Minoxidil vs Finasteride

Topical vasodilator (hair-growth stimulant)

5α-reductase inhibitor

An over-the-counter topical foam or solution (and an off-label low-dose oral tablet) that stimulates regrowth in pattern hair loss.

A once-daily 1 mg oral tablet (Propecia) that blocks DHT to slow hair loss and regrow hair in men with male pattern baldness.

Hair loss (androgenetic alopecia)

Hair loss (androgenetic alopecia)

• Androgenetic alopecia — male and female pattern hair loss (topical Rogaine, available over the counter)
• Severe hypertension (oral minoxidil tablets, prescription)
• Low-dose oral minoxidil for hair loss is used off-label and is not FDA-approved for that purpose

• Male pattern hair loss (androgenetic alopecia) in men, using finasteride 1 mg (Propecia)
• Benign prostatic hyperplasia, using finasteride 5 mg (Proscar)

• Topical 5% foam or solution applied to the scalp once (women) or twice (men) daily
• Off-label oral minoxidil for hair loss: roughly 0.625–5 mg once daily under clinician supervision
• Oral minoxidil for hypertension: 5 mg daily to start, titrated up to 10–40 mg daily
• Regrowth takes about 3–6 months, and hair is lost again within months of stopping

• Hair loss: 1 mg by mouth once daily
• Three or more months of daily use is generally needed before benefit is seen
• Benefit is gradually lost within about a year of stopping

• Scalp itching, dryness, or irritation (topical)
• Unwanted facial or body hair growth (hypertrichosis)
• A temporary increase in shedding when first starting
• Fluid retention and ankle swelling (oral)

• Rapid heartbeat or chest pain (oral)
• Pericardial effusion, occasionally progressing to tamponade (oral)
• Lightheadedness from a drop in blood pressure (oral)
• Contact dermatitis or severe scalp allergic reaction (topical)

• Decreased libido
• Erectile dysfunction
• Decreased volume of ejaculate
• Ejaculation disorder

• Depression and, rarely, suicidal thoughts
• Male breast cancer (rare)
• Sexual side effects that persist after stopping in some men
• Allergic reactions including swelling of the lips or face

• Adults with male or female pattern hair loss at the crown or hairline (topical)
• People seeking an off-label oral option when topical treatment is impractical or ineffective

• Adult men with mild to moderate male pattern hair loss at the vertex and mid-scalp
• Men who prefer an oral tablet over topical treatment

• Known hypersensitivity to minoxidil
• Pheochromocytoma (oral)
• Topical use on a scalp that is broken, infected, or sunburned

• Women who are or may become pregnant
• Children
• Known hypersensitivity to finasteride

• Topical minoxidil is only for androgenetic alopecia, not sudden or patchy hair loss
• Stop and seek care for chest pain, rapid heartbeat, dizziness, or sudden unexplained weight gain
• Oral minoxidil carries a boxed warning for serious cardiac and fluid effects and is prescribed with a beta-blocker and a diuretic
• Not for use in pregnancy or while breastfeeding without clinician guidance

• Women should not handle crushed or broken PROPECIA tablets when they are pregnant or may potentially be pregnant because of the possibility of absorption of finasteride and the subsequent potential risk to a male fetus
• PROPECIA causes a decrease in serum PSA levels; any confirmed increase in PSA while on PROPECIA may signal the presence of prostate cancer and should be evaluated, even if those values are still within the normal range for men not taking a 5α-reductase inhibitor
• 5α-reductase inhibitors may increase the risk of high-grade prostate cancer
• Mood changes including depression have been reported; stop and seek care if they occur