Finasteride vs minoxidil

Finasteride and minoxidil are the two treatments for pattern hair loss with the most evidence behind them, and they do different jobs. Finasteride is a daily tablet that lowers DHT, the hormone that shrinks hair follicles in male pattern hair loss. Minoxidil is applied to the scalp and stimulates growth where it goes on. Finasteride is FDA-approved for men only; topical minoxidil is approved without a prescription for men and women.

They are not rivals so much as partners. In a 12-month study of 450 men, the combination helped more men than either one alone. Below are the trial numbers, side effects and October 2026 prices side by side.

How each one works

Male pattern hair loss is driven by dihydrotestosterone (DHT). In people who are genetically sensitive to it, DHT gradually shrinks follicles on the crown and hairline until they produce thin, short hairs or none at all.

• Finasteride blocks the type II 5-alpha reductase enzyme that turns testosterone into DHT. Less DHT means less pressure on the follicles, so it mainly slows or stops loss, and in many men regrows some hair.
• Minoxidil does not touch hormones. It was first a blood pressure tablet, and how it regrows hair is not fully understood. Applied to the scalp, it stimulates growth where it goes on, and only while you keep using it.

What the trials show

Finasteride

The Propecia label reports three 12-month trials in 1,879 men aged 18 to 41 with mild to moderate hair loss, with extension studies that ran to 5 years.

The placebo groups shrank over the years, so the 5-year comparison rests on few men, but the direction holds throughout: men who took finasteride were far less likely to keep losing hair.

Minoxidil

In a 48-week trial of 393 men, 5% topical minoxidil twice a day was clearly better than the 2% strength and placebo, with 45% more regrowth than 2% and an earlier response. It also caused more itching and irritation than the 2% solution. The men’s Rogaine label says results may show at 2 months with twice-a-day use, and some men need at least 4 months.

Head to head, and together

The 450-man study published in Dermatologic Therapy in 2015 randomly assigned men to finasteride 1 mg, 5% topical minoxidil, or both, for 12 months:

Side effects were uncommon in that study (1.8% on finasteride and 6.1% on minoxidil). It was a single study in Chinese men, so treat the exact percentages as one data point, but it matches the way dermatologists usually use the two drugs: finasteride to protect what you have, minoxidil to push regrowth.

Side effects

Finasteride has no boxed warning, but its label lists serious postmarketing reports. These include depression, suicidal ideation and behavior, and sexual problems that continued after men stopped the drug. In the first-year trials, decreased libido (1.8% vs 1.3% on placebo), erectile dysfunction (1.3% vs 0.7%) and ejaculation disorder (1.2% vs 0.7%) were slightly more common than on placebo. Finasteride also lowers PSA, which matters for prostate cancer screening, and women who are or may be pregnant should not handle crushed or broken tablets. Our finasteride side effects guide covers each one.

Topical minoxidil mostly causes scalp irritation, itching and, sometimes, unwanted facial hair. The Drug Facts label says to stop and ask a doctor if you have chest pain, a rapid heartbeat, faintness, dizziness, sudden weight gain or swollen hands or feet.

Oral minoxidil is a different matter. The tablets are approved only for severe high blood pressure and carry a boxed warning for fluid around the heart and worsening angina, so low-dose use for hair loss is off-label. See oral vs topical minoxidil.

Which one fits you

• If you are a man and your hairline or crown is thinning, finasteride addresses the cause. Pairing it with minoxidil gives the best odds, based on the study above.
• If you are a woman, minoxidil is the approved option. Finasteride is not approved for women. See the best hair loss treatments for women.
• If you want to avoid hormonal effects, minoxidil alone is the choice, accepting that it does less to slow loss in men.
• If you are worried about finasteride’s sexual or mood side effects, raise them with a clinician before starting. Topical finasteride is sometimes offered as an alternative, but it is compounded, not FDA-approved, and the subject of a 2025 FDA alert. See topical vs oral finasteride.

What they cost in October 2026

These are the published monthly prices at the online providers we track, read on October 18, 2026.

Scroll sideways to see the full table

Generic finasteride from Hims starts at $22 a month and from Strut Health costs $25, with physician visits and shipping included. Keeps charges $80 for 90 tablets, about $26.67 a month. Our cheapest finasteride list ranks every provider by price.

A finasteride tablet plus a minoxidil solution bought separately usually costs less than a compounded blend that combines them. Hims is the exception: its spray starts at $35 a month, against $37 for its finasteride and minoxidil serum bought separately. The blends are more convenient, one product instead of two, but they are not FDA-approved, and no trial has tested the specific blends sold online. Compare them on our prescription serums and sprays list.

The bottom line

Finasteride is the stronger single treatment for men with male pattern hair loss: in its trials, far fewer men kept losing hair on it than on placebo. Minoxidil is the treatment approved for both men and women, and it adds regrowth on top. Used together, they helped the most men in a direct comparison.

Neither works overnight, and both stop working when you stop. Talk through the side effects with a licensed clinician, then compare providers on our hair loss hub.