Hair loss in men: Finasterid vs. Minoxidil compared

Originally caused hair loss (androgenic alopecia) is the most common cause of hair loss in men. About 80 percent of all men are affected over their lives. The first signs, typically insiders' corners and a clearing tone, can already occur from the age of 20.

The cause lies in a genetically caused hypersensitivity of the hair follicles to dihydrotestosterone (DHT), an active form of the male sex hormone testosterone. DHT lets the sensitive hair follicles shrink, which leads to thinner hair and finally to complete hair loss in the affected areas.

The good news: There are effective drug treatment options that can stop hair loss and in many cases also promote revival. The two main active ingredients are finasteride and minoxidil, which have different mechanisms of action and can complement each other.

Finasterid is a prescription drug that inhibits the conversion of testosterone to DHT. It blocks the enzyme 5-alpha reductase, which is responsible for this conversion, and thus reduces the DHT level by about 70 percent.

Application: Finasteride is taken once a day as a tablet in a dosage of 1 mg. Taking should take place regularly, as the hair loss resumes within a few months when the drug is put down.

Effectiveness: In clinical trials, Finasterid was able to stop the hair loss at 83 percent of men and to cause a visible increase in hair density at 66 percent. The first results show after 3 to 6 months, the full extent of the effect after 12 to 24 months.

Side effects: In a small part of users (1 to 2 percent) sexual side effects can occur, including reduced libido, erection disorders or ejaculation disorders. In most cases, they form back after the drug has been put off. Rarely is reported on persistent side effects, which is why a medical accompaniment of therapy is recommended.

Minoxidil is a topical (externally applicable) remedy for hair loss, which is available in Germany without prescription in the pharmacy. It was originally developed as a blood pressure sink, whereby hair growth was discovered as a side effect.

Application: Minoxidil is applied to the affected scalp areas twice a day as a 5-percent solution or foam. The time of action is at least 4 hours, so many users prefer the application in the morning and evening.

Effectiveness: Minoxidil improves blood circulation of the hair follicles and extends the growth phase of the hair. In studies, about 60 percent of users showed an improvement in hair growth. The effect is particularly pronounced in the apex area and is less pronounced at the secret Council corners.

Side effects: Local skin irritations, itching and dandruff formation at the application site are the most common side effects. At the beginning of the treatment, a temporarily reinforced hair loss can occur (so-called shedding), since resting hair can be replaced by new ones. This effect is temporary and a sign that the treatment works.

Both active ingredients have their strengths and can be used individually or in combination depending on the situation:

Effectiveness: Finasteride shows in studies a somewhat higher effectiveness than minoxidil, especially on the hairline and on the secret Council corners. Minoxidil is particularly effective in the vertex. The combination of both active ingredients generally achieves the best results.

Application: Finasteride is much easier to use with a tablet daily than minoxidil, which must be applied twice a day. However, Finasteride is prescription-only, while Minoxidil is available without prescription.

Side effect profile: Finasteride can cause systemic side effects (especially sexual dysfunction), while minoxidil predominantly has local side effects. The risk-benefit ratio must be weighed individually.

Costs: Both active compounds are comparatively favorable as generics. The monthly costs are typically between 15 and 30 euros for both options. The costs are usually not covered by statutory health insurance.

Combination therapy: The simultaneous use of finasteride and minoxidil is possible after medical consultation and shows in many cases better results than monotherapy. Finasteride combats the hormonal cause, while Minoxidil directly promotes blood circulation and hair growth.

Finasterid is subject to prescription and requires a medical prescription. This regulation can be done conveniently and discreetly online via telemedical platforms. The attending physician will check with a medical questionnaire whether finasteride is suitable for you and there are no contraindications.

Since hair loss is a subject that many men feel uncomfortable, telemedicine offers a particularly low-swelling access here. The entire consultation takes place digitally, and the drug is delivered discretely home.

Important for online consultation: Completely provide all relevant information on pre-disorders and current medication. In particular in the case of planned or existing child planning, open communication with the doctor is crucial, since finasteride can lead to malformations of the male fetus in pregnant women.

For a realistic expectation: The treatment of the inherited hair loss requires patience. First results show after 3 to 6 months, and the treatment must be continued permanently to maintain the effect. When put down, the hair loss will resume within a few months.