Finasteride vs minoxidil: which is which, and how they differ

Finasteride works on the cause. Male pattern hair loss is driven largely by dihydrotestosterone (DHT), a hormone that gradually shrinks genetically sensitive follicles. Finasteride reduces how much testosterone your body converts into DHT, which is why it is taken as a daily tablet: it changes a body-wide hormone level, not just the scalp.

Minoxidil works on the follicle. It does not touch DHT at all. It is thought to extend the growth phase of the hair cycle and improve blood flow to the follicle, which is why it is applied where you want the effect, as a topical solution or foam on the scalp. An oral form of minoxidil also exists but is prescription-only and used off-label.

• Route: finasteride is an oral tablet; minoxidil is usually applied topically to the scalp.
• Access: oral finasteride is Schedule 4 (prescription-only) in Australia; topical minoxidil is sold over the counter at pharmacies.
• Mechanism: finasteride lowers DHT (the hormonal cause); minoxidil acts locally on the follicle.
• Commitment: both only work while you keep using them, so either is an ongoing routine rather than a course you finish.
• Assessment: finasteride needs a practitioner because it carries real considerations, including a serious pregnancy warning; over-the-counter minoxidil does not, though a review is still worthwhile.

Yes, and it is common. Because they work through different mechanisms, finasteride and minoxidil are often used alongside each other, and many telehealth plans combine them for that reason. Whether a combination suits you, and at what strengths, is exactly the kind of thing a practitioner weighs up during an assessment rather than something to self-prescribe.

The trade is simplicity versus coverage. A single active is one product to manage; a combined plan is more to keep on top of, but targets the problem from two angles. Neither is automatically better, and the right answer depends on your situation and how much routine you will realistically stick to.

For topical minoxidil on its own, a pharmacy is the direct route, since it does not need a prescription. The catch is that you are managing it yourself with no assessment, and you cannot get finasteride that way.

For finasteride, or for a combined and assessed plan, you need a practitioner: your own GP, or an online telehealth service where a registered Australian practitioner reviews your case and prescribes if it is appropriate. Mosh is one Australian men's service that runs this kind of assessment for hair loss, usually as a subscription with the medicine and delivery included.