Finasteride vs minoxidil: which should I start with?

Short answer

• If you’re a man with pattern (androgenetic) hair loss and no plans for fathering a child soon, start with finasteride (oral) — it’s the most effective at stopping progression. Add minoxidil if you want extra regrowth.
• If you’re a woman, pregnant, trying to conceive, or want an OTC option first, start with topical minoxidil (Rogaine or equivalents).
• For best results many people use both (finasteride + minoxidil).

Why (mechanisms & effectiveness)

• Finasteride (oral, typically 1 mg/day — brand Propecia or generic finasteride) reduces DHT, the hormone that shrinks hair follicles. It’s better at halting progression and produces measurable regrowth for many men.
• Minoxidil (topical — Rogaine, Kirkland, Lipogaine, others) is a vasodilator that stimulates hair growth and thickening. It’s available OTC and helps regrow hair, but is generally less powerful than finasteride at stopping hair-loss progression by itself.

Safety and important caveats

• Finasteride can cause sexual side effects (reduced libido, erectile dysfunction) in a minority of men and may rarely affect mood. It is teratogenic — women who are pregnant or may become pregnant must not handle crushed tablets or take it.
• Minoxidil commonly causes scalp irritation or unwanted facial hair; systemic side effects are rare.
• Both need consistent, long-term use. Expect 3–6 months to see early changes and up to 12 months for full effect. Stopping either will usually reverse gains.

Practical starter recommendations

• If you’re a healthy man with male-pattern hair loss: talk to your clinician about starting finasteride 1 mg daily (Propecia or generic finasteride). Many people then add Rogaine 5% foam daily for better regrowth.
• If you are a woman (or a man who prefers to avoid prescription meds at first): start minoxidil 5% foam (Rogaine for men or women’s 5% foam) or 2% solution for women if advised by a doc.
• If you’re unsure or worried about side effects: see a dermatologist for evaluation and personalized plan (including topical finasteride trials, low-dose strategies, PRP, lasers, etc.).

Where to get them (brands/services)

• Finasteride (prescription): Propecia (brand) or generic finasteride (cheaper) — available from local pharmacies or online through telemedicine providers such as Hims, Keeps, Roman.
• Minoxidil (OTC): Rogaine (brand), Kirkland Signature (Costco generic), Lipogaine — available at drugstores or online.
• For specialized care: book a dermatology consult (in-person or telederm) if you have rapid loss, scarring, patchy loss, medical conditions, or want advanced options.

Next steps

1. Identify your pattern of loss (photos help).
2. If you’re a man and okay with prescription meds, schedule a visit (primary care or telemedicine) to discuss finasteride + minoxidil. If you’re a woman or pregnant/trying to conceive, start with minoxidil and see a dermatologist.
3. Reassess after ~3–6 months and follow up with your clinician.

If you want, tell me your age, sex, medical history, and how fast the hair loss is progressing and I can give a more specific starting plan.