Tag Archive for: oral finasteride

What Is Topical Finasteride?

If you’re searching for hair loss treatments, finasteride is a name you’ll need to familiarize yourself with. Why? Only two hair loss products have received the FDA’s seal of approval — minoxidil is one of them. The other product is finasteride

What is finasteride?

Although there are many different types of hair loss, the most common type is androgenetic or androgenic alopecia, also known as male pattern baldness or MPB. As part of a class of medications called 5-alpha reductase inhibitors, finasteride treats male pattern baldness by blocking testosterone’s ability to develop into dihydrotestosterone (DHT). DHT is a hormone that causes hair loss in adults, especially men. By blocking the production of DHT, finasteride reduces the amount of DHT within the scalp. (01)

Isn’t finasteride used for prostate issues?

Yes, finasteride is also prescribed for symptoms of benign prostatic hypertrophy (BPH) — an enlargement of the prostate gland. When used for BPH, finasteride reduces urinary frequency and urinary retention. However, the doses used in the treatment of BPH are much higher than the doses used to treat hair loss. As a treatment for BPH, finasteride is sold under the name Proscar.

What is finasteride’s history?

During finasteride’s use as an FDA-approved treatment for BPH under the name Proscar, researchers noticed its effectiveness against hair loss. Several years afterward, lower-dose finasteride was approved for hair loss under the name Propecia.

How does finasteride work against hair loss?

Finasteride works by inhibiting the action of the 5 alpha-reductase enzymes. Concentrated in the oil glands of hair follicles, 5 alpha-reductase, which helps convert testosterone into DHT, another hormone. For people who have the genes for hair loss, DHT binds to hair follicle receptors and diminishes the follicle’s size. If the follicle becomes too small, gradual hair loss occurs. 

Finasteride inhibits 5 alpha-reductase, thus reducing serum DHT (the DHT in the blood). Without DHT to constrict hair follicles, hair loss slows and — for many people — hair regrows. With less DHT in the blood, some people see their hair loss stop completely. In short, finasteride protects hair follicles from DHT damage and stops hair loss.

Which Types of Hair Loss Does Finasteride Treat?

The average person loses 100 hairs each day, even with no hair loss issues. Hair falls away as part of each strand’s natural growth cycle, and the loss is negligible. Each strand of hair grows until its fullest length, then rests and eventually falls away. Afterwards, another strand grows to take its place. (02)

Excessive hair loss is more than a normal part of a hair’s growth cycle. Hair loss can become a problem when more than the average amount of hair is lost over time or if hair fails to regrow. For many people — about an estimated 80 million US adults — a balding scalp or thinning hair is the result of hereditary factors. (02)

If a person’s hair loss stems from DHT’s damage to hair follicles, then finasteride can help.

Is oral finasteride better than topical finasteride?

Finasteride requires a physician’s prescription. A physician can determine the cause of hair loss and prescribe the most appropriate treatment. Getting to the root of the problem determines what works and what doesn’t — like oral finasteride versus topical finasteride. 

Oral finasteride, though effective, comes with a myriad of side effects. Many of the side effects of oral finasteride are life-altering, for example:

  • Decreased sex drive 
  • Pain or tenderness in the testicles 
  • Numbness in the testicles
  • A reduction in sperm count
  • Difficulty obtaining or maintaining an erection (erectile dysfunction)
  • Reduced ejaculatory volume
  • Severe mood changes
  • Breast enlargement 

In rare cases, oral finasteride may cause permanent side effects. 

Fortunately, taking finasteride topically reduces many of the more problematic side effects caused by taking finasteride orally. However, topical finasteride isn’t without precautions and still necessitates professional oversight to monitor and prevent side effects. Though not as severe as oral finasteride, some topical finasteride side-effects include:

  • Decreased sex drive 
  • Inability to urinate 
  • Swelling of hands and feet
  • Increased liver enzymes
  • Headaches
  • Testicular tenderness
  • Scalp irritation
  • Contact dermatitis 
  • Depression or anxiety
  • Dizziness or weakness

Can you buy finasteride over the counter?

Because finasteride works best for people with an inherited tendency for hair loss, it’s safest to have a physician determine its use. Therefore, finasteride is not a product that anyone can purchase at a pharmacy without a prescription. Finasteride is not an over-the-counter medication and requires a physician’s approval.

Is topical finasteride effective for hair loss?

Topical finasteride works excellently against hair loss. What’s more, topical finasteride avoids many of the adverse side effects that may deter others from completing treatment. The following are studies highlighting the effectiveness of oral finasteride.

  • A 2016 article published in the journal Dermatology Clinics and Research of 107 people found that:
    • Both topical and oral finasteride are equally effective.
    • However, participants on topical finasteride were more likely to complete treatment because there were less side effects. (03)
  • A 2019 literature review published in the Journal of Drugs and Dermatology found that topical finasteride delivered: (04)
    • A significant decrease in the rate of hair loss.
    • An increase in hair counts.
    • A reduction in DHT levels within the scalp and plasma.
  • A 2021 study published in the Journal of European Academy of Dermatology and Venereology utilized 458 study participants found: (05)
    • No serious adverse side effects in participants.
    • Fewer complaints of sexual side effects when using topical finasteride.
    • Topical finasteride improves overall hair count while producing fewer adverse side effects. 

To summarize, the topical application of finasteride is as effective as taking the drug orally. However, adverse side effects are less common with the topical application of finasteride when compared to oral treatment. 

When taken orally, finasteride goes through the digestive system and into the bloodstream. Applied as a topical, it bypasses the digestive tract and goes straight to its target with little to no side effects. This aspect makes topical use much more desirable, making users more likely to stick with the treatment! 

How do you balance the effectiveness of finasteride versus the side effects?

Getting the most benefits from finasteride with minimal side effects is achieved through:

  • Combining both finasteride and minoxidil, the two only FDA-approved medications for hair loss.
  • Customizing hair loss treatment to the needs of each individual, making every formula unique to each person’s needs.

Because each person is different, it’s essential to make every finasteride treatment as specific to the person as possible. By catering the therapy to each person, adverse side effects are less likely to occur. And because side effects like the loss of libido and a reduction in sperm count can lead to non-adherence with treatment, catering each treatment to the patient makes it more likely that customers finish their treatment and see successful results.

Making That First Step Towards Finasteride Hair Treatments

Happy Head requires a physician assessment to begin treatment. Happy Head, in collaboration with the physician and the customer, determines the most effective hair loss treatment with the least amount of side effects. The involvement of a licensed professional helps to improve safety, provides valuable feedback, and determines the most successful path toward stopping hair loss. 
With the help of board-certified dermatologists, you can find the right balance of finasteride treatments to suit your hair loss needs. Happy Head understands that hair loss can hurt. Losing your hair can be a traumatic event, even if it occurs slowly over time. Add the fact that hair loss treatments often come with side effects, and it can make anyone feel overwhelmed when searching for treatments. With Happy Head, help is just around the corner!

Resources:

(01) https://medlineplus.gov/druginfo/meds/a698016.html

(02) https://www.aad.org/media/stats-numbers

(03) https://www.scitcentral.com/article.php?journal=19&article=60&article_title=Randomized%20Comparative%20Research%20Study%20of%20Topical%20and%20Oral%20Finasteride%20with%20Minoxidil%20for%20Male%20Pattern%20Androgenetic%20Alopecia%20in%20Indian%20Patients

(04) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609098/(05) https://pubmed.ncbi.nlm.nih.gov/34634163/

What Are The Results of Finasteride?

Male pattern baldness is something that exists commonly and everywhere. It is something that many men experience in their lifetime. This is backed by the fact that at least 85% of men are affected by this when they are about to turn 50. These findings were recorded by the American Hair Loss Association. Finasteride is something that can help. We’ll take a look at the results of finasteride.

This is a cause of concern for many men because they don’t want to turn bald. However, there is not much that can be done to stop this from happening except hair loss treatments. One of these treatments is known as Finasteride, whether it’s oral finasteride or topical finasteride.

What Is Finasteride?

What is it and what are the results of results of finasteride? This is a small pill that one has to take daily. It is used to treat male pattern baldness and has been of use to many men around the globe. However, one thing to remember here is that it is not a magic pill that will solve your problems overnight.
Instead, you have to take it daily and you have to be consistent. In many cases, you will start seeing results after at least 4 – 6 months of taking this pill daily.
If you don’t see any results even after a year of taking this then it is time you prepare a visit to your doctor because this medicine is highly effective.

Get Customized Finasteride

 

How Does It Work?

Are the results of finasteride worth the taking? The finasteride medication interacts with the testosterone in the body. It is responsible for converting testosterone into DHT (dihydrotestosterone) that is responsible for the male pattern baldness. When your body is producing more DHT your hair follicles will reduce and this will cause your hair to become thin and fall out. However, what Finasteride does is that it reduces the production of this hormone. In the long run, your follicles will stop shrinking and your hair will not thin or fall. Do remember that this medication is only suitable for men as it interacts differently with female hormones and so they are not advised to take it.
In many cases, this medication has worked towards reducing the production of DHT in the scalp by at least sixty-percent! This is a significant number and any male experiencing hair loss or hair thinning problems can make the use of this medication. From this process, you will start seeing the results of finasteride.

Is It Effective?

Is finasteride effective and when will I be able to see the results of finasteride? One study was done on men who took Finasteride daily for two years. These were the results that were found in this study:

  • Sixty-six percent of men showed a boost in the growth of their hair
  • Five percent of men showed an even greater increase
  • Thirty-one percent of men had a fairly moderate increase in hair growth
  • Thirty percent of men exhibited a slight increase
  • Eighty-three percent of men did not experience any more hair loss after taking the pill

This shows that if you are consistent with taking the pill, it will fix your hair loss problems by a significant amount. It does three things to men with problems of male pattern baldness and hair loss:

  • Increases growth of hair
  • Halts male pattern baldness
  • Halts hair loss

Of course, these results vary individually as some may experience one of these and some may experience all. This is because individuals have different reactions to the same medicine. And this is the way the results of finasteride are described as. For some people, this pill may not even work. However, this is something that happens rarely but it does happen. One thing to remember here is that this medication is only extremely effective when it comes to hair loss and thinning. If you have an area on your head that has completely lost hair then Finasteride may not work as effectively. This is because this medication does not reverse hair loss.

Topical Finasteride

 

How Effective Is It In Growing Back Hair?

The main function of finasteride is to reduce the thinning and falling out of hair. However, in many cases, it has been observed that it also encourages the growth of hair. So what is the results of finasteride, or even Propecia, and how can it help?
This depends on the individual, however, studies done have shown that the medication has the potential to aid regrowth of hair. It is said to grow hair again faster and in many cases thicker as well.
One note to take here is that it will not magically change the quality of your hair neither the texture. This is because the main function of this medicine is to halt hair loss and thinning. It may only grow back faster and thicker but there will no dramatic changes in the way your hair feels or appears.
It is important that you do your research first and read reviews from other people before deciding to take this medication. The best course of action is to first talk to your doctor and if they approve then you can start this daily pill to fix your hair problems.

How You Can Use It Effectively For Amazing Results

This is something many people wonder as they want the medication to be as effective as possible on their hair. The only way it will be effective for you is if you consult your doctor first.
Once you do, you have to follow the instructions they have given to you. You need to remember that this is a process that takes time and consistency. In the first few months, you may not even see any noticeable changes. However, if you keep at it then by 6 – 7 months you will start seeing the results of finasteride and changes that will just keep on increasing. Another thing to keep in mind is that you should also be consistent in the time you take the medication. For example, if you take it in the morning then that is the time you should take it daily. This is because having a gap between doses that is too wide may impact the finasteride you have in your body i.e. it may reduce.
Once it reduces it will not be as effective. This is why it is essential to take the dose at the same time every day so the level of Finasteride in your body can stay consistent.
Man with full hair, no baldness

Results of Finasteride Compared To Other Treatments For Hair Loss

Firstly, this is an effective treatment because it directly tackles the hair loss issue and it is not too heavy on the pocket either unlike other treatments. There are many other treatments that you can get at pharmacies. These can take other forms as well such as creams, lotions, and capsules. Some are prescription based and some you can get over the counter. It entirely depends on what you want and what your doctor has recommended.
One other effective treatment is a capsule that has shown promising results of finasteride over time known as Avodart. However, this is the only prescription based so you need to talk to your doctor first.
There are also other options available such as hair supplements. These are not as effective as other methods. If you want something effective, safe, and cheap then Finasteride is your best bet.
You will just have to wait and be consistent so if you are willing to do that then this will prove to be the most effective treatment for your hair loss problems. The results of this treatment are extremely positive from almost all its users.

Prescribed Finasteride

 

Can You Speed Up The Results From Finasteride?

When we take medication, we always want the results to be apparent fast. How fast can I see the results of finasteride? This is something many people wonder because no one wants to wait a long time for their hair problems to go away. Here are some effective ways you can speed up the results from Finasteride. Do remember that these may not work for everyone.

Diet

Be mindful of what you eat. Did you know that more than 20% of men who have male pattern baldness also have an iron deficiency? Another reason is that your body may be lacking the fatty acids it needs for hair growth.
This is why it is important to fulfill your nutritional needs so that your hair can also do better.

Rest

Getting enough sleep and rest is important for maintaining and healthy lifestyle. If you’re are experiencing stress in your life, try ways to control and reduce stress. Just like with many of the other medications we use, getting enough rest is important and can affect the results of finasteride on your head.

Stress

Hair loss and stress can be related. There are three types of hair loss that is associated with stress. These three are Telogen effluvium, Trichotillomania, and Alopecia areata.

Telogen effluvium

Telogen effluvium is when a notable amount of stress pushes large numbers of hair follicles into a resting phase which causes the the hair growth process to stop.

Trichotillomania

Trichotillomania is when you constantly have the urge to pull out hair from your scalp. This may be a problem to take care which will not have the results of finasteride.

Alopecia areata

This is when your immune system attacks the hair follicles, which in result will cause hair loss. If you do use topical finasteride, you may see the results of finasteride.

Scalp Massage

This is already known to be effective when it comes to stimulating your hair growth. This is because blood circulation is increased which encourages the growth of hair. Relax and help your hair grow faster with a daily scalp massage.

Take Finasteride With Minoxidil

Minoxidil usually comes in a liquid form and it is supposed to be rubbed on the scalp two times a day. It has shown promising results because more than 40% of men have re-growth once they start using this. This is why both of them combined can be an extremely effective treatment for hair loss prevention and in seeing results of finasteride. This is probably by far the most effective treatment out there for males who are dealing with hair loss problems or male pattern baldness. It takes time but it is also safe.

Conclusion

This is why if you want to treat your male pattern baldness then you can opt for Finasteride. However, you must consult your doctor first before taking any kind of medication. Using or taking finasteride may be worth the results of finasteride. They will advise you the best and also give you a set of instructions that you need to follow while taking this medication. Once you start taking it all you have to do is be patient and consistent and the amazing results will automatically come!
Disclaimer: The information in this article does not constitute medical advice and should only be used for informational purposes only. The information in this article is not a substitute for professional medical advice and please do not rely on this information to make medical decisions. Please make sure to discuss the risks and benefits of any treatment with your medical doctor before beginning treatment.

See Online Doctor for Finasteride

Side Effects of Topical Finasteride: Review of Current Medical Literature

Oral finasteride, also known as Propecia, is an oral medication that has been prescribed by physicians for decades for hair loss. It works in the majority of patients by reducing hair loss and stimulating hair growth however there are side effects. One of the most concerning side effects are the sexual side effects, which occur in 1.8% to 3.8% of patients who take it. As a result, many physicians have been switching to topical finasteride as an alternative. In recent years, there have been many studies on the efficacy and side effects of topical Finasteride. In this article, we will review the clinical trials and scientific data to evaluate the side effect profile of topical finasteride. 

In one of the first single-blind, placebo-controlled clinical trials of topical finasteride, Mazarella et al.1 (1997) published a study of 52 subjects ranging from 19 to 28 years of age. The patients were treated with topical finasteride 0.005% vs placebo for 16 months. Here were the results.

  • There was a significant reduction in the rate of hair loss after 6 months of treatment.
  • There were no reports of local or systemic side effects.

In another double blind, randomized clinical trial study of 45 male patients, Hajheydari et al.2 (2009) compared oral finasteride 1mg vs topical finasteride 1% for a total of 6 months.

  • Authors concluded that “the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.”
  • 1 person had erythema of the scalp after application of the topical finasteride. 

In a prospective pilot study conducted in 15 patients for 9 months by Rafi and Katz3 (2011), patients applied a topical solution called NuH Hair, which is a novel topical combination of finasteride, dutasteride, and minoxidil, with the option to add oral finasteride, minoxidil and/or ketoconazole shampoo for 9 months. 

  • Significant growth was demonstrated after 3 months of use of the topical solution.
  • There were no reports of sexual side effects or irritation or redness reported. 

In a randomized clinical study by Tanglertsampan C.4  (2012), 33 male patients ranging between 27 to 49 years old were enrolled to compare the efficacy and safety of a 24 weeks application of minoxidil 3% lotion versus minoxidil 3% combined with 0.1% finasteride lotion.

  • This study showed that finasteride combined with minoxidil is superior to minoxidil alone by itself.
  • Contact dermatitis and redness was observed in 4 patients (24%) using the finasteride + minoxidil combination. No sexual side effects were observed. 

Caserini et al. conducted two pharmacokinetic studies on topical finasteride. In a randomized clinical study of 23 males, Caserini et al.5 (2014) compared topical finasteride 0.25% twice daily vs oral finasteride 1mg once daily for 7 days. They measured DHT and testosterone levels in the serum (systemic DHT levels).

  • Similar reduction in serum DHT was observed by the use of topical 0.25% finasteride twice daily  (68-75% ) and oral finasteride 1mg (62-72%).
  • No sexual side effects were observed. 

In another randomized clinical trial, Caserini et al.6 (2015) did another study involving 50 male patients studying DHT in both the serum and the scalp. 

  • This pharmacokinetic study confirmed that topical finasteride 0.25% (1ml application twice daily) and oral finasteride 1mg (once daily) both have similar reduction in scalp (47-51%) and serum DHT levels (74-76%). No changes in testosterone were observed.
  • In the portion of the study where patients used 1ml of topical finasteride 0.25% twice daily, there were 2 patients (11%) that had the following side effects. Elevated ALT levels, pollakiuria and testicular pain. 
  • about 37-54% when 0.1ml, 0.2ml, 0.3ml and 0.4ml of topical 0.25% finasteride was used, showing relatively similar results to 1ml twice a day application of topical 0.25% finasteride. Serum DHT was reduced by 24% with the use of 0.1ml, 26% with 0.2ml, 44% with 0.3ml and 48% with use of 0.4ml of 0.25% topical finasteride. This testing suggests that lower dosage of topical finasteride may lead to lower reduction of serum DHT levels and thus lower sexual side effects (assuming that serum DHT is solely responsible for the sexual side effects).  
  Scalp DHT Serum DHT
Oral FInasteride 1mg 51% 76%
1ml (twice daily) of 0.25% Topical finasteride 47% 74%
1ml (once daily) of 0.25% Topical finasteride 71% 76%
0.1ml (once daily) of 0.25% Topical finasteride  52% 24%
0.2ml (once daily) of 0.25% Topical finasteride 47% 26%
0.3ml (once daily) of 0.25% Topical finasteride 37% 44%
0.4ml (once daily) of 0.25% Topical finasteride 54% 47%
Oral vs Topical Finasteride

In a retrospective assessment and prospective crossover cohort study of 50 male between 20 to 40 years old by Chandrashekar et al.7 (2017), all 50 patients used minoxidil 5% and oral 1mg finasteride for 2 years.They then stopped and their treatment differed.

  • Results showed that 80% to 84.4% of these patients maintained good hair density while on the topical combination of minoxidil 5% + finasteride 0.1% treatment for 1 year.
  • No sexual side effects were reported. 

The studies8 above demonstrate that topical finasteride has clinically proven, evidence-based, scientific data to show its efficacy in growing hair and that it has a lower side effect profile compared to oral finasteride. Out of the 7 clinical studies reported above, only one study showed one event with sexual side effects (testicular pain). This is 1 out of 268 subjects in all of the studies, which equates to a rate of 0.37%. In contrast, oral finasteride is associated with sexual side effects in 1.8% to 3.8% of patients, which means that in the above 268 subjects, there should have been about 5 to 10 subjects experiencing some form of sexual side effects. However, this was not the case. Only 1 person had sexual side effects as opposed to 5 to 10 individuals. 

Pharmacokinetic studies by Caserini et al. suggest that lower doses of topical finasteride result in lower reduction of serum DHT compared to oral finasteride and thus lower sexual side effects. No study has conclusively shown the reason of how finasteride can cause sexual side effects. Certainly serum DHT is a contributing factor but may not be the only factor. The reason for this conclusion is because there are studies that patients were on high dosage of topical finasteride and still had no sexual side effects. 

In conclusion, the majority of studies on topical finasteride show no to only a few sexual side effects. However, this does not mean that sexual side effects can not happen. It just suggests that risk of sexual side effects are lower due to the fact that the finasteride is not taken orally. Additional larger clinical studies are needed to address the sexual side effects of topical finasteride. 

References:

1. Topical finasteride in the treatment of androgenic alopecia. Preliminary evaluations after a 16-month therapy course. GF Mazzarella, GF Loconsole, GA Cammisa, GM Mastrolonardo & Ga Vena; Pages 189-192 | Received 23 Aug 1996, Accepted 18 Mar 1997, Published online: 12 Jul 2009

2. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Hajheydari Z1, Akbari J, Saeedi M, Shokoohi L. .Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51.

3. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. Rafi and Katz. SRN Dermatol. 2011;2011:241953. doi: 10.5402/2011/241953. Epub 2011 Apr 11.

4. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil / 0.1% finasteride in male pattern hair loss: a randomized, double-blind, comparative study. Tanglertsampan C1. J Med Assoc Thai. 2012 Oct;95(10):1312-6.

5. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Caserini M, Radicioni M, Leuratti C, Annoni O, Palmieri R.  Int J Clin Pharmacol Ther. 2014 Oct;52(10):842-9. doi: 10.5414/CP202119.

6. Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Caserini M, Radicioni M, Leuratti C, Terragni E, Iorizzo M, Palmieri R. Int J Clin Pharmacol Ther. 2016 Jan;54(1):19-27. doi: 10.5414/CP202467.

7. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. B. S. Chandrashekar, T. Nandhini, Vani Vasanth, Rashmi Sriram, and Shreya Navale. Indian Dermatol Online J. 2015 Jan-Feb; 6(1): 17–20. Doi: 10.4103/2229-5178.148925

8. A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. Sung Won Lee, MD,1 Margit Juhasz, MD,1 Pezhman Mobasher, MD,1 Chloe Ekelem, MD,1 and Natasha Atanaskova Mesinkovska, MD, PhD1. J Drugs Dermatol. 2018 Apr 1; 17(4): 457–463.

The information in this article does not constitute medical advice and should only be used for informational purposes only. The information in this article is not a substitute for professional medical advice and please do not rely on this information to make medical decisions. Please make sure to discuss the risks and benefits of any treatment with your medical doctor before beginning treatment. 

Efficacy of Topical Finasteride: Review of Current Medical Literature

In one of the first single-blind, placebo-controlled clinical trials of topical finasteride, Mazarella et al.1 (1997) published a study of 52 subjects ranging from 19 to 28 years of age. The patients were treated with topical finasteride 0.005% vs placebo for 16 months. Here were the results.

  • There was a significant reduction in the rate of hair loss after 6 months of treatment.
  • There was slight to marked reduction of the balding areas in the patients using the topical finasteride.
  • 73% of the patients using the topical finasteride reported moderate effectiveness.

In another double blind, randomized clinical trial study of 45 male patients, Hajheydari et al.2 (2009) compared oral finasteride 1mg vs topical finasteride 1% for a total of 6 months.

  • Both the oral finasteride 1mg and the topical finasteride 1% showed statistically significant increase in total and terminal hair count after 4 months.
  • There was no significant difference between the two groups in hair thickness, total hair counts and the size of bald area.
  • Authors concluded that “the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.”

In a prospective pilot study conducted in 15 patients for 9 months by Rafi and Katz3 (2011), patients applied a topical solution called NuH Hair, which is a novel topical combination of finasteride, dutasteride, and minoxidil, with the option to add oral finasteride, minoxidil and/or ketoconazole shampoo for 9 months. 

  • Significant growth was demonstrated after 3 months of use of the topical solution.
  • In those patients who utilized the NuH Hair along with either Rogaine foam, Propecia, and ketoconazole shampoo saw significant growth was achieved in as little as 30 days.

In a randomized clinical study by Tanglertsampan C.4  (2012), 33 male patients ranging between 27 to 49 years old were enrolled to compare the efficacy and safety of a 24 weeks application of minoxidil 3% lotion versus minoxidil 3% combined with 0.1% finasteride lotion.

  • Hair count increased in both groups but was only significant in the finasteride + minoxidil group.
  • This study showed that finasteride combined with minoxidil is superior to minoxidil alone by itself.
  • Finasteride combined with minoxidil showed significantly higher efficacy by global photographic assessment compared to the minoxidil group.

Caserini et al. conducted two pharmacokinetic studies on topical finasteride. In a randomized clinical study of 23 males, Caserini et al.5 (2014) compared topical finasteride 0.25% twice daily vs oral finasteride 1mg once daily for 7 days. They measured DHT and testosterone levels in the serum (systemic DHT levels).

  • Similar reduction in serum DHT was observed by the use of topical 0.25% finasteride twice daily  (68-75% ) and oral finasteride 1mg (62-72%).
  • No relevant changes occurred for serum testosterone.

In another randomized clinical trial, Caserini et al.6 (2015) did another study involving 50 male patients studying DHT in both the serum and the scalp. 

  • Scalp DHT was reduced by 71% with the use of 1ml topical finasteride 0.25% once daily application vs 51% reduction in scalp DHT with the use of oral finasteride 1mg once daily.
  • Interestingly, once a day application of the 1ml topical finasteride 0.25% lead to a higher reduction of scalp DHT (71%) vs twice a day application of 1ml topical finasteride 0.25% (47%).
  • Serum DHT decreased by 60 – 70% with the use of both 1ml topical finasteride and 1mg of oral finasteride. 
  • This pharmacokinetic study confirmed that topical finasteride 0.25% (1ml application twice daily) and oral finasteride 1mg (once daily) both have similar reduction in scalp (47-51%) and serum DHT levels (74-76%). No changes in testosterone were observed.

In a retrospective assessment and prospective crossover cohort study of 50 male between 20 to 40 years old by Chandrashekar et al.7 (2017), all 50 patients used minoxidil 5% and oral 1mg finasteride for 2 years.They then stopped and their treatment differed.

  • 45 of the patients that stopped the above treatment immediately started topical minoxidil 5% + finasteride 0.1% treatment for 1 year.
  • Results showed that 84.4% of these patients maintained good hair density while on the topical combination.
  • 5 of the patients stopped all treatments for 8-12 months and then started the topical minoxidil 5% + finasteride 0.1% for 1 year.
  • Results showed that 80% of these patients maintained good hair density.

The studies8 above demonstrate that topical finasteride has clinically proven, evidence-based, scientific data to show its efficacy in growing hair. Firstly, pharmacokinetic studies suggest that topical finasteride results in a similar reduction in scalp DHT as oral finasteride. Studies also suggest that topical finasteride causes a statistically significant increase in total and terminal hair count. Additionally, when topical finasteride was compared to oral finasteride, both the oral finasteride 1mg and the topical finasteride 1% showed statistically significant increase in total and terminal hair count and that no significant difference was observed with respect to hairthicknes and hair counts. Authors concluded that “the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.” When topical finasteride was combined with topical minoxidil, the combination of finasteride with minoxidil was superior to minoxidil alone by itself. Finally, 84.4% of patients who were on oral finasteride for about 2 years and then switched over to topical finasteride with minoxidil maintained good hair density. Thus far, these studies with a total patient count of 268 show that topical finasteride can cause hair growth and have similar efficacy as oral finasteride. Additional large cohort studies are still needed to better evaluate the efficacy of topical finasteride vs oral finasteride. 

References:

1. Topical finasteride in the treatment of androgenic alopecia. Preliminary evaluations after a 16-month therapy course. GF Mazzarella, GF Loconsole, GA Cammisa, GM Mastrolonardo & Ga Vena; Pages 189-192 | Received 23 Aug 1996, Accepted 18 Mar 1997, Published online: 12 Jul 2009

2. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Hajheydari Z1, Akbari J, Saeedi M, Shokoohi L. .Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51.

3. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. Rafi and Katz. SRN Dermatol. 2011;2011:241953. doi: 10.5402/2011/241953. Epub 2011 Apr 11.

4. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil / 0.1% finasteride in male pattern hair loss: a randomized, double-blind, comparative study. Tanglertsampan C1. J Med Assoc Thai. 2012 Oct;95(10):1312-6.

5. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Caserini M, Radicioni M, Leuratti C, Annoni O, Palmieri R.  Int J Clin Pharmacol Ther. 2014 Oct;52(10):842-9. doi: 10.5414/CP202119.

6. Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Caserini M, Radicioni M, Leuratti C, Terragni E, Iorizzo M, Palmieri R. Int J Clin Pharmacol Ther. 2016 Jan;54(1):19-27. doi: 10.5414/CP202467.

7. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. B. S. Chandrashekar, T. Nandhini, Vani Vasanth, Rashmi Sriram, and Shreya Navale. Indian Dermatol Online J. 2015 Jan-Feb; 6(1): 17–20. Doi: 10.4103/2229-5178.148925

8. A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. Sung Won Lee, MD,1 Margit Juhasz, MD,1 Pezhman Mobasher, MD,1 Chloe Ekelem, MD,1 and Natasha Atanaskova Mesinkovska, MD, PhD1. J Drugs Dermatol. 2018 Apr 1; 17(4): 457–463.

The information in this article does not constitute medical advice and should only be used for informational purposes only. The information in this article is not a substitute for professional medical advice and please do not rely on this information to make medical decisions. Please make sure to discuss the risks and benefits of any treatment with your medical doctor before beginning treatment. 

Topical Finasteride. Does it really work?

The gold standard for hair loss has always been oral finasteride, also known as Propecia(R). However, over the last several years, many physicians have stopped prescribing oral finasteride due to the risks of sexual side effects, which may be permanent in some cases. Doctors have started to look into other alternatives to oral finasteride and this is why the popularity of topical finasteride has surged in the last 4 years. This article will use evidence based medicine and the current clinical studies available to evaluate the safety and efficacy of topical finasteride. 

Oral Finasteride is an oral pill that has been prescribed by physicians for decades for hair loss. It works in the majority of patients in stopping hair loss and growing hair however there are side effects. The popularity of oral Finasteride has been decreasing due to its sexual side effects, which occur in 1.8% to 3.8% of patients who take it. The majority of cases of these sexual side effects are temporary, which means that the side effects will resolve once the patient stops taking the oral medication. However, according to the FDA, there are some cases where the side effects can be permanent. Examples of sexual side effects of oral Finasteride include decreased libido, erectile dysfunction, testicular pain, testicular numbness, penile curvature changes, lack of morning erections, decreased ejaculate, decreased sperm count and any form of sexual dysfunction. Other side effects of oral Finasteride include breast enlargement, depression, fogginess of head, and diabetes (please note that this is not a complete list).

Topical finasteride is a compounded medication prepared by compounding pharmacies. It doesn’t exist commercially in the US market. This means that it is not a product that is available right off the shelf. It’s a formula that has to be written specifically by your physician and the compounding pharmacy has to make it monthly. A review of the literature on Pubmed shows that there are so far about 67 articles, case studies, and clinical trials on topical finasteride worldwide. This article will review some of those articles examining efficacy and safety of topical finasteride compared with oral finasteride. 

In a clinical trial of 45 male patients comparing the therapeutic efficacy of topical finasteride vs oral finasteride1, the study showed that the therapeutic effects of both finasteride gel and finasteride tablets were relatively similar to each other. There were no significant differences between the two groups as a viewpoint of hair thickness, hair counts and the size of bald area. This the authors concluded that there were similar increase in hair counts and terminal hair counts between the two groups. 

In another study of 50 patients who were on oral finasteride, 84.4% of those patients showed good maintenance of hair density while switching over from oral finasteride to a topical finasteride +  minoxidil combination2. This study showed that patients don’t have to be on oral finasteride forever; topical finasteride was a good alternative in maintaining the results of the oral finasteride. 

In a systematic review of 119 studies involving topical finasteride studies, authors concluded that topical finasteride showed a significant decrease in the rate of hair loss, increase in total and terminal hair counts, and positive hair growth assessment. No changes in serum testosterone were noted3.

Finasteride works by inhibiting conversion of testosterone into DHT. When finasteride is taken orally, it reduces scalp DHT by ~50% but it also affects serum DHT by around 60-70%. This study showed that oral finasteride significantly reduces systemic DHT levels. In contrast, topical finasteride applied at certain dosage resulted in an appropriate inhibition of scalp DHT (47-52%), while serum DHT level reduced only by 24-26%, potentially minimizing the untoward sexual side-effects linked to a systemic DHT reduction4. Since topical finasteride is not taken orally, its effect on serum DHT may be less, according to this study, thus potentially reducing the unwanted sexual side effects. 

In another study comparing minoxidil 3% vs Minoxidil 3% fortified with topical finasteride, the authors stated that global photographic assessment showed significantly greater improvement in the group where minoxidil was fortified with finasteride compared to minoxidil alone by itself5. More importantly, at 24 weeks, the authors concluded that using topical .1% finasteride did not show any sexual side effects. 

Topical Finasteride has clinically proven, evidence-based, scientific data to show its efficacy in growing hair while lowering the risk of  systemic side effects since it is not taken orally. Topical Finasteride is a compounded medication that is prescribed by a doctor. Sometimes it is used alone by itself or it can be fortified with other medications such as Minoxidil, Retinoic Acid etc. to boost efficacy.  

References:

1. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Hajheydari Z1, Akbari J, Saeedi M, Shokoohi L.; Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51.

2. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride.; Chandrashekar BS1, Nandhini T1, Vasanth V1, Sriram R1, Navale S1. Indian Dermatol Online J. 2015 Jan-Feb;6(1):17-20. doi: 10.4103/2229-5178.148925.

3. A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women.Lee SW, Juhasz M, Mobasher P, Ekelem C, Mesinkovska NA.; J Drugs Dermatol. 2018 Apr 1;17(4):457-463.

4.  Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Caserini M, Radicioni M, Leuratti C, Terragni E, Iorizzo M, Palmieri R.; Int J Clin Pharmacol Ther. 2016 Jan;54(1):19-27.

5. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil / 0.1% finasteride in male pattern hair loss: a randomized, double-blind, comparative study. Tanglertsampan C1.; J Med Assoc Thai. 2012 Oct;95(10):1312-6.

Disclaimer: The content/images on this video are not a guarantee of individual results. Individual results may vary. The information provided is for general information and educations purposes only and does not replace a need for a formal consultation.

The information in this article does not constitute medical advice and should only be used for informational purposes only. The information in this article is not a substitute for professional medical advice and please do not rely on this information to make medical decisions. Please make sure to discuss the risks and benefits of any treatment with your medical doctor before beginning treatment.