Finasteride and minoxidil are both clinically proven to treat male pattern baldness, but they work through completely different mechanisms. Understanding these differences is essential to choosing the right treatment — or deciding whether to use both together.
Finasteride: Tackling the Root Cause
Finasteride is an oral tablet taken once daily. It works by blocking DHT, the hormone responsible for shrinking hair follicles in genetically susceptible men. By reducing serum DHT levels by around 60–70%, finasteride addresses the underlying hormonal cause of male pattern baldness.
- Pros: Targets the hormonal cause; one small tablet daily; well-studied over decades; prescription ensures clinical oversight
- Cons: Prescription-only in the UK; potential sexual side effects in a small percentage of men; not suitable for women
Minoxidil: Stimulating Growth Directly
Minoxidil is a topical solution or foam applied directly to the scalp, typically twice daily. It works by widening blood vessels around hair follicles, increasing nutrient delivery and prolonging the anagen (growth) phase of the hair cycle. Importantly, minoxidil does not affect DHT levels at all.
- Pros: Available over the counter from UK pharmacies without a prescription; no hormonal effects; suitable for both men and women
- Cons: Must be applied directly to the scalp twice daily; can cause initial shedding; liquid formulation may cause scalp irritation
What Does the Evidence Say?
Head-to-head studies suggest that finasteride is generally more effective than minoxidil for maintaining existing hair and promoting regrowth at the crown and mid-scalp. A key study published in Dermatologic Therapy found that finasteride 1 mg produced superior hair count increases compared to minoxidil 2% over 12 months. The 5% minoxidil formulation narrows this gap somewhat.
Can You Use Both Together?
Many men in the UK use both treatments simultaneously for a combined approach. Evidence from a 2017 meta-analysis in the Journal of the American Academy of Dermatology confirms that combination therapy produces superior outcomes to either treatment alone. This dual approach is widely regarded as the gold standard for non-surgical hair loss treatment.
Which Should You Choose?
Consider finasteride if you want a systemic treatment addressing the hormonal cause. Choose minoxidil if you prefer an over-the-counter option or want to avoid potential hormonal side effects. Speak to a GPhC-registered pharmacist or your GP to decide what is right for your situation.