Minoxidil vs Finasteride: Which is Better for Hair Loss?

Minoxidil Spray and Finasteride Tablets have been the go-to treatments for androgenetic alopecia (male pattern baldness) for decades. They have both clinical studies and years of real-world use to back up how well they work to stop male hair loss, but through very different mechanisms.

In this blog, we’ll break down how minoxidil and finasteride work respectively, whether you can use them together, and which is better for hair loss.

How does Minoxidil work?

Minoxidil was originally prescribed as a medication to treat high blood pressure in the 1970s, which brought about a side effect called hypertrichosis (hair growth) in about one fifth of users. This led to the development of a spray version to treat androgenetic alopecia in men, being extended to women as well later down the line. Minoxidil 5% Spray is now widely available as an over the counter, licensed treatment for male or female pattern baldness.

How minoxidil works to stop hair loss isn’t fully understood yet, but it’s thought to help reactivate dormant hair follicles in the following ways:

• Boosting circulation to shrunken hair follicles, renewing the supply of blood with oxygen and nutrients needed for a healthy growth cycle.
• Shortens the telogen (resting) phase, prompting follicle to re-enter the anagen (growth) phase. Also thought to extend the anagen phase, leading to thicker, longer hair.
• Promoting growth factor expression like VEGF (Vascular Endothelial Growth Factor), which stimulates angiogenesis (formation of new blood vessels)

Researchers think the presence of an enzyme called sulfotransferase on the scalp itself might impact how a person is likely to respond to minoxidil. The enzymes are thought to convert minoxidil into its active form: minoxidil sulphate, so those with low amounts on their scalp might not respond to the spray. If you’ve been using Minoxidil Spray for more than 6 months and you think you might be a non-responder, there is an alternative version, Minoxidil capsules, which we will talk about in more detail below.

How does Finasteride work?

Finasteride directly counteracts the effects of the hormone which causes male pattern baldness: dihydrotestosterone (DHT). It belongs to a group of medications called 5a-reductase inhibitors, so in a nutshell, it blocks the enzyme which converts testosterone into DHT. Some men are more genetically sensitive to DHT, which binds to their hair follicles and causes them to shrink, so hair grows thinner and shorter with each cycle, resulting in noticeable hair loss. Finasteride lowers DHT levels by approximately 70%, which helps prevent or stop hair loss.

Which one is better?

It depends on the extent of your hair loss, medical history, lifestyle preferences etc.

Objectively, Finasteride tablets have been shown in clinical trials to stop hair loss in a higher proportion of men than Minoxidil Spray. Finasteride 1mg was shown to stop hair loss in 90% of users and even regrow hair in 60%. On the other hand, a study found Minoxidil 5% Spray to be effective in 84% of men at stopping hair loss.

If suitable, they are typically most effective when used together – a 2015 clinical trial found finasteride was superior to minoxidil by itself, but a combined therapy was best of all.

Alternative formulations

While studies show Finasteride tablets and Minoxidil Spray are effective in most people that use them, it doesn’t mean they will be the best fit for everybody.

As mentioned earlier, it has been suggested by researchers that certain people might not respond to Minoxidil Spray if they naturally have a low amount of sulfotransferase enzymes on their scalp. Minoxidil capsules, on the other hand, are absorbed directly into the bloodstream and metabolized inside the body, so it is thought it is converted into the active minoxidil sulphate in the liver, where there is a higher concentration of the key enzymes. If this is the case, Oral Minoxidil could be a suitable alternative for non-responders to the spray. That’s not the only reason somebody might consider the capsules. Some people experience side effects like dryness or irritation with Minoxidil Spray, which the capsules can bypass.

In the same vein, spray versions of finasteride come with a lower risk of side effects than the tablets, because they work directly on the hair follicles, rather than being absorbed into the bloodstream. A 2022 study found that no serious adverse events were reported in participants using topical finasteride, and the improvement in hair count was similar to oral finasteride. In other words, existing evidence suggests that topical finasteride is as effective as the tablets but has a lower chance of side effects.

If you’re unsure what the best treatment option is for you, you can take our free consultation for personalised recommendations.

All of our blog articles are reviewed for medical accuracy by our Medical Director before publication.

Posted in: All, Finasteride, Hair loss