Medications

Should I Use Finasteride, Minoxidil, or Both?

A few factors can make all the difference in how well these male hair loss treatments work for you.
male pattern baldness illustration
Colleen Travers

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Colleen Travers,   

Jan 31, 2020 • 4 min read

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Whether you’ve recently seen a dermatologist who prescribed finasteride (the generic form of Propecia) to treat your hair loss or you took matters into your own hands by picking up some over-the-counter minoxidil (the generic form of Rogaine), you may be wondering if combining these two medications might speed up or deliver better results.

First, it’s important to understand how these drugs work. Minoxidil was initially used as a blood pressure medication with a reported side effect of increased hair growth when treating patients with high blood pressure and cardiovascular disease. “This led to the development of topical preparations of minoxidil, which were shown to be effective in treating hair loss,” says Douglas Buethe, MD, a dermatologist at Mercy Medical Center in Baltimore, MD. “But when applied topically, too little medication is absorbed through the skin to impact blood pressure.”

While the exact mechanism of minoxidil is unknown, as a vasodilator, it is thought to increase blood flow around the hair follicles, stimulating growth. This then shifts the hair follicles to spend more time in the growth phase (known as the anagen phase) versus the resting (or telogen) phase of a hair cycle. This results in more hair growth and thickness. However, when starting out on minoxidil the hair cycles temporarily flip at first, staying longer in that resting phase versus the growth phase. This will cause hair loss before hair growth during the first month or two of using minoxidil. “It's important not to get discouraged and stop using minoxidil entirely, as it's a fairly common side effect that resolves with time,” says Dr. Buethe.

The Verdict on Taking Finasteride and Minoxidil Together  

Losing excessive amounts of hair can be stressful, and if you’re in a period where you’re continuing to lose hair even while on minoxidil, you may want to also get a prescription for finasteride. “This medication is a 5-alpha reductase inhibitor that blocks the conversion of testosterone into its more potent metabolite dihydrotestosterone (DHT),” says Dr. Buethe. DHT is responsible for shortening the growing phase of hair follicles, which leads to developing male pattern baldness over time. Because both of these hair loss treatments work differently in stimulating hair follicles, Dr. Buethe actually recommends using both medications simultaneously in order to treat male pattern baldness more effectively. (Plus, it’s completely safe to do so.)

When Not to Take Finasteride and Minoxidil at the Same Time

There are a few scenarios where taking minoxidil and finasteride together might not be the right move for you. Having hypersensitivity to either medication will warrant removing it from your hair loss treatment plan. Minoxidil in particular contains propylene glycol, which can sometimes cause scalp irritation. “Minoxidil tends to be effective only if used consistently, so individuals who have difficulty with medication compliance, who find the application of a topical solution to be cumbersome, or who do not like the texture of topical preparations of minoxidil may want to avoid it as well,” says Dr. Buethe.

For finasteride, Dr. Buethe warns that a very small percentage (less than 2%) of patients may experience sexual dysfunction, including a decreased libido and erectile dysfunction (ED), when taking the medication. This is usually reversible once you stop taking it. “Finasteride can lower sperm count (again, resolving when the medication is stopped), so men who are family planning may want to avoid it,” says Dr. Buethe. “Other uncommon side effects include gynecomastia (development of breast tissue), testicular pain, and depression.” If you already deal with issues like ED or are worried about developing any of these side effects, be sure to discuss it with your doctor to see if finasteride is right for you.

One last thing to keep in mind: If you’re 50 years or older or at-risk for prostate cancer, finasteride can lower prostate specific antigen (PSA) levels, which is a blood test used to screen for prostate cancer. “Make sure to inform your primary care doctor, in case a PSA screening is recommended based on your age or medical history, since taking finasteride can affect interpretation of the results,” says Dr. Buethe. “Additional screening for prostate cancer, including a digital exam, may be necessary.” In these cases, using minoxidil alone may be suggested.

If you think you might benefit from finasteride, Blink Offers online doctor consults for $5. You can get your hair loss medication prescribed or refilled online from the convenience of your smartphone or computer.

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This article is not medical advice. It is intended for general informational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.

Blink Health is not insurance. The discount prescription drug provider is Blink Health Administration, LLC, 1407 Broadway, Suite 2100, New York, NY 10018, 1 (844) 265-6444, www.blinkhealth.com.

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