Minoxidil vs finasteride: what the experts say

Minoxidil has the higher Guru Score, above 90% against below 70% for finasteride, but the experts we track do not treat them as rivals. Every expert in our finasteride guide said yes to minoxidil, and the two who gave finasteride a mixed verdict still called it effective. Their doubts are about its side effects. Minoxidil on the scalp helps hair grow and is sold without a prescription for men and women, while finasteride is a prescription tablet for men that lowers the hormone behind pattern hair loss. Many people use the two together.

Below is how the two differ, how the experts who reviewed both rated them, who each one suits, how they work together, and what to know before starting either one.

What is the difference between minoxidil and finasteride?

They tackle hair loss from two different ends. Minoxidil began as a blood pressure tablet, and extra hair growth was one of its side effects (US label). On the scalp, as a liquid or a foam at 2% or 5%, it is approved to regrow hair in hereditary hair loss (US label). Dr. Mamina, a dermatologist, calls minoxidil “the gold standard FDA-approved treatment for female pattern hair loss,” and says it works by “prolonging that anagen phase, the growth phase of the hair cycle.”

Finasteride works on the cause instead. It blocks the enzyme that turns testosterone into DHT, the hormone that gradually shrinks hair follicles in people prone to pattern hair loss, and so slows that shrinking (Kaufman and colleagues). The 1 mg tablet is licensed for male pattern hair loss (FDA label).

They also reach you differently. Minoxidil on the scalp is sold without a prescription in the US and the UK (US label, UK label). Finasteride is a prescription medicine in both, and in the UK the NHS does not provide it for hair loss, so it comes from a private prescription (NHS). Minoxidil tablets exist too, but for hair loss they are an off-label use of a prescription blood pressure medicine and need a doctor (Olsen and colleagues).

Which do the experts rate higher, minoxidil or finasteride?

Minoxidil, clearly. It has a Guru Score above 90% from more than 15 experts, with nobody saying no. Finasteride has a Guru Score below 70% from a much smaller group of fewer than ten experts. Nobody said no to it either, but two of them gave it a mixed verdict.

Every expert in our finasteride guide also appears in our minoxidil guide, which makes this a fair side-by-side test. All of them said yes to minoxidil. Four said yes to finasteride too, and none rated finasteride above minoxidil. The two who rated it lower are both dermatologists: Dr Dray and Dr. Shereene Idriss. Dr Dray calls it minoxidil “the most evidence-based hair loss treatment that you could buy without a prescription.”

Every verdict, with a link to the moment each expert gave it, is in our minoxidil guide and finasteride guide.

Why do the experts rate finasteride lower?

Because of its side effects, not because they doubt it works. Dr Dray says: “For men Oral Finasteride is very effective.” In the same breath she adds that “they can have some sexual side effects, so that's not always something people want,” and that “people are not always so enthusiastic about taking oral medications.”

Dr. Shereene Idriss says the drop in libido “can truly really happen, I actually had patients who've complained about this and it is very hard to reverse, so I personally do not give finasteride orally anymore.” She uses it on the scalp instead, because “we believe there's going to be much less systemic absorption.”

The regulators take the side effects seriously too. In the one-year trials, sexual side effects were uncommon but more frequent than on a placebo, and there have since been reports of sexual problems that continued after stopping (FDA label). The UK medicines regulator links finasteride with depression and suicidal thoughts (MHRA, 2024), and since May 2026 tells anyone on the 1 mg tablet who develops low mood or suicidal thoughts to stop and contact a doctor straight away (MHRA, 2026). The European Medicines Agency confirmed suicidal thoughts as a side effect, and still concluded the benefits outweigh the risks for the approved uses (EMA).

Topical finasteride is not the easy way round. In the US there is no FDA-approved version, and the FDA has had reports of side effects with compounded scalp products, including erection problems and depression (FDA). Dr Dray notes that one study found topical finasteride as effective as the tablet, but “that study only looked at out to 6 months.”

Is minoxidil or finasteride better for hair loss?

For men, both have strong evidence. In two one-year trials in more than 1,500 men, finasteride 1 mg a day raised hair counts on the crown while men on a placebo kept losing hair (Kaufman and colleagues). Its effect on a receding hairline at the temples has not been established (FDA label). For minoxidil, a 48 week trial in 393 men found 5% beat 2% for regrowth (Olsen and colleagues, 2002). Dr. Daniel Sugai, a dermatologist, says: “Finasteride is a nice oral prescription medication.”

For women, the experts point to minoxidil. A Cochrane review found evidence for it in women, though much of it was of moderate to low quality (Cochrane). Doctorly, a pair of dermatologists, put it simply: “Everyone should be using 5% minoxidil and preferably the foam one,” “regardless of gender.” The evidence for 5% over 2% is clearer in men than in women, though (Lucky and colleagues, Cochrane).

Finasteride is licensed for men only, and the NHS says women should not use it for hair loss (NHS). A one-year trial in women past menopause found it did no better than a placebo (Price and colleagues). Dr. Mamina says it “can be definitely a very helpful addition” for women past menopause, but that is off-label, and the trials so far do not settle whether it helps.

Can you use minoxidil and finasteride together?

Yes, and many people do. The NHS calls the two the main treatments for male pattern hair loss (NHS), and a review of five trials found the pair did better on photo assessments than either one alone, with no more side effects (Chen and colleagues).

Some of the experts mix them on the scalp. Dr. Daniel Sugai says “minoxidil compounded with finasteride” can be “a nice option,” and that he has “a few patients over age 60, say 65, or doing very well on that.” Keep the caveat in mind, though: in the US these compounded mixes are not FDA approved (FDA).

Which is easier to live with, minoxidil or finasteride?

Each has its own trade-off. Minoxidil's side effects are mostly on the surface: itching, irritation and unwanted hair on the face if it spreads beyond the scalp, plus an early shed for many people (UK label, Lucky and colleagues). It also goes on every day. Dr. Shereene Idriss switched to minoxidil tablets “because I couldn't take the irritation from the topical one.”

Finasteride is one tablet a day, but its side effects, while uncommon, are the ones the regulators warn about, so it needs a doctor and a conversation about your mood before you start (MHRA).

Neither is a cure. If you stop minoxidil, you will probably lose the regrown hair within three to four months (US label), and Dr. Daniel Sugai warns that “your hair is going to fall out and go back to baseline.” If you stop finasteride, the benefit starts to reverse by six months and is back to where you started by 9 to 12 months (UK label).

Can you use minoxidil or finasteride while pregnant?

No, on both labels. The US minoxidil labels say it may be harmful in pregnancy and breastfeeding (US label), and the UK label says it should not be used then (UK label). Finasteride must not be used by women who are or may become pregnant, because it blocks a hormone a male baby needs to develop normally, and they should not handle crushed or broken tablets (FDA label). Anyone who is pregnant, breastfeeding or trying for a baby may want to talk to their doctor before starting either one.