Finasteride vs minoxidil: which should I start with?

Short answer

• For most men with androgenetic (pattern) hair loss, oral finasteride (1 mg) is the most effective single prescription to stop progression and often regrow hair; minoxidil (topical) is helpful and can be added.
• For women (especially of child‑bearing potential), start with topical minoxidil (Rogaine); oral finasteride is generally not recommended for women who may become pregnant.

Why (brief)

• Finasteride (Propecia or generic finasteride 1 mg): blocks DHT, the hormone driving male pattern baldness. Strong evidence it halts hair loss and helps regrow hair on the crown. Side effects: possible sexual dysfunction, mood changes (uncommon), and teratogenic risk in pregnancy (relevant for women). Requires a prescription.
• Minoxidil (Rogaine OTC or generic minoxidil 2%/5%): a topical vasodilator that stimulates hair growth and prolongs hair life. Fewer systemic side effects; can irritate the scalp. Works for both men and women (women usually use 2% or 5% foam). Available over the counter.

Practical points

• Timeframe: expect stabilization around 3–6 months and clearer regrowth by 6–12 months. Stopping either will reverse benefits.
• Many people do best on combination therapy (finasteride + minoxidil).
• Cost/access: minoxidil is OTC and inexpensive. Finasteride needs a prescription; generic is inexpensive compared with brand Propecia. Telehealth services (Keeps, Hims, Roman, Nurx) can prescribe finasteride conveniently and offer combination packs with minoxidil.
• Monitoring: men starting finasteride should discuss baseline medical history; finasteride can lower PSA levels (tell your doctor if you have prostate concerns). Women who are pregnant or planning pregnancy should not handle crushed finasteride tablets.

Specific brand/service recommendations

• Minoxidil: Rogaine (brand) or generic minoxidil 5% foam (men) and 2% or 5% foam for women — why: well‑studied, easy to obtain, affordable.
• Finasteride: generic finasteride 1 mg or Propecia — why: best evidence for preventing male pattern hair loss; generics are cost‑effective.
• Telehealth/order: Keeps, Hims, Roman, Nurx — why: convenient online consults, subscription plans that include generic finasteride and minoxidil options.
• If you want specialized care: see a board‑certified dermatologist or hair-loss clinic for diagnosis, prescription, and options like PRP, topical compounded meds, or hair transplant.

What I’d suggest next

• If you’re a man comfortable with the small sexual side‑effect risk: consider starting finasteride (prescription) and add minoxidil (OTC) for faster/better results.
• If you’re a woman (or a man who wants to avoid systemic meds): start minoxidil first.
• If you’re unsure about the diagnosis or have medical questions, book a visit with your PCP or a dermatologist.

If you want, tell me your sex, age, medical history, and how fast your hair loss started and I can give a more tailored suggestion and help draft questions for a prescriber or pick a telehealth plan.