Will finasteride compensate for minoxidil?

Will finasteride take over where minoxidil ?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts related to minoxidil and finasteride for AGA.

Question

I have male balding and am using topical minoxidil. I want to start finasteride and stop my minoxidil.
Will finasteride just take over given DHT is root cause of problem?

Answer

Most likely finasteride will help more than minoxidil. But it’s no guarantee!. That’s important to be aware of!
Absolutely you run the risk of loss if minoxidil was helping and finasteride does not help ‘as much.’

Key analyses by Gupta et al in 2022 showed the finasteride is more effective than minoxidil. So the most likely scenario is a person can switch no problem. However, 10 % of males don’t respond to finasteride! So you if you WERE responding to minoxidil and now are one of the few that DOES NOT respond to finasteride… you lose hair!

DHT is important but there is a multimillion dollar pharmaceutical industry that is banking on the fact there is more than just DHT. If minoxidil helps, it’s lifelong. Could something substitute perfectly for it (like finasteride) - well maybe. Recent data suggests that 5 mg oral minoxidil is more effective than 1 mg finasteride - so how can one say DHT is champion. No.

It’s important but way more complex than the simplistic view of the lay public and thousands and thousands of males who think this is entirely a nice tightly bound story of DHT. No. Of course DHT is important. If one wants to start finasteride and stop minoxidil I advise my own patients to do one at a time. If a person is one of the 10-15 % who don’t respond at all to finasteride then disaster and chaos breaks out when finasteride is started and minoxidil stopped.

Be sure to review all this with your dermatologist.