Finasteride vs. Minoxidil for Male Pattern Baldness
Oral finasteride 1mg daily is more effective than topical minoxidil for male pattern baldness, with clinical studies showing an 80% improvement rate versus 52% with minoxidil. 1, 2
Mechanism of Action
Finasteride:
- 5α-reductase inhibitor that blocks conversion of testosterone to dihydrotestosterone (DHT)
- DHT is the primary androgen responsible for male pattern hair loss
- Reduces scalp DHT levels by 64.1% at 1mg dose 3
Minoxidil:
- Vasodilator that promotes hair growth through multiple pathways
- Acts as anti-inflammatory agent and Wnt/β-catenin signaling inducer
- Originally developed as an antihypertensive medication 1
Efficacy Comparison
Finasteride
- 80% clinical improvement rate (increased hair intensity) 2
- Prevents further hair loss in 83% of men after 2 years 4
- Shows progressive improvement over time (48% improvement at 1 year, 66% at 2 years) 4
- Long-term studies show durable improvements over 5 years of treatment 5
Minoxidil
- 52% clinical improvement rate 2
- FDA-approved for topical use at 5% concentration for men 6
- Results may be seen as early as 2 months but may take up to 4 months 6
- Requires twice daily application for effectiveness 6
Side Effects
Finasteride
- Sexual dysfunction (decreased libido, ejaculation disorder, erectile dysfunction) in 3.8% of users 4
- Sexual side effects are reversible upon discontinuation 4
- May cause gynecomastia in some patients 1
- Lowers PSA levels by 50% after 12 months (important for prostate cancer screening) 7
Minoxidil
- Topical: Scalp irritation 2
- Systemic: Can cause sodium and water retention, reflex tachycardia when absorbed systemically 1
- Temporary increase in hair shedding during first 2 weeks of use 6
Treatment Recommendations
- For maximum efficacy: Oral finasteride 1mg daily is the preferred first-line treatment
- For patients concerned about sexual side effects: Topical minoxidil 5% solution twice daily
- For optimal results: Combination therapy with both finasteride and minoxidil provides synergistic effects 1
Important Considerations
- Results take time - visible improvement typically begins at 2-4 months, with comprehensive assessment at 12 months 1
- Continuous treatment is necessary to maintain results; discontinuation leads to reversal of benefits within 12 months 6
- Finasteride is contraindicated in women of childbearing potential due to teratogenicity 1
- Neither treatment completely restores hair; maintenance of existing hair and modest regrowth is considered successful 1
Monitoring
- Take baseline photos before starting treatment
- Evaluate at 3 months for initial response
- Critical evaluation at 6 months
- Comprehensive assessment at 12 months to determine continuation 1
For patients using finasteride, be aware that it reduces PSA levels by approximately 50%, which must be considered when screening for prostate cancer 7.