4

So as I understand it, there are two main solutions for male pattern baldness:

Finasteride and Minoxidil.

Finasteride works by reducing the production of some hormone that is damaging to the follicles, so already I am not a fan since it's a hormone treatment rather than an actual scalp treatment. On the other hand, Minoxidil is a pure scalp treatment. It actually is about your hair and helping it grow.

Finasteride is also quite expensive. Minoxidil is far cheaper, since you can buy 3 flasks that will last you several months, while 1 package of Finasteride pills only last 30 days.

Finasteride has many (serious) side-effects. There are sexual side-effects, possible risks of prostate cancer, and some men even get boobs. I know the last one is quite rare, but the sexual side-effects are worryingly common. I've read it happens to roughly 5 % of users ... that is a lot, in my honest opinion. On the other hand, Minoxidil's worst side-effect is probably some rash or something.

So with all this in mind, why in the world would anybody choose Finasteride over Minoxidil? At least one ought to try Minoxidil first, no, and then only go to Finasteride if Minoxidil don't work?

2
  • This is a good question, even if not framed in the usually recommended format. Can you include at least one reference source for the info you present? That will help encourage answers. Welcome!
    – DoctorWhom
    Aug 1 '19 at 1:03
  • @DoctorWhom I agree it's a good question, and although it lacks references, I think the question itself demonstrates enough prior research to meet site requirements. But at least one reference would definitely improve it and encourage answers.
    – Carey Gregory
    Aug 1 '19 at 4:41
1

That's a nice question.

First of all, it is important to note that whenever a question of which drug to use arises, a number of factors should be taken into consideration, that is to say: prescribing a treatment is not simply a game of matching condition to drug (I am not saying that this is what the OP is saying or implying, this is just to illustrate that the process is complicated).

The physician should take into account the patient's main complaint (current condition), age, weight, sex (particularly important for hair loss...), sensitivities (if any are known), physical condition, underlying diseases (if any), other concurrent drugs, and more. These are all "filters" of a sort that help the physician narrow down the list of possible drugs that may be suitable for the patient's current predicament (this question deals with two therapeutic options, but sometimes there are many more drugs to choose from, e.g. when starting treatment for hypertension).

In addition, doctors also apply more subjective considerations to their decisions, such as their good judgement and experience, knowledge of drug prices (even if this is not a pure medical consideration, the doctor may apply it if he thinks that it's better for a patient to take a slightly less effective drug which is cheaper and the patient will be able to afford it, than if the patient will not be taking any treatment because the better option is more expensive/unavailable to the patient), and more.

Now, on the topic of this question:
Your comparison between minoxidil and finasteride is quite on-spot. You could also say that minoxidil is even more available on account that is is an over-the-counter drug, while finasteride requires a doctor's prescription. In that case, minoxidil would surely be preferred by most clinicians. The cases when finasteride would be preferable to minoxidil are more limited and may include the following:

  1. Hypersensitivity to minoxidil (as with any drug, probably rare but should be borne in mind). Even susceptibility for non-dangerous side effects may cause a patient to avoid using minoxidil.
  2. Minoxidil was tried and found to be ineffective - this is a common issue in drug therapy, and for that reason it is good to have first-line therapy, second-line therapy, third-line therapy and so on. Also, according to a publication of the AAFP (American Academy of Family Physicians): "Finasteride (Propecia), 1 mg per day orally, is approved to treat androgenetic alopecia in men for whom topical minoxidil has been ineffective."
  3. Finasteride is available as a topical solution but also as a tablet. Minoxidil tablets are not used for treatment of hair loss, only for treatment of hypertension. Some patients may prefer to conveniently take a finasteride tablet than apply/rub a minoxidil solution/foam on their head, particularly if they are in a an environment where it would be less convenient to use the topical form.

In conclusion, the selection of a treatment is based on both the doctor's and patient's preferences. These may not always be the same, but the final selection should be some average of both, so even when one alternative seems to shine above all others, it may not always be that way for all patients.

1

Not the answer you would want to hear but have you considered combined therapy?

combined treatment of male androgenetic alopecia with oral finasteride and topical minoxidil found that “the combined medication showed the best efficacy.

Hair loss article commenting on a 2015 study

It really depends on how much hair loss you are getting. If you are getting a lot of hair loss, then probably finasteride is the better way to go. Apparently, minoxidil does not stop hair loss as effectively.

https://www.forhims.com/blog/minoxidil-vs-finasteride-do-either-really-work

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service, privacy policy and cookie policy

Not the answer you're looking for? Browse other questions tagged or ask your own question.