Finasteride vs minoxidil: which should I start with?

Short answer

• If you are an adult man with classic male‑pattern (androgenetic) hair loss: start finasteride (1 mg daily) as first‑line because it is the most reliable at stopping progression and often improves density, and add topical minoxidil if you want additional regrowth or faster visible results.
• If you are a woman (especially of child‑bearing potential): start with topical minoxidil (OTC) — finasteride is generally avoided in women who can become pregnant because of fetal risk and is used only under specialist supervision in some post‑menopausal women.
• If you prefer to try something OTC first, start with minoxidil (brand examples below).

Why (brief):

• Finasteride (oral) blocks DHT, treats the underlying hormonal driver of male pattern hair loss. It’s usually the best single prescription therapy for men.
• Minoxidil (topical) is an over‑the‑counter vasodilator that stimulates hair growth and can help thicken hairs; works best as an adjunct to finasteride for men and is the main medical option for most women.

Brands and services (specific):

• Finasteride: Propecia (brand), or generic finasteride 1 mg (same active drug; usually much cheaper). Telehealth providers that prescribe and ship finasteride: Keeps, Hims, Roman. You can also get it through your primary care doctor or a dermatologist.
• Minoxidil: Rogaine (brand), Kirkland minoxidil (Costco, lower‑cost generic), or generic topical minoxidil (store brands). Rogaine 5% foam or 5% solution is common for men; women often use 5% foam or 2% solution depending on tolerance and label instructions.

What to expect and safety:

• Timeline: both take months. You may see reduced shedding in ~3 months and better regrowth by 6–12 months. Continue therapy long term — benefits reverse after stopping.
• Finasteride side effects: small risk of sexual side effects (reduced libido, erectile dysfunction), possible mood changes. Discuss risks with your prescriber. Women who are or may become pregnant must not handle crushed tablets or take it.
• Minoxidil side effects: scalp irritation, itching, flaking; sometimes initial increased shedding for a few weeks. Rare systemic effects with topical use.
• If you have concerns about side effects or are on other meds, see a physician or dermatologist.

Practical suggestion

• If you are a man and okay with a prescription: start finasteride 1 mg daily (generic) and add minoxidil 5% foam once daily if you want faster or greater regrowth.
• If you are a woman or don’t want a prescription: start minoxidil (Rogaine 5% foam or 2% solution) following product directions, and see a dermatologist if limited response after 6–12 months.
• If uncertain, get a quick telederm visit (Keeps, Hims, Roman, or your local dermatologist) for a tailored plan and prescription if appropriate.

If you tell me your sex, age, current pattern/stage of hair loss, and whether you’re comfortable taking a daily prescription pill, I can give a more specific recommendation.