Is finasteride (Propecia) or minoxidil (Rogaine) more efficacious in treating androgenetic alopecia?

Finasteride vs. Minoxidil for Androgenetic Alopecia

Finasteride monotherapy demonstrates superior efficacy compared to minoxidil monotherapy for treating androgenetic alopecia, with an 80% clinical cure rate versus 52% for minoxidil in head-to-head comparison. 1

Direct Comparative Evidence

The most definitive head-to-head trial comparing these agents found that oral finasteride 1 mg daily achieved significantly better outcomes than topical minoxidil 5% twice daily over 12 months 1:

• Finasteride produced an 80% clinical cure rate (increased hair intensity) compared to 52% for minoxidil 1
• This difference was statistically significant (p < 0.05) 1
• Both treatments were safe, with mild and reversible side effects 1

Why Finasteride Outperforms Minoxidil

Finasteride targets the underlying pathophysiology of androgenetic alopecia by inhibiting DHT production, while minoxidil acts as a nonspecific hair growth stimulant 1. This mechanistic difference explains finasteride's superior efficacy in monotherapy 1.

The Optimal Treatment Strategy: Combination Therapy

While finasteride alone is more effective than minoxidil alone, combining both agents produces significantly superior results compared to either monotherapy 2, 3, 4:

• Combination therapy achieves higher global photographic scores (p < 0.00001), more patients with marked improvement (p < 0.001), and fewer patients with deterioration 2
• A 2024 trial demonstrated that combined topical minoxidil 5% plus topical finasteride 0.25% increased hair density by +81 hairs/cm² at 6 months, significantly outperforming either agent alone 4
• 79% of combination therapy patients achieved marked improvement versus only 8% with finasteride alone and 41% with minoxidil alone 4

Clinical Algorithm for Treatment Selection

For maximal efficacy in androgenetic alopecia:

1. First-line: Combination finasteride + minoxidil 5, 2, 4

   • Oral finasteride 1 mg daily OR topical finasteride 0.25% once daily 3, 4
   • Topical minoxidil 5% twice daily 3, 4
   • Initial improvements visible at 2-3 months 5

2. For patients seeking maximum results: Add PRP to combination therapy 5, 6

   • Three intradermal PRP sessions spaced one month apart 6
   • Continue finasteride + minoxidil throughout 6
   • Maintenance PRP every 6 months 5, 6
   • This triple combination represents the most effective evidence-based approach 5

3. If monotherapy is required (patient preference/contraindications):

   • Choose finasteride over minoxidil based on superior efficacy 1

Critical Treatment Considerations

• Continuous treatment is mandatory—discontinuation results in loss of gains within months 5
• Combination therapy has similar safety profiles to monotherapy, with no increased adverse events 2, 4
• Topical finasteride formulations (0.25%) minimize systemic DHT suppression (~5% reduction) while maintaining efficacy 3
• Finasteride side effects (decreased libido in 15% of patients) resolve immediately upon discontinuation 1