Finasteride is an FDA-approved drug that’s been around since the 1990s. It’s currently used to treat pattern hair loss (androgenic alopecia) and prostate inflammation (specifically, benign prostate hyperplasia). When used for hair loss, men are meant to take this prescription-only medication once a day in the form of 1-milligram pills.
Despite being FDA-approved for such a long time, finasteride hasn’t worked well for everyone. Its main issue is that its hormone-blocking properties cause systemic side effects, which include issues like erectile dysfunction and breast tissue growth. This has led to the creation of a different formulation of this medication: topical finasteride. Applying this drug directly to the seems to be just as effective and dramatically reduces side effects.
What is topical finasteride?
Topical finasteride is a liquid-based version of the FDA-approved drug finasteride. It’s usually applied as a gel, serum, or spray to the scalp.
According to a review in the Journal of Drugs and Dermatology, topical finasteride concentration can range from as little as 0.005 percent to as much as 1 percent. Concentrations on the lower end of the spectrum are typically used when this medication is combined with another topical hair loss treatment.
You should know that changing the concentration and formulation (like switching from oral pills to a cream or lotion) of topical finasteride means that this version of the drug is no longer FDA-approved for androgenic alopecia or any other condition. So if you’re wondering where to buy topical finasteride, you’re unfortunately unlikely to find it sold in stores or online.
That being said, topical finasteride may be on its way to FDA approval. According to a study in the Journal of the European Academy of Dermatology and Venereology, a 0.25 percent topical finasteride spray recently completed phase III clinical trials.
Topical finasteride has been shown to work well on its own. Research has also shown that it’s effective when combined with other hair loss treatments including dutasteride, a similar hormone blocker approved to treat androgenic alopecia in parts of Asia, and minoxidil, an FDA-approved topical liquid and foam that increases blood flow to the scalp. It’s also been shown to work well when used alongside ketoconazole shampoo, a DHT-blocking shampoo with antimicrobial properties.
Does topical finasteride actually work?
Topical finasteride definitely works. It seems to be just as effective and easy to use as oral finasteride, but has none of the same systemic side effects. The main concern at this time is the wide range of concentrations being tested – particularly since most studies seem to show improvements in hair regrowth, even when tested at lower concentrations.
That being said, the phase III clinical trial used topical finasteride in a concentration of 0.25 percent. This concentration correlates with a recent model published in Annales Pharmaceutiques Françaises, which also identified a 0.25 percent concentration as the optimal dose for topical finasteride. This modeling study obtained this value by analyzing the hair regrowth results that can be achieved after using different concentrations of oral finasteride.
How long does topical finasteride take to work?
According to the Journal of the European Academy of Dermatology and Venereology study, topical finasteride is able to slow the progression of hair loss and improve hair growth in as little as 12 weeks. The Journal of Drugs and Dermatology article agrees, reporting increased hair growth by the third month of treatment.
According to the same study, this is roughly the same amount of time oral finasteride takes to work. Studies usually find that both oral and topical finasteride results continue to improve hair regrowth over the next few months of treatment, as well.
Topical finasteride in combination treatments
Even when used at lower concentrations, topical finasteride’s beneficial effects on hair regrowth are unquestionable – especially when used to enhance the effects of an FDA-approved hair loss treatment like minoxidil. According to a review in the Journal of Dermatological Treatment, using 5 percent minoxidil solution with 0.1 percent topical finasteride was more effective at improving hair regrowth than combining both FDA-approved 5 percent minoxidil and 1-milligram doses of oral finasteride.
The same review also mentioned a similar study, in which 3 percent minoxidil solution (which is not FDA-approved for the treatment of androgenic alopecia) was tested alone and in combination with 0.1 percent topical finasteride. After 6 months of treatment, only people who had used the minoxidil-finasteride combination had grown more hair.
Almost all hair loss treatments take 3 months to work, which is typical since hair regrowth is dependent on the hair growth cycle. But when combined with other medications, like dutasteride and minoxidil, topical finasteride has the potential to work even faster.
For example, the Journal of Drugs and Dermatology study reported that when a topical finasteride, dutasteride, and minoxidil formulation was combined with ketoconazole shampoo and FDA-approved 5 percent minoxidil solution and oral finasteride, it took just one single month to work. Unfortunately, so far, studies have yet to report similarly impressive results when topical finasteride is used on its own.
Topical finasteride vs. oral finasteride
Topical finasteride and oral finasteride are both designed for single, daily use, though according to the Journal of Drugs and Dermatology study, some studies have explored twice-daily use of the topical medication. Topical and oral finasteride work similarly: They’re hormone-blockers that can lower dihydrotestosterone (DHT) levels. The main difference between these two formulations is that topical finasteride acts locally, while oral finasteride is systemic.
According to a study in the Plastic Reconstructive Surgery Journal, DHT is the main hormone involved in pattern hair loss. When this androgen binds to hair follicles, it causes smaller, thinner hairs to be produced. This phenomenon is known as miniaturization. If left untreated, it eventually leads to balding.
Oral vs. topical finasteride side effects
Blocking DHT is an important strategy in stopping the progression of androgenic alopecia. However, oral finasteride may block a little too much DHT. Since this medication is taken orally, StatPearls Publishing and the U.S. National Library of Medicine, it has the potential to cause systemic side effects that include:
- Decreased libido and/or lack of interest in sex
- Erectile dysfunction
- Decreased ejaculation volume
- Testicular pain
- Decreased semen quality (which can temporarily affect the ability to have children)
- Breast tissue growth
- Nipple discharge
- Itchy skin
- Skin rashes or hives
- Shortness of breath
- Low blood pressure
In addition to these issues, oral finasteride has the potential to cause post-finasteride syndrome, a cluster of side effects that can continue to affect people even after they’ve discontinued the medication. According to an article in BMJ, post-finasteride syndrome symptoms include additional issues like fatigue, metabolic anomalies, reduced cognition, memory impairment, anxiety, depression, and insomnia.
In contrast, topical finasteride causes almost none of these problems, and mainly causes topical side effects, like scalp irritation and dermatitis. In rare cases, it has been associated with:
- Dizziness and/or lightheadedness
- Ear and nose pain
- Increased liver enzymes
- Testicular pain
Topical finasteride has a DHT reduction ability that’s similar to oral finasteride. But as a topical solution, its effects – both positive and negative – are usually isolated to the scalp. This is part of the reason topical finasteride tends to cause fewer and less severe side effects.
Is topical finasteride effective?
Topical finasteride is a safe, effective medication proven to slow hair loss and regrow hair. The downside is that this drug is still in the experimental research stage. It only recently completed phase III clinical trials.
Topical finasteride has DHT-blocking properties that allow it to combat the hormonal component behind the progression of androgenic alopecia. This means that it works just like FDA-approved oral finasteride. However, since it is applied to the scalp, most of the effects are local. Only a small percentage gets into the bloodstream, so it’s unlikely to cause any of the systemic side effects that make oral finasteride so infamous.
If you were trying to choose between topical and oral medications: Finasteride in topical form is the clear winner. Once topical finasteride becomes available to the public, its high effectiveness and low side effects will undoubtedly make it highly popular. In the meantime, consider using the FDA-approved topical treatment minoxidil. The 5 percent solution is thought to be the most effective for men.