what type of treatment might work best for you. Whether due to androgenic alopecia or even something as unassuming as everyday stress, we aim to pinpoint and address the root of your hair loss problems and treat them accordingly, all with the help of a physician.

Get started with our free hair quiz today.