EXPERT GUIDE

What is topical finasteride?

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Medically reviewed by Dr. Sternberg Written by Alex Rode on 24 Jun 2022

Androgenetic alopecia otherwise known as male pattern baldness is a widespread problem many people face at some point in their life. Thus, it has been a prolific topic for discussion in the medical and beauty field. Hair loss problems can be treated differently, and the key factor is to choose a suitable treatment for the particular case. The treatment may range from over-the-counter pills to different procedures and even hair transplants.

What is topical Finasteride?

One of the well-established and most effective medicines for hair loss is finasteride. Oral finasteride is approved by Food and Drug Administration (FDA). It is usually administered in tablets. Its main task is to block testosterone from converting into dihydrotestosterone (DTH), the hormone that influences the growth of hair follicles, thus, leading to baldness in males. Recent studies show that topical finasteride may have fewer side effects while showing the same advantages as the tablet form. Finasteride is sold under various commercial names. 

How do minoxidil and finasteride work?

Topical finasteride can be liquid, gel, or in the form of droplets. The substance is applied to the scalp area, directly treating the hair loss, thus, presumably influencing other systems less and causing fewer side effects. It is not yet available commercially, but it is possible to get it at the compounding pharmacies. Its efficiency and safety are still under investigation and study.

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What is more effective? Topical or Oral Finasteride?

Finasteride is typically taken in tablets once per day. Even though it has long been approved and used to treat hair loss effectively, finasteride’s tablet form may cause undesirable side effects such as erectile dysfunction, decreased libido, increased risk of depression, and others. Studies suggest that 96% of men do not experience such side effects when using oral finasteride. Considering this, some men prefer to avoid these reactions and opt for topical finasteride.

On the other side, studies are showing that people applying topical finasteride still may face the same side effects, though at a lower rate. Topical finasteride may be advantageous for people suffering the hair loss and yet extremely anxious about possible side effects from tablets. Applying topical finasteride may not be as easy and convenient as taking a pill, so this slight detail should also be considered. If the skin on the scalp gets too sensitive or irritated by the spray, administrating tablets may be a better choice in this case. 

Hair loss treated with Finasteride or Minoxidil

In the study by Hajheydari 2009, 38 males were divided into two groups. One group used 1% topical finasteride and a placebo pill, and another group used 1 mg oral finasteride and a placebo gel. Both groups showed significant improvement in general, with the oral finasteride group experiencing the results a bit earlier. 

The study by Caserini 2014 studied two groups consisting of 23 males. One group took 1mg oral finasteride, while another group used topical finasteride 0.25% solution BID for seven days. The study results showed that DHT level in the blood of patients taking oral finasteride decreased by 62-72%, and 68-75% of those taking topical finasteride. 

No incidents with lower libido, ejaculation problems, or similar were reported in these studies. So, taking this into consideration, additional research is needed to prove the efficacy and safety, though the current results give hope for it to be approved in the future.

Pro Cons
Tablet finasteride has been approved by FDA for treating hair loss. The topical finasteride has not been approved by FDA for treating hair loss.
Dihydrotestosteron (DHT) levels were decreased by 64% when using a 1 mg dose, according to the Drake studies. Some possible side effects are erectile dysfunction, decreased libido, depression, swelling, dizziness, etc. However, according to Drake studies, decreased libido was spotted in 2.6% of cases when using 1 mg finasteride. In comparison, the placebo group showed 4.5%.
48% of men have experienced improved hair growth compared to 7% of the placebo group after one year, according to Kaufman’s studies. The topical form of the finasteride may cause skin irritation, while the tablet form may cause more potent side effects (according to some studies).
Roberts’ studies show that finasteride helps improve hair growth and hair count. Topical finasteride cannot be obtained commercially yet, only by the doctor’s prescription in compound pharmacies.
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Topical Finasteride before and after

Studies on how efficient topical finasteride is in treating hair loss are still ongoing. Preliminary results of various study works suggest that it has the potential to treat the problem, increasing hair growth and decreasing hair loss. Older and newer studies show topical finasteride’s positive effects on people who took part in the research. However, more evidence-based research is required, and the authors of these studies highlight the need to continue this work. 

Finasteride Before and After

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What is the best concentration?

As finasteride is not yet approved for treating hair loss, so there is no definite answer to this question. More studies are being held to determine the safety and efficiency of the drug and the best concentration. For instance, the study by Caserini compared the results from using different doses of finasteride in randomized parallel groups. This study showed that applying the medicine once per day provides better efficiency than applying it twice a day. The 300 and 400 μL doses may cause a greater risk of side effects. Other studies conclude that the doses of 100µL (0.2275mg) and 200µL (0.455mg) of topical finasteride 0.25% solution prove to be the most effective. More studies and research are needed to determine the best vehicle, concentration, side effects, and other questions about the finasteride.

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Can I take topical finasteride without minoxidil?

Topical finasteride is usually administered together with other ingredients. Most often, it is paired with minoxidil. Minoxidil is an FDA-approved medicine to treat hair loss. It helps stimulate hair loss while finasteride prevents hair from falling out. Finasteride can be prescribed as the first option before minoxidil as it influences the DHT production. However, these two medicines can be used together simultaneously and even improve each other’s efficacy. It is essential to use the medication in an appropriate dosage if one strives to get the best results. 

Since these two medications have different directions of their influence, it is considered not risky to take them together. Though, caution should always be exercised when using various drugs, not only for treating hair loss. If you use other medications, too, it is worth consulting your healthcare provider to determine if these medications can be used at the same time. In addition, more research would provide a better overview of why these two medications work well together.

svg Important

Finasteride should be used only by men over 18 years old suffering from male pattern baldness in oral or topical form.

How to use topical finasteride?

Topical finasteride is applied to the scalp area affected by hair loss. It may be a bit inconvenient depending on the size of the affected area and a bit expensive, as this is not a commercial medicine and has to be procured in compounding pharmacies. Some doctors prescribe topical finasteride when oral tablets are not tolerated and cause strong side effects. It is better to consult the doctor for the concentration and how to apply the medicine.

Finasteride dht supression per dosage graph

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What are the side effects?

Men using topical finasteride may experience the same side effects as those using finasteride tablets. The finasteride’s most common side effects are sexual dysfunction, decreased libido, depression, swelling, dizziness and weakness, pain in testicles, allergic reactions, inability to urinate, swelling or pain in breasts, headache, etc. According to the studies, the rate of such side effects is lower. 

It is believed that topical finasteride does not get absorbed in the system as much as the oral tablet and, thus, causes fewer potential side effects. And many clinical studies showed a lower sexual dysfunction rate. Therefore, a topical form of the finasteride may be an option if tablets cause the person to experience sexual dysfunction. In rare cases, topical finasteride may cause skin irritation and itching. Such side effects typically may be solved by discontinuing the medication. What concerns sexual dysfunction side effects, they may continue after the drug has been discontinued. Thus, it should be done with care.

Some people may experience temporary hair shedding. It is typically connected to minoxidil as it may stimulate hair loss at the beginning of its use. It should disappear in the course of a few months. If side effects continue for a long time, it is worth consulting your healthcare provider in order to be on the safe side.

How to obtain topical finasteride?

As mentioned earlier, topical finasteride is not available over the counter or in pharmacies. It can only be obtained by prescription from your medical provider because FDA has not approved topical finasteride for hair loss purposes. Studies on topical finasteride efficacy and safety are still in progress. To get the best result, it is worth consulting a doctor and making the appropriate treatment plan for your particular case. 

There are also some DIY methods of preparing topical finasteride from tablets. It involves crushing the tablet and adding minoxidil solution to it. Preparing it at home is not recommended as there is no proof of it being safe or effective. Tablets are not produced to be topical. Thus, such a homemade solution may cause skin irritation as tablets contain various additives to make them more suitable for peroral use. Topical finasteride can be prepared in special compounding pharmacies by the doctor’s prescription, who determines that it is effective and needed in the given case of hair loss.

How much does topical finasteride cost?

It may seem an easy question. However, it depends on many factors. Generic finasteride is not very expensive, with the topical one costing a bit more. The price for topical finasteride varies from pharmacy to pharmacy and depends on where you are. If you plan to buy it offline, you also need to count in the need for an appointment with your healthcare provider.

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What happens when you stop taking topical finasteride?

Finasteride works as long as it is used. Its effect wears out. If the patient stops using it, the body cannot continue blocking the enzyme that converts testosterone into DHT. DHT subsequently reduces hair growth. Some patients claimed that side effects persisted even after the treatment was stopped. However, there are not enough research cases to support these statements. This issue needs further investigation by the researchers.

Alternatives to topical finasteride?

Even though other medications can help improve hair growth or reduce baldness, none of them can provide a permanent solution to the problem. There are other approved drugs for treating hair loss besides finasteride. Some people may be more willing to opt for different medicine after considering the side effects of finasteride. 

Most common prescribed hair loss treatments

One of the options is to apply minoxidil alone. It is an approved medicine for hair growth for men and women. Minoxidil does not prevent hair loss. It instead stimulates hair growth. Thus, one of the side effects experienced at the beginning of treatment is hair loss as minoxidil makes the hair in its resting-state fall out and new hair replace it. This medication can help make some areas on the scalp look thicker and denser for some men. Very often, minoxidil is paired with finasteride to improve the results. 

Another option is dutasteride. Like finasteride, it influences 5-alpha enzymes and blocks DHT formation. This drug is not FDA-approved for hair loss treatment. The doctor must prescribe it in combination with other medication to produce a desirable effect safely. Dutasteride also has a variety of side effects, such as impotence, painful ejaculation, depression, anxiety, and others.

A hair transplant may help solve hair loss permanently. Medication can help reduce baldness or improve the situation, but it is not capable of regrowing hair. Transplanting hair may be a game-changer in some cases. So, it is worth considering and studying the topic to regain confidence, self-esteem, and thick hair.

Frequently Asked Questions

How dangerous is topical finasteride?

What happens if I stop applying topical finasteride?

How long does it take for topical finasteride to take effect?

Sources

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