Comparison
Finasteride vs. Minoxidil
Finasteride or minoxidil – what is proven for hereditary hair loss?
The short answer
Both are proven against hereditary hair loss in blinded trials, by different routes. Finasteride inhibits 5-alpha reductase and lowers DHT; in 1,553 men, hair count was 107 above placebo after one year and 138 after two years. It is prescription-only, and since the Dear Healthcare Professional letter of 15 September 2025, suicidal thoughts of unknown frequency have been listed in the product information. Minoxidil does not lower DHT; as a scalp solution it outperformed placebo in 393 men and is available without prescription in pharmacies. The tablet is approved only for high blood pressure and was not superior to the foam in a head-to-head trial. The sources name no study comparing finasteride directly with minoxidil. The decision on finasteride and the minoxidil tablet belongs with a doctor.
The numbers side by side
| Axis | Finasteride | Minoxidil | Difference |
|---|---|---|---|
| Human evidenceHow much and how good the data in humans are | 9 | 8 | Finasteride better studied |
| MechanismHow well the chain of action is understood | 9 | 5 | Finasteride better studied |
| Safety dataHow well safety has been studied – not how safe it is | 8 | 7 | Finasteride better studied |
| Hype gap10 means: the advertising stays level with the data | 4 | 5 | Minoxidil closer to the data |
| Track record of useHow much documented use in humans exists – does not measure whether it works | 9 | 9 | even |
| Rating | Well supported, heavily overhyped · Well supported, heavily overhyped | ||
“Track record of use” measures how long and how widely something has been used in humans – not whether it works. The BK-Score is a subjective assessment by Biohacking Kompakt based on published scoring rules (German). It is not a scientific rating, not the consensus of a professional society and not a medical recommendation.
Why these numbers
Finasteride
The effect on hair is among the most cleanly measured in this field: two blinded trials with 1,553 men aged 18 to 41, counted on 5.1 square centimetres at the crown (baseline 876 hairs). After one year 107 more hairs than on placebo, after two years 138, each p < 0.001, with a blinded extension in 1,215 men. Safety data 8, because the side effects are well documented from approval trials and decades of use; the axis rates the data, not the danger. The side effects are the reason for the mixed direction: since the Dear Healthcare Professional letter (Rote-Hand-Brief) of 15 September 2025, suicidal thoughts have been listed as a side effect in the product information, frequency explicitly unknown. Sexual dysfunction is the most common reason for stopping.
Minoxidil
Evidence 8, because use on the scalp is proven in blinded trials – in 393 men, the 5% solution was superior to the 2% solution and placebo after 48 weeks (Olsen 2002) – while the tablet was not superior to the foam in the only blinded head-to-head comparison to date, with 90 men (Penha 2024). Mechanism 5, because the blood pressure reduction via potassium channels is well understood, but the route to hair growth only partly, even after more than 30 years (Messenger 2004). Safety 7, because use on the skin has been documented for decades and the cardiac risks of the tablet are known from hypertension treatment, but for the low dose against hair loss mainly retrospective analyses without a control group exist (Vañó-Galván 2021); the axis rates the data, not the danger. Hype 5, because the tablet is promoted as a stronger alternative to the solution, which it has not proven to be in direct comparison. Application 9, because minoxidil has been widely used for decades and is available without prescription for the scalp up to 5%. Direction positive: the data support hair growth; the limitations concern the unapproved tablet.
Frequently asked questions
Is finasteride stronger than minoxidil?
The sources cannot answer that; they name no study comparing the two directly. The studies can only be laid side by side, and they measure different things: Kaufman 1998 counted hairs on 5.1 square centimetres at the crown over one and two years for finasteride, while Olsen 2002 counted non-vellus hairs in the target area over 48 weeks for minoxidil solution. Both showed a clear lead over placebo. No ranking follows from this.
How do finasteride and minoxidil differ in how they work?
Finasteride inhibits type II 5-alpha reductase and thereby reduces the conversion of testosterone to DHT, the hormone that shrinks the follicles in hereditary hair loss. This chain of action is well described. Minoxidil does not lower DHT. How it stimulates hair growth is only partly understood despite more than 30 years of use; it probably shortens the resting phase of the follicles and lengthens the growth phase.
What are the side effects of finasteride and minoxidil?
With finasteride, sexual dysfunction is the most common reason for stopping. Since 2025, suicidal thoughts have been confirmed as a side effect of the tablets, with unknown frequency; with depressed mood, treatment should be stopped and medical advice sought. With minoxidil on the scalp, itching and irritation are the most common. On the tablet, increased body hair growth was common, and the prescribing information also lists pericardial effusion from hypertension treatment. Help with suicidal thoughts in Germany: Telefonseelsorge 0800 111 0 111.
Do you need a prescription for finasteride or minoxidil?
Finasteride is prescription-only and belongs in medical hands, partly because of its psychiatric side effects. Minoxidil as a solution or foam for use on the scalp is exempt from prescription but remains pharmacy-only. Minoxidil tablets are prescription-only and in Germany approved only for hard-to-treat high blood pressure. For hair loss, the tablet is an off-label use that a doctor decides on.
See all ratings in the ranking (German app)
Information only, not medical advice and not a usage or dosage recommendation. Prescription-only and unapproved substances belong in a doctor's hands.