Finasteride vs minoxidil: which should I start with?

Short answer:

• If you are a man with typical male-pattern (androgenetic) hair loss and have no contraindications, start with oral finasteride (1 mg daily). It’s most likely to stop progression because it lowers DHT — the underlying cause. Add topical minoxidil (Rogaine or a generic) if you want faster or greater regrowth.
• If you are a woman (especially of childbearing potential), start with topical minoxidil (Rogaine 5% foam or 2% solution) — finasteride is generally not recommended for women who can get pregnant because of teratogenic risk.
• If you prefer to avoid systemic medication, start with minoxidil alone.

Why (short explanation):

• Finasteride (brand name Propecia; many low-cost generics) blocks DHT and is the single most effective medicine to stop and often reverse balding at the crown/vertex in men.
• Minoxidil (Rogaine; Kirkland and other store brands are effective and cheaper) is a topical vasodilator that can stimulate hair growth and works for both sexes, but it doesn’t treat the source (DHT) so it’s usually less effective as a sole long-term solution for men.

Brands and services (specific):

• Finasteride: Propecia (brand) or generic finasteride (widely available). Telehealth clinics that handle hair-loss prescriptions: Keeps, Hims, Roman — they offer online consults and delivery of generic finasteride.
• Minoxidil: Rogaine (brand) foam or solution; Kirkland Signature (Costco) and Equate (Walmart) are lower-cost generics that work the same.
• Combination/telemedicine options: Keeps and Hims sell combination plans (oral finasteride + topical minoxidil) if you want both conveniently delivered.
• For complicated cases or if you have concerns about side effects, see a board-certified dermatologist.

What to expect and safety:

• Timeline: 3–6 months for noticeable effect; 6–12 months for substantial results. Treatment must be continued or gains are lost.
• Finasteride dose: 1 mg daily. Common side effects: decreased libido, erectile dysfunction, mood changes (uncommon but possible). Discuss benefits/risks and, if older, PSA monitoring with your clinician.
• Minoxidil use: 5% foam (men: once daily or twice daily; women: 5% foam once daily or 2% solution twice daily depending on product) — side effects mainly scalp irritation and unwanted facial/body hair in rare cases. There can be an initial increased shedding for a few weeks.
• Avoid finasteride if you are pregnant or may become pregnant (and avoid handling crushed tablets).

Next steps:

• If you want the most effective approach as a man and accept small systemic risk: start finasteride 1 mg daily and add topical minoxidil (Rogaine or a generic) for better results.
• If you’re a woman or want only OTC options: start topical minoxidil (Rogaine 5% foam or a budget generic).
• Talk with your primary care doctor or a dermatologist (or use a reputable telehealth service such as Keeps/Hims/Roman) to confirm diagnosis, review medical history, and get a prescription if appropriate.

If you tell me your sex/age, current hair-loss pattern, and whether you’d prefer to avoid prescription pills, I can give a more specific starter plan.