A portion of individuals suffering from male pattern baldness choose not to use finasteride at all and opt instead for a minoxidil-only protocol. This is an option for those wanting to avoid finasteride as minoxidil will still provide a boost in appearance even if it’s not targeting the root of the issue as effectively.
Therefore it’s important to know how long minoxidil only lasts, you don’t want to use something expecting it to last for 10+ years and then be heavily disappointed when you only get 3 years of solid benefits from the product.
Depending on the severity of loss you may be able to maintain a nice appearance for long periods. Of course – someone experiencing aggressive loss won’t maintain healthy hair long-term without getting down to solving the root cause. This is all extremely personal and how you choose to treat hair loss (if at all) is ultimately your decision.
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Introduction
It is important to be aware of the fact that minoxidil alone will not target the root cause of androgenic alopecia (male pattern baldness) which is caused in large part by genetic susceptibility to DHT and related factors involving things like androgen receptors, etc.
You don’t want to be someone coping with minoxidil alone thinking it will be the end-all solution for you.
I think it’s important to consider the following either way: if you are genetically determined to be a NW 3 at age 30 (for example) then you would still likely hit that because DHT will still be attacking those follicles fairly heavily regardless of if you use minoxidil or not.
The exact mechanisms of minoxidil are still fairly debated and unclear but the common theories and science suggest that it may be a vasodilator, induce growth factors, anti-inflammatory, and may also be slightly anti-androgenic although this is heavily debated in terms of the science.
At the end of the day, minoxidil just isn’t targeting DHT to the extent that finasteride or other anti-androgens are – we can state that for certain.
So with that in mind, minoxidil alone may still be an interesting choice for those against finasteride use or for those with less aggressive hair loss looking for a boost.
And yes – combined with the DHT inhibition of finasteride for maintenance minoxidil is an extremely powerful growth stimulant that allows for that extra density, thickness, and overall appearance gain. In terms of risks vs rewards I still think minoxidil is a great option – I’ll have to do a writeup specifically on it soon.
Potential
As long as you understand the mechanism and fact that minoxidil mainly acts as a growth stimulant you may choose to use it alone without any other therapy due to fear of side effects, etc. Hair loss is such a personal thing that everyone should make informed decisions based on their personal goals.
It’s all a spectrum of time, energy, money, and physiologic effects weighed against the benefits gained (or maintained).
With that said I think minoxidil alone has potential for those looking to get a few years out of their hair without committing to heavier pharmaceuticals.
For example, if you’re a NW 1.5 at say 35 years old and want to commit to minoxidil over 10 years you’d likely maintain aesthetic benefits for a good portion of that time even if the underlying hair is still being attacked by DHT.
Take someone like Andrew Huberman for example – if he isn’t already using it, minoxidil could provide aesthetic benefits to his hair even if he doesn’t want to commit to something like finasteride. I know personally he is fairly against finasteride so the example fits – he’d still be losing hair to an extent from DHT but not badly enough to warrant starting finasteride especially when you consider he is in his 40’s with such great hair already.
Of course, this is just an example but I hope you can see the nuance here of how someone with a good baseline might not necessarily need finasteride in their lifetime but would want to squeeze out some aesthetic benefits from something like minoxidil.
Someone experiencing heavy diffuse thinning or higher Norwood stages at a younger age may want to opt for something like finasteride to maintain over a longer period. If your hair is getting ravaged by DHT at age 25 it’s hard to imagine you would last to 40 with a decent head of hair without targeting it specifically.
The opposite is true for finasteride – many have maintained long term with this pharmaceutical and this is shown in the science.
Minoxidil Studies
“Thirty-one men with androgenetic alopecia completed 4 1/2 to 5 years of therapy with 2% and 3% topical minoxidil. Hair regrowth with topical minoxidil tended to peak at 1 year with a slow decline in regrowth over subsequent years. However, at 4 1/2 to 5 years, maintenance of nonvellus hairs beyond that seen at baseline was still evident. Topical minoxidil appears to be effective in helping to maintain nonvellus hair growth in men with androgenetic alopecia.”
“In a five-year study, 2% minoxidil exhibited peak hair growth in males at year one with a decline in subsequent years. Topical minoxidil causes hair regrowth in both frontotemporal and vertex areas. The 5% solution and foam were not significantly different in efficacy from the 2% solution.”
Interpretation
These results provide the following facts:
- Minoxidil provides peak growth after about one year of use
- After the first year growth slowly tapers off
- Twice daily seems more efficacious for maintaining
This seems favorable for minoxidil use.
Finasteride Studies
Since I mentioned finasteride over the long term I thought I would quickly provide a source for that claim as well. There are anecdotes online discussing use and maintenance well over 20 years but I quickly found two studies showing extremely high rates of success over both 5 and 10 years.
“The proportions of patients with improvement (MGPA ≥ 5) or prevention of disease progression (MGPA ≥ 4) at treatment year 10 were 91.5% (487/532) and 99.1% (527/532), respectively.”
“In the present study, the proportion of patients showing improvement – including no disease progression – was 98.4% after 5‐year treatment of finasteride. This score is similar to the scores in previous studies by Rossi et al. (93.0%) and Yoshitake et al. (100%). This suggests that long‐term use of finasteride can, at least, prevent the progression of AGA in most cases. AGA is a progressive disease.”
The evidence is fairly clear here.
Bonus Value
As a bonus for this post, I will quickly mention the concept of microneedling. It has been shown that microneedling may increase the efficacy of minoxidil through a variety of supposed mechanisms. The data isn’t concise but I did a post on microneedling as a concept here.
However, I do want to state my opinion on microneedling is still wary. There have been studies showing potential scarring with scalp microneedling so you need to make a decision weighing the potential pros and cons against your personal goals. If you aren’t responding well to minoxidil alone this may be something to try.
Something less intensive to look into is tretinoin, it is shown to increase enzymes in the scalp related to minoxidil’s efficacy. It has even turned people who weren’t responding to minoxidil treatment into people who began responding to minoxidil treatment. I would choose this any day over potentially scarring my scalp.
Tretinoin Study 1, Tretinoin Study 2
My Opinion
I’ve browsed hair loss communities for years. The main thing I can say is that I’ve seen lots of guys maintain long-term (~20 years) with finasteride and haven’t seen the same for minoxidil.
Don’t get me wrong – I’ve seen positive results but these guys likely aren’t experiencing more aggressive loss.
This anecdote kind of describes the situation I’m talking about.
Ultimately my opinion reflects what I’ve written here and with the data:
- Finasteride is the best option for dealing with the root cause over a long period
- Minoxidil is a great option for growth stimulation but may not last as long
- It depends on your situation, preferences, opinions, etc
Conclusion
While I use finasteride and haven’t opted for minoxidil personally – I tried my best to remain unbiased in writing this post and I hope you got a lot of value from the information, theories, and logic provided. I think if you are someone who does want that aesthetic enhancement and is against finasteride – minoxidil can be an option to squeeze extra life out of your hair.