Most hair loss advice online treats treatment like a single decision: pick the “best” med and stick with it. But androgenetic hair loss (male-pattern thinning) is rarely a one-lever problem.

The simplest way to think about it is this: hair loss is usually driven by two forces happening at once—a slow, hormone-driven miniaturization of follicles and a shortening, weakening growth cycle that makes hairs thinner, shorter, and easier to shed. Finasteride and minoxidil tend to address different parts of that equation, which is why many people do better using both than using either one alone.

This isn’t about “more meds = more results.” It’s about matching the tool to the mechanism.

The two problems you’re trying to solve

1) The “root cause” problem: follicle miniaturization

In androgenetic hair loss, follicles gradually shrink over time (miniaturize), producing thinner hairs until they stop producing visible hair altogether. This process is strongly influenced by DHT (dihydrotestosterone) in genetically susceptible scalps.

Finasteride lowers DHT levels (specifically by inhibiting 5-alpha reductase), which can help slow or stabilize the miniaturization process.

2) The “growth cycle” problem: weaker, shorter growth phases

Even if you slow the underlying miniaturization, you still need the hair you have to stay in its growth phase longer and produce thicker shafts.

Minoxidil supports hair growth by pushing more follicles into the growth phase and helping hairs stay there longer. It’s less about “blocking the cause” and more about improving output—helping follicles perform better.

That’s why the combo can be powerful: one helps protect the follicle from ongoing miniaturization, and the other helps maximize visible growth from the follicles that are still active.

Why “just minoxidil” can feel like a roller coaster

A lot of people start with minoxidil because it feels direct: you take it, you expect growth. And some people do see improvement—especially in density and shedding.

But here’s the catch: if DHT-driven miniaturization is still progressing in the background, minoxidil can become a “treadmill.” You might maintain for a while, or gain some thickness, but the underlying process may keep narrowing the runway over time.

That’s often when people say:

    •    “It worked at first, then it plateaued.”

    •    “I’m shedding again.”

    •    “I can’t tell if it’s doing anything anymore.”

Minoxidil can help follicles perform, but it doesn’t reliably stop the slow miniaturization that’s reducing follicle capacity in the first place.

Why “just finasteride” can feel slow (or like nothing is happening)

Finasteride is often more about stabilizing than creating dramatic cosmetic change fast.

Some people expect a visible “fill-in” quickly and get discouraged. But finasteride’s biggest value is what you don’t see: slowing the process that causes progressive thinning.

That can feel like:

    •    “My hair isn’t getting worse, but I don’t see new growth.”

    •    “It’s subtle.”

    •    “I expected a bigger change.”

For many patients, finasteride is the “protect the foundation” move. Minoxidil is the “improve the cosmetic outcome” move.

Who the “both” approach usually makes the most sense for

Using both is often worth considering when:

    •    You’re seeing active thinning (not just mild recession)

    •    You want the best shot at stabilization + density

    •    You’ve tried one option and hit a plateau

    •    You’re early enough that follicles are still alive (miniaturized, but not gone)

The earlier you address both mechanisms, the more follicle “inventory” you may still have to work with.

When using both may not be necessary

There are situations where one may be enough—at least for a period of time:

    •    Very early hair loss where you mainly want to slow progression (finasteride-first approach)

    •    Someone who can’t tolerate or doesn’t want one of the medications

    •    A person focused on a specific area where one tool is more relevant (for example, some people target crown density and prioritize minoxidil)

The key is being honest about your goal:

Are you aiming for maintenance? Visible density improvement? Or both?

Common misconceptions that lead to frustration

“If I’m shedding, it means it’s not working.”

Not necessarily. Hair cycling can look messy before it looks better. A temporary increase in shedding can occur when more hairs shift cycles.

“More is always better.”

Not true. Better is better. The goal is a plan you can actually sustain.

“If I stop, I’ll be fine if I restart later.”

Hair loss treatments often work while you use them. Stopping can mean you lose the benefit you gained or maintained. If you restart later, you may not “pick up where you left off.”

“Vitamins alone can fix it.”

Vitamins matter when you’re deficient. But most male-pattern hair loss isn’t caused by a vitamin deficiency. Supplements are supportive—useful in the right context, not usually the primary driver.

A practical way to decide without overthinking it

If you’re trying to choose a sensible, evidence-based direction, ask yourself:

    1.    Do I want to slow future loss?

Finasteride is often the primary lever for that.

    2.    Do I want to improve visible density over time?

Minoxidil is often a direct lever for that.

    3.    Do I want both stabilization and cosmetic improvement?

That’s where combination therapy often makes the most sense.

No hype—just matching goals to mechanisms.

Don’t ignore the “other causes” of hair thinning

Not all thinning is purely androgenetic. Even when male-pattern loss is the main driver, additional factors can stack on top of it (stress, nutrition, iron status, thyroid issues, etc.). If your shedding feels sudden, diffuse, or different than your baseline pattern, it can be worth checking.

That’s where basic bloodwork can reduce guesswork—less anxiety, more clarity.

Closing thought: clarity beats “trial and error”

Hair loss is emotionally loud. The internet is louder. The best outcomes usually come from a calm plan you can actually follow—not bouncing from product to product every two weeks.

If you want a structured, provider-guided option, you can review Avendano Health’s hair loss treatment here: https://avendanohealth.com/hair-loss 

If you’d rather start by checking health markers that can contribute to thinning or shedding, you can view cash-pay lab options here: https://avendanohealth.com/lab-work 

These links are there for patients who want next steps—not urgency, not pressure—just a clear path forward.