Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 1/13/2021
Losing your hair is scary, and we’re not exaggerating when we say it can force you to reckon with how you feel about your appearance. You’re getting older — and it shows. And (for most of us) it can be an unnerving predicament.
You can look at hair restoration, hair transplant, and even hair pieces, but the seemingly least disruptive hair loss treatments should be your first stop. Because if you can slow or even stop your balding with a topical medication, why would you want to do more?
Finasteride is generally sold as an oral medication with a prescription.
But what if there were a topical medication that could work just as well? What if a topical solution including finasteride could deliver similar results without the fear of side effects?
Daily application of a simple product is hardly work if it results in good hair density or even slows the progress of your receding hairline.
Topical finasteride is not approved by the FDA, but there is a growing body of research on its effects.
Androgenic alopecia, also known as androgenetic alopecia and male pattern baldness, affects as many as 50 million men in the United States alone.
It’s referred to as “pattern” baldness, because hair loss generally occurs in a predictable pattern, beginning over the temples and receding into an M shape, and at the top of the head.
Overtime, this pattern spreads, ultimately leading to total baldness (if you don’t shave it off before then).
This type of hair loss is related to hormones known as androgens, and is largely genetic.
In short, increased levels of dihydrotestosterone (DHT) and the enzyme 5-alpha reductase impact hair growth. The growth cycle of hairs is shortened leading to follicular miniaturization, which results in increasingly shorter and thinner hair.
As this progresses, there is also a delay in how quickly new hairs replace shedded hair strands in the hair follicles.
Eventually, the hairs are not replaced at all, and your hairline slowly inches back.
Topical finasteride is not approved for use by the Food and Drug Administration (FDA) but is found in very low concentrations in combination products (those that include multiple kinds of medication). That said, scientists are currently researching its effectiveness and safety. More on that later.
Finasteride is an oral medication approved by the FDA under the brand name Proscar® for the treatment of benign prostate hyperplasia (enlarged prostate) and hair loss in both men and women under the name Propecia®.
It was initially approved in 1992, so has years of research behind it.
The drug works as a 5-alpha reductase inhibitor which limits the conversion of testosterone to dihydrotestosterone, and thereby reducing DHT circulating in the body and limiting its effects on hair loss.
The vast majority of existing literature on finasteride refers to the systemic or oral variety, as it has the longest track record. However, there is ongoing research into topical finasteride, and as that body of scientific research grows, so does the likelihood that it may one day gain approval for prescription use.
In the scientific world, “systematic reviews” and “metaanalysis” are words to describe scientific papers that look at multiple clinical studies.
These are useful when you want to get the lay of the land on a topic, without diving into the gritty details.
But, they only provide a very high level look. So the next time you find yourself on PubMed wading through placebo-controlled analyses, you can skip to these summaries.
A 2018 systematic review of seven topical finasteride studies found that the medication was correlated with a “significant” decrease in hair loss rate, significant increase in total hair counts, and positive hair growth assessment.
he studies noted a decrease in both scalp DHT and serum DHT levels from baseline throughout the body. The authors concluded that the results were “safe and promising” and recommended continued research and follow-up.
A 2020 review of 33 scientific articles on topical finasteride had similar findings — the studies “showed positive results with a favorable safety profile,” and the authors called for continued research.
One reason people seek out alternatives to oral finasteride is the systemic side effects. And while the risk of side effects is real, many of them, such as sexual side effects, have been blown out of proportion by the media and websites touting alternatives.
The side effects men are most concerned about are the sexual side effects, and who wouldn’t be. Sexual dysfunction is nothing to take lightly. These potential effects include decreased sex drive, erectile dysfunction, and ejaculation problems. They are believed to occur in fewer than 5% of cases, and they generally happen early on in the therapy and then subside as your body gets accustomed to the medication. In extreme cases, the effects may last longer.
These side effects are certainly a concern. And topical finasteride does seem to skirt those potential problems.
Oral finasteride is prescribed in 1mg tablets, where topical finasteride is generally used in a 0.1% or less concentration. Further, it isn’t clear how much of that medication reaches the bloodstream when compared to the systemic therapy.
That said, the disclaimer is: more research is needed on the potential side effects of topical finasteride. Because the topical formulation is applied directly to the skin, skin irritation is likely the most common potential problem.
Oral finasteride is often prescribed in conjunction with topical minoxidil, and the evidence suggests the two medications work best side by side. But this may also be true for topical finasteride.
While more research is necessary into exactly how and why these two medications work so well together, the available research suggests that minoxidil works to increase absorption of topical finasteride, which leads to better results. And many formulas exist that combine the two medications.
We’ve talked more about the relationship between finasteride and minoxidil in our Minoxidil vs. Finasteride guide.
Oral finasteride is a gold standard when it comes to prescription medications for the treatment of male pattern hair loss and hair regrowth.
It’s been around a long time, and has a large body of scientific literature supporting its use and effectiveness.
Topical finasteride, on the other hand, is relatively new to the game.
While the research is promising, more is needed to ensure it’s worth your money and doesn’t come with deal-breaking risks.
As always, if you’re noticing more hairs in the drain than you’re comfortable with, the best thing you can do is schedule a time to speak with a certified healthcare professional to talk more about what you’re experiencing and what your best direction forward is.
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