Finasteride, minoxidil, or both?
The two medicines with the strongest evidence for pattern hair loss work in different ways. Here they are on the same measures, with the spray form of finasteride.
How long before you can judge it
One figure = one month.
- Minoxidil6months
- Finasteride tablet12months
- Finasteride spray6months
- Both together12months
All options stay on the page. Choose one to bring it forward.
| — | Minoxidil | Finasteride tablet | Finasteride spray | Both together |
|---|---|---|---|---|
| How you use it | Lotion or foam on the scalp, once or twice a day. | One 1 mg tablet a day. | A few sprays on the scalp once a day. | Minoxidil on the scalp and a finasteride tablet each day. |
| How it works | Helps follicles grow for longer. It does not touch the cause, DHT. | Lowers DHT, the hormone that shrinks follicles, so it slows the cause. | The same medicine on the scalp, with far less of it in the blood. | Two routes at once: one supports growth, the other slows the cause. |
| When you can judge it | Judge at 6 months. | Check at 6 months, judge at 12. | The main trial judged it at 24 weeks. | Check at 6 months, judge at 12. |
| How sure we can be | Good: several large trials. Recommended for men and women by the 2017 European guideline. | Good: several large trials. Recommended for men by the 2017 European guideline. Not for women who could become pregnant. | Some: smaller or fewer trials. One large trial in men found it close to the tablet; longer studies are still missing. | Some: smaller or fewer trials. The 2017 European guideline says men can consider it. Common in practice; few trials test it head to head. |
| Common downsides | Scalp irritation; an early shed; the gain fades if you stop. | Sexual side effects in some men; mood changes are now a listed side effect. | Scalp irritation. Sexual side effects were no more common than with placebo in the trial. | The side effects of both. |
| Where you get it | Pharmacy, no prescription. | Prescription only. | Prescription; approved in some EU countries. | Pharmacy for minoxidil, prescription for finasteride. |
| How you pay | Small monthly cost. | Small monthly cost, plus doctor visits. | Costs more than the tablet. | Both monthly costs. |
| Read the guide | Minoxidil | Finasteride tablet | Finasteride spray | Both together |
Where this comes from
Numbered in the order the guide first cites them.
- 1
The 2017 European guideline recommends topical minoxidil for women and men and finasteride 1 mg for men, suggests low-level laser as an add-on, makes no recommendation on PRP, and advises judging results at 6 months. Its own expiry date was June 2020, and we found no newer version.
Kanti V, Messenger A, Dobos G, et al. (2017). S3 – European Dermatology Forum Guideline for the Treatment of Androgenetic Alopecia in Women and in Men. European Dermatology Forum, S3 guideline (literature to Oct 2015, expiry 06/2020)
- 2
Across 23 studies in men, dutasteride, finasteride 5 mg and topical minoxidil 5% added about 15 to 19 hairs/cm² over placebo at 24 weeks, but the evidence was rated low quality for several comparisons.
Gupta AK, Venkataraman M, Talukder M, et al. (2022). Relative Efficacy of Minoxidil and the 5-α Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients: A Network Meta-analysis. JAMA Dermatol 2022;158(3):266–274
- 3
Across trials in women, minoxidil nearly doubled the chance of moderate or marked regrowth compared with placebo, 2% and 5% did about the same, and finasteride 1 mg did no better than placebo.
van Zuuren EJ, Fedorowicz Z, Schoones J (2016). Interventions for female pattern hair loss. Cochrane Database Syst Rev 2016;(5):CD007628
- 4
In 1553 men, finasteride 1 mg gave about 107 more hairs than placebo at 1 year and 138 more at 2 years in a 5.1 cm² crown area, while hair loss kept getting worse on placebo.
Kaufman KD, Olsen EA, Whiting D, et al. (1998). Finasteride in the treatment of men with androgenetic alopecia. J Am Acad Dermatol 1998;39(4 Pt 1):578–589
- 5
The EU regulator confirmed suicidal thoughts as a side effect of finasteride tablets with unknown frequency, added a patient card to 1 mg packs, found no link for finasteride skin spray, and judged that benefits still outweigh risks.
European Medicines Agency (2025). Measures to minimise risk of suicidal thoughts with finasteride and dutasteride medicines. EMA/142716/2025, 8 May 2025
- 6
In 458 men over 24 weeks, a 0.25% finasteride spray added about 20 hairs in the target area against 7 with placebo, close to the finasteride tablet (21), while lowering blood DHT less (about 35% against 56%).
Piraccini BM, Blume-Peytavi U, Scarci F, et al. (2022). Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol 2022;36(2):286–294