Finasteride vs Minoxidil Compared

In androgenetic alopecia, the hereditary form of hair loss, finasteride and minoxidil are the two ingredients that have been studied the longest. They are often pitted against each other, yet they act at different points. This comparison sets out how they work, what the studies show, their side effects and their prescription status in Switzerland. It is not a recommendation for either ingredient.

How the two ingredients work

Finasteride inhibits the enzyme 5-alpha reductase type II. This enzyme converts testosterone into dihydrotestosterone (DHT). In people with a genetic predisposition, DHT gradually shrinks the hair follicles until they only produce fine, short hairs. ^[1] In a study with scalp biopsies, finasteride lowered DHT in the scalp by around 64% after 42 days and DHT in the blood by around 71%. ^[2]

Minoxidil was originally developed as a blood pressure medicine. On the scalp it shortens the resting phase, moves follicles into the growth phase earlier and can prolong that phase. The active form is thought to be minoxidil sulphate, which is produced in the scalp. The exact mechanism is still not fully understood. ^{[3] [4]} Minoxidil does not change your hormones. So it does not slow the cause of miniaturisation, but supports hair growth at the follicle itself.

You can find more detail on the pages for finasteride and minoxidil.

Prescription status in Switzerland

Oral finasteride is authorised in Switzerland for mild to moderate androgenetic alopecia in men and is prescription-only. ^[5] There is also an authorised topical finasteride product, which is prescription-only as well. Prescription-only medicines may only be dispensed on a doctor's prescription. ^[7]

Authorised topical minoxidil products with 2% and 5% are in dispensing category D, meaning they are available without a prescription after professional advice at pharmacies and drugstores. ^{[6] [7] [18]} By contrast, no oral minoxidil product is authorised in Switzerland. ^[18] If minoxidil is taken by mouth for hair loss, this is use outside the authorisation (off-label), for which a doctor takes responsibility. The guide to minoxidil prescriptions in Switzerland explains the rules in detail.

Doctors can also prescribe individually compounded formulas, which a pharmacy prepares on prescription. Which form is suitable is a medical decision.

What head-to-head studies show

Direct comparison studies are rare and mostly small. In an open randomised study from Turkey with 65 men, hair density improved after 12 months in 80% of participants on oral finasteride and in 52% on topical minoxidil 5%. The difference was statistically significant, but the study was not blinded. ^[8]

Analyses across many studies carry more weight. A network meta-analysis of 23 studies found more thick terminal hairs after 48 weeks with oral finasteride than with topical minoxidil 5%, on average around 26 hairs per square centimetre. ^[9] A systematic review showed that both ingredients clearly outperform placebo, with wide variation between studies. ^[10]

In practice this means two things. Both ingredients are well supported by evidence, and oral finasteride performed somewhat better on average in the comparisons. How an individual responds cannot be predicted from this. The guide on finasteride efficacy and studies goes deeper into the evidence for finasteride.

Combination according to studies

Because the two ingredients act in different ways, they have often been studied together. In a randomised study from China with 450 men, the appearance of the hair improved after 12 months in 80.5% on finasteride, 59% on minoxidil and 94.1% on the combination. ^[11] A meta-analysis of five randomised studies found better scores in photographic assessment for the combination than for a single treatment. There was no significant difference in measured hair density or in side effects. ^[12]

Combinations in a single topical solution have also been studied. In a small double-blind study with 40 men, a solution containing finasteride and minoxidil performed better than minoxidil alone, while DHT in the blood fell by only around 5%. ^[13] For topical finasteride on its own, a larger phase III study is available. ^[17]

Whether a combination is an option for you, in what form and how far apart the applications should be, is decided by your treating doctor.

Side effects and safety

With finasteride, sexual side effects are the main concern, such as reduced libido or erectile problems. A meta-analysis of 15 placebo-controlled studies found a 1.66-fold higher risk of sexual dysfunction with finasteride 1 mg compared with placebo, affecting a small share of users. ^[14] In November 2025 Swissmedic also highlighted the risk of mood changes and suicidal thoughts. Since then, 1 mg products come with a patient card. ^[15] Pregnant women should not touch damaged tablets. ^[5]

Topical minoxidil acts mainly locally. Itching, flaking or redness of the scalp are common, often caused by the vehicle. Allergic contact dermatitis is rare. ^[16] In the first weeks, shedding can increase temporarily as hairs in the resting phase are pushed out. ^[4] Accidental contact with the face or hands can cause unwanted hair growth there.

The guide to finasteride side effects covers this in more detail.

What both have in common

However different their mode of action, three points apply to both. First, they take time. In the pivotal studies, the response was assessed after 6 to 12 months, and visible changes often appear only after several months at the earliest. ^{[1] [4]}

Second, they only work while you use them. After stopping, the hair returns over several months to the course it would have taken without treatment. ^{[1] [3]} Both are therefore long-term treatments rather than a one-off course.

Third, both work in hereditary hair loss, not in every form. Patchy hair loss, hair loss after stress or illness, and deficiencies have other causes. That is why the first step is working out which form you have. The guide to the causes of hair loss and the page on androgenetic alopecia give an overview.

Who decides what suits you

Which ingredient, which form, which concentration and whether a combination makes sense depends on the diagnosis, severity, previous conditions, tolerability and your preferences. A doctor weighs this up. You can buy topical minoxidil without a prescription, but advice at the pharmacy or drugstore is part of the deal.

For a medical assessment you can go to your GP, a dermatologist or an online consultation. The comparison of telemedicine, dermatologist or hair clinic sets out the options and what they cost.