It’s not a life or death decision. But it’s a big decision nevertheless — and if you choose the wrong treatment plan, it may cost you your hair.
Obviously, finasteride AKA Propecia, is far more effective than minoxidil. It works astoundingly well, stopping hair loss in its tracks — and often promoting some regrowth too — in about 90% of its users.
But finasteride comes with a variety of unappealing, potential side effects, including impotence, gynomastia (man boobs), depression, and others.
Minoxidil works too but it’s more of a hassle to use — and unlike finasteride, it doesn’t address the root cause of pattern hair loss. Sure, minoxidil may buy some time. But its effectiveness will decrease a little with each passing year and it works best on mild hair loss.
So which product should you use for your hair loss battle? Or should you use both of them simultaneously?
Here are the factors you should consider as you put together your treatment plan.
1. Your Age
The younger you are, the more likely it is that minoxidil alone isn’t going to cut it. At least not in the long run. Sure, it can buy you time.
But if you’re under 30 and already going bald, then there’s a pretty decent chance your hair loss is of the aggressive variety.
So if your hair is important to you, you’ll probably want to at least consider finasteride. Then, depending on your results using finasteride, you could add minoxidil as a supplementary treatment.
Dealing with a simple receding hairline or slightly thinning crown?
Minoxidil may be sufficient to help you retain your locks. Eventually it will lose its effectiveness and you’ll probably lose hair as a result.
But assuming you’re not genetically programmed to go completely bald and you’re not losing your hair in chunks, minoxidil may be the ticket for you. Granted, finasteride works considerably better and most men tolerate it without issue.
2. The Degree of Your Hair Loss
Perhaps you’re experiencing “diffuse” thinning throughout your entire scalp.
If that’s the case, again, minoxidil alone probably won’t work for you in the long-term.
Finasteride might not even be sufficient for you, but that’s probably your best starting point to address the issue. Aggressive hair loss often demands a multi-prong approach to treatment, including finasteride, minoxidil, and additional therapies in extreme cases.
Mild hair loss, on the other hand, often responds favorably to minoxidil.
3. Your Genes
How bald is your father? What about your uncles and grandfathers?
In other words, how bald do think you’ll eventually become?
Many men follow a similar hair loss “path” as one of their close relatives. For example, say you’re thinning now at 25. If your dad also started thinning around that point and is now bald at 50, then there’s a decent probability that you’ll follow in his follicular footsteps.
More baldness in your family tree means you’re more likely to face an uphill battle.
4. How Much You Value Your Hair
Not interested in going bald, like ever? Then I’d say you should strongly consider finasteride.
If you’re willing to “roll the dice” and understand that doing so may lead to baldness, by all means, take your chances with minoxidil.
5. Your Comfort Level with Pharmaceuticals
Some people, myself included, just don’t like the idea of taking a prescription drug over the course of decades to combat a cosmetic issue such as hair loss.
That’s not to say I’m anti big-pharma. On the contrary. I think big pharma is a big reason why humans are living longer now than they have at any other point in history.
Nevertheless, based on my previous experiences using prescription drugs, I’ve come to believe that long-term prescription use often leads to lasting side effects, often of the mild or annoying type.
In my case, Accutane permanently damaged my body’s oil-production capabilities and left me with chronically dry skin and chapped lips. Antidepressants made me gain a ton of weight — and it took me almost five years to lose that weight after stopping treatment.
Virtually all the research indicates finasteride is a safe and well-tolerated drug. But it’s a relatively new medication, and its long-term side effects aren’t fully established.
If you’re comfortable with taking a drug for years or decades, then by all means, go for it. It’s FDA-approved, recommended by reputable organizations like the American Hair Loss Association, and trusted by top doctors throughout the world.
6. Your Mental State
Men with serious psychological conditions such as severe depression or anxiety are often advised against using finasteride.
The drug is known to cause psychological side effects (nocebo). Basically, if you expect finasteride to give you horrible side effects, or you have a negative mindset and live in constant fear that you’ll develop side effects from the drug, guess what? You’re probably going to experience an array of unpleasant side effects.
On the other hand, if you stay positive, have an open mind, and expect the drug to work for you, like it has for millions of others, then you’ll probably be just fine.
Alternatives and Supplementary Treatments
Finasteride and minoxidil aren’t the only hair loss treatments. But they are the two treatments that have been proven, time and time again, to effectively address the condition.
Other options are available, but they haven’t been studied as extensively in terms of efficacy. A few of those options include:
The nuclear option. Whereas finasteride lowers DHT levels by about 70%, dutasteride absolutely obliterates the so-called “baldness” hormone, lowering DHT levels by approximately 98%.
It’s not FDA approved for hair loss in the US, but the treatment is frequently prescribed “off label.” It’s something of a last resort for men with aggressive balding who don’t respond to finasteride.
Surprisingly, laser therapy has been shown to mitigate hair loss to some degree. It’s more of a commitment than either finasteride or minoxidil — and it’s unlikely to work nearly as well as either of them.
But research shows light therapy can reboot thinning hairs and slow the balding process in men and women. If you’re looking to throw the kitchen sink at your hair loss, consider adding a laser helmet, cap or comb to your treatment arsenal.
Will any shampoo stop hair loss altogether? Probably not. But shampoos with the active ingredient ketoconazole may deliver some mild benefits. Mild being the operative word.
To learn more about Ketoconazole or any of the other top hair loss treatments on the market, check out my in-depth post on the best ways to attack balding in 2020.
The Bottom Line – Minoxidil, Finasteride, or Both?
It’s a big decision, as I said in the intro. Many men who start on minoxidil end up regretting it, especially if they’re young, prone to hair loss of the aggressive variety, or both.
Finasteride is, by far, the more potent solution that works for 9 out 10 men. But it has more potential effects than minoxidil, and whether or not it’s worth the risk is a decision you’ll have to make for yourself.
If you’re a younger guy and/or genetically susceptible to aggressive hair loss, then using both treatments will give you the best chance at winning your battle against male pattern baldness.
For men over 30 year with mild hair loss, such as a simple receding hairline, minoxidil alone may be sufficient. I hope this post helped you as you explore your treatment options and begin fighting the good fight against hair loss. If it doesn’t work out, shaving your head is always an option!
Robert Price is a writer, consumer advocate, and hair loss nerd with thousands of hours of experience in the field. His goal is to keep you out of the hair loss rabbit hole, underworld, or whatever you want to call it. He founded Hair Loss Daily, the unbiased hair loss blog, in 2016. You can learn more about Robert in the my story section of this website.