Minoxidil and finasteride are the two most established medical treatments for androgenetic alopecia, and they work through entirely different mechanisms. Understanding the difference helps patients know what to expect and why both long-term commitment is essential and discontinuation leads to loss of benefit.
Minoxidil, how it works: Extends the anagen (active growth) phase of the hair cycle and increases the diameter of miniaturised follicles. Available as a topical solution, foam, or low-dose oral tablet
Minoxidil , who can use it: Both men and women. Topical minoxidil is the standard starting point for most hair loss patients. Oral low-dose minoxidil is increasingly used when topical formulations are not well tolerated
Minoxidil, what to expect: Reduction in shedding typically noticed within six to eight weeks. Visible improvement in density over three to six months. Results maintained only with continued use — stopping leads to return of hair loss within months
Finasteride, how it works: Blocks the enzyme (5-alpha reductase) that converts testosterone to dihydrotestosterone (DHT). Lower DHT levels slow follicular miniaturisation and in some cases allow partial regrowth
Finasteride, who can use it: Men with androgenetic alopecia. Not used in premenopausal women who may become pregnant due to the risk of foetal harm
Finasteride, what to expect: Slows progression and may produce modest regrowth. Full benefit seen over 12 to 24 months of consistent use. Like minoxidil, results are lost if treatment stops
For women with androgenetic alopecia associated with PCOS or androgen excess, anti-androgen medications including spironolactone may be appropriate in coordination with a gynaecologist or endocrinologist. I discuss the most appropriate medical hair loss treatment for each patient's diagnosis, age, and profile at every initial consultation.
Written by Dr Meenakshi K, MBBS (M S Ramaiah Medical College), DVD (Bangalore Medical College), Consultant Dermatologist, Spectrum Diagnostics, Subramanyanagar / Skin Affair Clinic, Mahalakshmipuram / Kaya, Sadashiva Nagar, Bengaluru. Phone: +91 6361319178.
