What is the comparison between finasteride (generic) and minoxidil (generic) for treating hair loss?

Finasteride vs Minoxidil for Hair Loss Treatment

For treating androgenetic alopecia, oral finasteride is more effective than topical minoxidil, with clinical cure rates of 80% for finasteride compared to 52% for minoxidil. 1

Mechanism of Action

• Finasteride is a 5α-reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (DHT), the androgen responsible for androgenetic alopecia in genetically predisposed individuals 2
• Minoxidil acts through multiple pathways to promote hair growth, functioning as a vasodilator, anti-inflammatory agent, Wnt/β-catenin signaling inducer, and has mild antiandrogen properties 3

Comparative Efficacy

• In a randomized comparative study, finasteride demonstrated superior efficacy with 80% of patients showing increased hair intensity compared to 52% with 5% topical minoxidil 1
• A study of Chinese patients with male androgenetic alopecia found improvement rates of 80.5% with finasteride, 59% with 5% minoxidil, and 94.1% with combination therapy after 12 months 4

Administration and Formulations

• Finasteride is typically administered orally at 1 mg/day 2
• Minoxidil is most commonly used as a 5% topical solution applied twice daily 1
• Topical finasteride formulations exist but are not FDA-approved, though they may provide similar efficacy to oral formulations with fewer systemic side effects 5

Side Effects

Finasteride

• Sexual dysfunction (decreased libido, ejaculation disorders, erectile dysfunction) occurs in approximately 3.8% of patients compared to 2.1% with placebo 2
• These sexual adverse events typically reverse upon discontinuation of therapy 2
• Increased body hair has been reported in some cases 1

Minoxidil

• Topical minoxidil may cause local irritation of the scalp 1
• Oral minoxidil (used off-label) can cause hypertrichosis and cardiovascular symptoms in a dose-dependent manner 3

Combination Therapy

• Combined treatment with finasteride and minoxidil has shown superior results compared to either treatment alone, with improvement rates of 94.1% versus 80.5% for finasteride alone and 59% for minoxidil alone 4
• The combination of platelet-rich plasma (PRP) and minoxidil is more effective than minoxidil monotherapy 6

Treatment Considerations

• Before starting treatment, it's essential to check for underlying causes of hair loss, such as thyroid dysfunction or iron deficiency 7
• For androgenetic alopecia, a probable efficacy ranking in decreasing order is: dutasteride 0.5 mg/day > finasteride 5 mg/day > minoxidil 5 mg/day > finasteride 1 mg/day > minoxidil 0.25 mg/day 3
• Topical finasteride may be an alternative for those concerned about systemic side effects of oral finasteride 5

Monitoring and Expectations

• Improvement with finasteride may be maintained during at least 2 years of treatment, with 83% of patients showing no further hair loss compared to baseline after 2 years 2
• Laboratory monitoring may show increased serum total testosterone and decreased free testosterone and prostate-specific antigen with finasteride treatment 1

Special Considerations

• Finasteride is contraindicated in pregnant women due to the risk of hypospadias in male fetuses 2
• For patients with limited patchy hair loss due to alopecia areata (a different condition), intralesional corticosteroids may be considered as first-line treatment 8