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What's better for male hair loss, minoxidil or finasteride?

By Howard Seidman, Contributing Writer, myOptumHealth

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A man's hair style can say a lot about his personality. But "going bald" may not be the statement you want to make.

Hair loss, also called male-pattern hair loss, affects half of men by age 50. Genetics usually influences this type of hair loss, which often leads to baldness on the forehead and on top of the head. Some men feel OK losing their hair. For others, going bald can play havoc with their self-image.

There are many options to combat hair loss, but only two treatments are approved by the U.S. Food and Drug Administration (FDA):

• Topical minoxidil (Rogaine and many generic brands), applied to the scalp as a cream or foam
• Finasteride (Propecia), taken in pill form

Both drugs are recommended for men over 18 with mild to moderate hair loss. Both have been shown to slow or stabilize hair loss, or re-grow some hair. Results are usually seen between six months and one year. For best results treatment should start when hair thinning is first noticed.

Both products are unlikely to re-grow thick, dense hair, and neither can re-grow hair in bald areas. You must take them indefinitely. If you stop taking these drugs, your scalp will return to its pre-treated state within six months for minoxidil, and within 12 months for finasteride.

What are they?

The discovery of minoxidil for hair growth came in the 1970s. Hair growth was a side effect of the drug, first used for high blood pressure.

Finasteride lowers levels of dihydrotestosterone (DHT), a product of testosterone, on the scalp. Too much DHT can causes hair follicles to die.

Why you might want to use them

Research shows that minoxidil works best for men younger than age 30 who have been losing hair for less than five years. Hair growth with minoxidil tends to work best on the top your head.

Finasteride (a pill) may work on more of the scalp's surface than minoxidil (applied to the scalp). It is labeled for generating hair growth on the top and middle front of head.

Why you might not want to use them

Minoxidil

Minoxidil comes in liquid and foam and must be rubbed into the scalp twice a day. Some men find it messy. You can expect more hair shedding at first, but this goes away.

Minoxidil can cause dry skin and rashes, or aggravate dandruff and psoriasis. But using the five percent foam version may help.

People with a history of heart conditions or related illnesses should always consult a doctor before taking Minoxidil.

Finasteride

The drug has more possible side effects than minoxidil. Though rare, the most common side effects are:

• Lower sexual drive and semen volume
• Erectile dysfunction

These side effects often ease with continued treatment. They usually resolve completely within days or weeks if you stop taking the drug.

Other considerations

Minoxidil is approved as an over-the-counter product and is likely not covered by insurance.

A prescription is required to get finasteride and is not usually covered by insurance if taken for hair loss.

While costs vary, finasteride (Propecia) generally costs much more than minoxidil. For example, three months of treatment with finasteride can typically cost more than $200 compared with three months of minoxidil (Rogaine) 5 percent, which may cost from $30.

View the original Decision focus: what's better for male hair loss, minoxidil or finasteride? article on myOptumHealth.com 

SOURCES:

• Ross EK, Shapiro J. Management of hair loss. Dermatologic Clinics. 2005;23:227-243. Accessed: 10/07/2009

• Habif TP. Hair diseases. In Habif: Clinical Dermatology. 4th ed. Philadelphia, PA: Mosby, Inc.; 2004. Accessed: 10/12/2009

• Rogers NE. Avram MR. Medical treatments for male and female pattern hair loss. Journal of the American Academy of Dermatology. 2008;59(4):547-566. Accessed: 10/07/2009

• National Cancer Institute. Prostate Cancer Prevention Trial (PCPT). Accessed: 10/12/2009