Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
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.
This is why many people turn to topical finasteride as a treatment option.
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), according to a systematic review published in the journal, Natural Products and Bioprospecting. 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 in men) and under the name Propecia® for hair loss in men, according to an article published in the book, StatPearls.
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, according to a systematic review of topical finasteride in the treatment of androgenetic alopecia in men and women published in the Journal of Drugs in Dermatology.
You might be interested in: How to Make Topical Finasteride
“I tried several different options before but Hims combined approach of all four methods by far created the best results.”
“Hims has been the greatest confidence boost, no more bald jokes! I look and feel so much younger!”
“When I show my barber my progress, he is always in disbelief. I have to recommend Hims to any guy who’s experiencing thinning.”
“Cost effective and affordable. My hair keeps growing thicker, fuller, and at a fast rate.”
“I noticed a huge change in the overall health and fullness of my hairline.”
“Now after 5 months I’m able to style waves first time in 10 years!”
“I decided to jump right in and I'm so glad I did. I definitely feel ten years younger!”
“In just as little over two and half months, I can really see the difference in thickness and in color.”
“4-months strong and my confidence boosted back up to 100% using Hims, future me really does thank me.”
“I’m a 34-year-old father of two and have been using Hims for over a year now. My hair is back to what it was in my mid-twenties.”
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 the topical application of 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 “meta-analysis” 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.
The same 2018 systematic review published in the Journal of Drugs in Dermatology of seven topical finasteride studies found that the medication was correlated with a “significant” decrease in rate of hair loss, significant increase in total hair counts, and positive hair growth assessment.
The studies noted a decrease in both scalp DHT and serum DHT levels from baseline throughout the body. The authors concluded that the finasteride results were “safe and promising” and recommended continued research and follow-up.
A 2020 review of 33 scientific articles published in the Journal of Dermatological Treatment 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, according to an article published in the Indian Dermatology Online Journal.
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.
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 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 a 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.
We’ve talked more about the relationship between finasteride and minoxidil in our Minoxidil vs. Finasteride guide.
Generic for Rogaine®, this FDA-approved over-the-counter version of topical minoxidil is used for regrowth on the crown of the head.
This is the FDA-approved dynamic duo. When used together, men saw better results in clinical trials compared to using either alone.
If you’re looking for something effective but don’t want too many steps in your routine, this once-a-day pill could be right for you.
Clinically proven to regrow hair in 3-6 months, no pills required.
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 but may present significant differences.
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.