The question
Male pattern hair loss, also called androgenetic alopecia, is the most common cause of hair loss in men. It usually begins as a slow retreat of the hairline at the temples, along with thinning at the crown. The researchers cite earlier surveys that put its prevalence in Chinese men at roughly one in five.
Two treatments are widely recommended as first-line options in guidelines: finasteride, a prescription pill, and minoxidil, a lotion rubbed into the scalp. Both had been tested before, but the authors said studies comparing them head to head, and studies of using them together, were scarce, especially in Chinese men.
So the team asked a practical question. Over a year, does each treatment work on its own, and does using both do better than either one alone?
Who was studied
The trial took place in the dermatology department of Huashan Hospital, part of Fudan University in Shanghai, China. Recruitment and follow-up ran from 2011 to 2014. Participants were adult Chinese men with male pattern hair loss across a range of stages on the standard Norwood-Hamilton scale. Men with other causes of hair loss, serious health conditions, or recent use of hair-affecting drugs were left out.
The authors enrolled several hundred men and used a random-number table to place each man into one of three groups. One group took finasteride, one used minoxidil solution on the scalp, and one did both. In the final analysis, efficacy was assessed in 428 men: 154 on finasteride, 122 on minoxidil and 152 on the combination.
Treatment lasted 12 months, and the men came back to the clinic every three months. At each visit a standard set of photographs was taken of the crown, the front and middle of the scalp, and the hairline, with the same camera settings and the same hairstyle each time. Two dermatologists who did not know which treatment each man was getting rated the photos on a seven-point scale that runs from a big decrease in hair to a big increase.
What they found
All three groups saw more hair over time, but not equally. After 12 months, improvement was seen in 80.5 percent of the men on finasteride, 59 percent of the men on minoxidil and 94.1 percent of the men on both. In plain terms, finasteride beat minoxidil alone, and the two together beat each by itself.
The timing differed too. At the three-month mark, finasteride and minoxidil looked about the same, while the combination group was already ahead. From month six onward, finasteride pulled clearly ahead of minoxidil, and the combination stayed in front through the end of the trial.
Finasteride worked better on the crown and the front and middle of the scalp than on the hairline at the temples. The authors explained this by noting that follicles at the temples are often more shrunken by the time men start treatment. Younger men on finasteride also did better than older men. Neither pattern reached statistical significance in the minoxidil group or the combination group.
Side effects were uncommon in this trial. Adverse reactions were seen in 1.8 percent of the men on finasteride and 6.1 percent of the men on minoxidil. The finasteride reactions included lowered sex drive, one case of erectile dysfunction, testicular pain and one case of impaired liver function. The most common problem with minoxidil was scalp irritation and contact dermatitis. The authors report that all of these went away after the drug was stopped.
- In Chinese men over 12 months, improvement was seen in 80.5% on finasteride, 59% on 5% minoxidil and 94.1% on both.[1]
- Efficacy was assessed in 428 men at the end of treatment: 154 on finasteride, 122 on 5% minoxidil and 152 on the combination.[1]
- Side effects were rare in the Chinese trial: 1.8% on finasteride and 6.1% on minoxidil, and they resolved after stopping.[1]
- A Chinese trial paper cites epidemiology putting androgenetic alopecia prevalence in Chinese men at 19.9 to 21.3%.[1]
How strong is this evidence
This was a randomized trial, which is a stronger design than a survey or a before-and-after report, because chance rather than choice decided who got which treatment. The groups were also similar at the start in age, how long the hair loss had lasted and how severe it was. That makes the comparison between groups fairer.
There are important limits, though. The trial was open-label, so the men and their doctors knew which treatment was being used. There was no placebo group, so the study cannot say how much of the change came from the drugs and how much from other factors, such as seasonal shedding or the way photos were taken. The photo raters were blinded, which helps, but the measure itself is a rating of improvement on a scale that counts even a slight increase in hair as improvement. Improvement does not mean a full head of hair.
Some men dropped out. Most of those who left did so because of side effects, and they were excluded from the efficacy results. Leaving out the men who stopped because of problems can make a treatment look better and safer than it would in everyday use.
The trial was run at one hospital, among Chinese men, over about a year. It cannot tell us about long-term safety, results at five or ten years, or whether the numbers would look the same in men of other backgrounds. The authors themselves called for longer studies with more participants. The paper lists a brand-name finasteride made by Merck and a Chinese-made minoxidil solution. The authors declared no conflict of interest, and the paper does not name a sponsor.
What it means for you
This study supports a message that many doctors already give: combining the two common treatments tended to beat using either one alone. In this trial the combination gave the best results, finasteride came second and minoxidil on its own came last.
The results do not mean the numbers will be the same for you. Improvement in this trial built up over months, and the best results appeared at the end of the year. Starting early, sticking with a treatment and having realistic expectations all matter.
Finasteride is a prescription medicine that affects hormones, so the decision to use it belongs in a conversation with a doctor. That is the right place to talk about the side effects mentioned above, including changes in sex drive, and to decide whether any check-ups are needed. Minoxidil is applied to the scalp, and the main thing to watch for is skin irritation.
If you have tightly curled or coily hair, keep in mind that this study was done in Chinese men, and that styling habits that cause breakage or pull on the hair can add to thinning in ways no pill addresses. Treat this as one solid piece of the puzzle, not as a prediction for your own scalp.
Related guides
- Thinning Hair in Men: Causes, Treatments, and Styling Solutions
- Hair Thinning and Loss Solutions for Pacific Islander Men: Causes, Treatments, and Cultural Perspectives
- More research-backed statistics
