Finasteride vs minoxidil: which should I start with?

Short answer

• If you’re a man with typical male-pattern hair loss and are OK with a prescription: start oral finasteride (1 mg) — it’s the single most effective medicine to stop progression and produce regrowth. For best results add topical minoxidil.
• If you don’t want a prescription or are a woman of childbearing potential: start topical minoxidil (OTC Rogaine or Kirkland). Finasteride is not recommended for women who may become pregnant.

Why (brief)

• Finasteride (oral 1 mg daily; Propecia or generic finasteride): blocks DHT, the hormone that causes pattern hair loss. Higher chance of halting loss and regrowth on the crown than minoxidil. Side effects can include decreased libido, erectile dysfunction, and mood changes in a small minority. Requires a prescription.
• Minoxidil (topical 5% foam or 5% solution; Rogaine is a common brand; Kirkland Signature is a lower‑cost generic): stimulates hair follicles and improves thickness; OTC, well tolerated, sometimes causes local scalp irritation. Works best when continued long term and is less powerful than finasteride alone for stopping DHT-driven loss.

Practical recommendations

• Men wanting the best chance to stop and regrow hair: finasteride 1 mg daily (generic finasteride or Propecia) + topical minoxidil 5% foam (Rogaine 5% foam or Kirkland 5%) — combine for additive benefit.
• Men who don’t want oral meds or want to try OTC first: start minoxidil alone.
• Women: use topical minoxidil (women’s Rogaine 5% foam is common). Oral finasteride is generally avoided in women of childbearing potential (teratogenic) and should only be considered under specialist care if postmenopausal or after careful counseling.
• Alternative (for men who don’t respond to finasteride): discuss dutasteride (Avodart) with a dermatologist — it’s more potent but off‑label for hair loss.

Where to get treatment

• Prescription/telehealth services that commonly prescribe finasteride and offer follow‑up: Hims, Keeps, Roman, Lemonaid. They can be convenient if you don’t have a local dermatologist.
• OTC minoxidil options: Rogaine (brand), Kirkland Signature (Costco), Equate (Walmart) — all effective; choose foam if you dislike the oily solution.

What to expect

• Start seeing stabilization in 3–6 months; measurable regrowth by ~6–12 months. Continued use is required — stopping causes loss of any gains.
• If you develop sexual side effects, mood changes, or unexpected symptoms on finasteride, stop and see your clinician. Women who are or may become pregnant should avoid handling crushed or broken finasteride tablets.

When to see a specialist

• Rapid hair loss, patchy/scarring patterns, very young onset, or if you’re unsure of the diagnosis — see a dermatologist for evaluation and tailored therapy.

If you’d like, tell me: your sex, age, pattern/timing of hair loss, and whether you’re comfortable with a prescription — I can give a more specific recommendation and suggest product options/cost comparisons.