Minoxidil without a prescription: which hair loss treatments you can buy in Spain and which need a doctor

Of the hair loss treatments with solid evidence behind them, topical minoxidil is the only one whose summary of product characteristics (SmPC) assumes that people apply it themselves and see a doctor if it isn't working. Even so, whether a particular product is dispensed with or without a prescription depends on how it is registered with the AEMPS, Spain's medicines regulator, so this needs checking product by product. Oral minoxidil for hair loss is an off-label use in Spain and always needs a doctor to prescribe and monitor it. The same goes for finasteride, whether as tablets or as a spray.

It's a reasonable question to ask, because the problem is very common. According to the European Dermatology Forum's S3 guideline, androgenetic alopecia affects around 30% of men by the age of 30 and around 50% by 50, and up to 80% of Caucasian men and 42% of women. With so many people affected, it makes sense that many want to start with something they can simply buy. Below we compare the options dimension by dimension, rather than one after another.

Access in Spain: what you can buy and what goes through a doctor

Topical minoxidil is registered in CIMA, the AEMPS's online medicines database. One example is a 5% (50 mg/ml) cutaneous solution, Minoxidil Biorga. Its SmPC advises seeing a doctor if there are no results, and checking with a doctor before starting if you have cardiovascular disease or arrhythmias. The way it is worded implies that people apply it themselves. There are several products on the market, and they don't all necessarily have the same dispensing conditions. If a particular one requires a prescription, its CIMA entry will say so, and your pharmacist can confirm it.

Oral minoxidil is a different matter. Using it at low doses for hair loss is off-label: the medicine is not authorised in Spain for that indication. That is why only a doctor can prescribe it, taking responsibility for that decision and for follow-up. Finasteride is also prescription-only. The SmPC for oral finasteride 1 mg restricts its use to men aged 18 to 41 with early-stage androgenetic alopecia. The patient leaflet for the topical spray (Caretopic, registered in CIMA) states that it is used under medical prescription. Dutasteride acts on the same enzyme as finasteride, 5-alpha-reductase, but we have not been able to verify that it has an authorised indication for hair loss in Spain, so we have left it out of this comparison.

Efficacy: what the trials show for each option

One important caveat before comparing: these figures come from different studies, with different populations, durations and ways of measuring results. They don't come from a single trial pitting all four options against each other, so they cannot be ranked from best to worst.

• Topical minoxidil: the van Zuuren Cochrane review (2016) on female pattern hair loss pooled 8 studies with 1,242 participants and found, on average, 13.18 more hairs per cm² with minoxidil than with placebo. In 6 studies, twice as many women had at least moderate regrowth with minoxidil as with placebo. Four studies compared the 2% and 5% strengths, and none found an advantage for the higher one.
• Low-dose oral minoxidil: a systematic review published in the International Journal of Dermatology in 2020 (10 articles, 19,218 patients) reported objective clinical improvement in 61-100% of cases of androgenetic alopecia. The range is wide because the studies included were very different from one another.
• Oral finasteride 1 mg: its SmPC states that it stabilises the process. In other words, it slows hair loss, but it does not cure baldness.
• Topical finasteride spray: a phase III trial (Piraccini et al., JEADV 2022) ran for 24 weeks in adult men at 45 European centres and compared it with placebo and with oral finasteride. We don't give its efficacy figures because we have not verified them.

If you are specifically weighing up the two forms of minoxidil, oral versus topical minoxidil: what head-to-head trials show reviews the studies that have actually measured them side by side.

How they are used and how long they take

Topical minoxidil is applied to the scalp twice a day. Its SmPC talks about continuing for 4 months or more before judging the result, so don't expect results within weeks. Oral finasteride is taken by mouth, 1 mg a day according to its SmPC. According to its patient leaflet, the finasteride spray is used at 1 to 4 sprays a day, always on prescription. With oral minoxidil, the doctor decides the dose, precisely because the SmPC does not cover its use for hair loss.

With all of them, patience matters most. There may be some initial shedding at the start, which can be alarming, and visible change takes months. We explain this in how long hair loss treatment takes to show results at 3, 6 and 12 months.

Side effects and precautions

According to the Cochrane review, the side effects of topical minoxidil are usually mild: itching, irritation, dermatitis and hair growth in other areas. It should not be used during pregnancy or breastfeeding. For low-dose oral minoxidil, the 2020 review lists excess hair growth and postural hypotension, meaning dizziness on standing up, as the most common side effects. This cardiovascular risk is one of the reasons it needs medical supervision.

Finasteride has a different profile. In May 2025, the EMA's pharmacovigilance committee (PRAC) confirmed suicidal ideation as a side effect of finasteride 1 mg and 5 mg. Most cases occurred in people being treated for hair loss. Since then, the 1 mg pack has included a patient card. If you notice mood changes, the advice is to seek medical advice and stop treatment. The EMA maintains that the benefits outweigh the risks. The SmPC also lists reported cases of breast cancer in men taking it. In addition, women who are pregnant or could become pregnant should not handle broken or crushed tablets. The fact that the spray is applied to the skin doesn't mean it is risk-free: it is still finasteride.

Cost: why we don't give a single figure

We don't have verified prices for these products, so we are not going to make them up. What we can say is what the cost depends on. For topical minoxidil, the brand and the format. For prescription options, you need to add up the medicine, the initial consultation and the follow-up reviews. In minoxidil prices in Spain: why topical and oral costs vary so much we break down those differences.

When each option is considered, in general terms

In practice, topical minoxidil is usually the first step when someone wants to start on their own and has no cardiovascular contraindications. Oral minoxidil is considered when a doctor judges that the benefit justifies off-label use and can monitor blood pressure and other effects. Oral finasteride is reserved, according to its SmPC, for men aged 18 to 41 in the early stages. The topical form is a prescribed alternative within the same family. None of these options suits everyone, and choosing between them requires an individual assessment.

For women the range of options is different, because finasteride 1 mg is not indicated for them. We go through this in female androgenetic alopecia: which treatments have evidence and which are authorised in Spain.

Key points and where to start

Topical minoxidil is the option closest to self-care, although it's worth checking for each product whether it needs a prescription. Oral minoxidil and finasteride need a doctor by design, not because of red tape: their risks call for follow-up. If hair loss is worrying you, in Spain there is medical treatment for hair loss with a prior assessment, prescription by a registered doctor where appropriate, and ongoing follow-up. That is what AiON does via telemedicine. You can:

Check in a few minutes whether the treatment is right for you