Interest in topical finasteride is on the rise. Curious? Here’s what you need to know.
If you’ve ever experienced hair loss – or even looked the term up online – chances are good you’ve come across finasteride. The only pill approved by the FDA to treat hair loss, finasteride is easily one of the most powerful hair loss medications available to date. It’s a slam dunk in your doctor’s arsenal for preserving and protecting the hair you still have. And, unlike many of the supposed ‘miracle’ treatments out there, finasteride (and its close chemical cousin dutasteride) really can deliver.
So why the recent up-ticked interest in the topical form of this medication? If you regularly use finasteride, should you be considering it? Read on for my thoughts.
The only pill FDA approved to treat hair loss, finasteride (and close cousin dutasteride) is a game changer in treating hair loss. If it’s such a slam dunk, why are people considering the topical form?
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Finasteride: The Refresher Crash Course Edition
I’ve spoken and written about finasteride at length, so if you want to know more about the in depth biological mechanisms, I recommend you check out one of my blogs or this video on the topic.
The short version of how finasteride works is that it’s an antiandrogen, meaning it blocks male hormones. Specifically, it inhibits the production of DHT (Dihydrotestosterone), the major contributor to androgenic alopecia - male pattern baldness.
The genetics are complicated, but if you inherit a particular sensitivity to DHT (which both men and women produce), then you’re at higher risk of experiencing androgenic alopecia. And that’s where finasteride comes in. Testosterone is converted to DHT by an enzyme called 5-alpha reductase. Finasteride inhibits this enzyme, reducing the overall amount of DHT and thereby halting/reducing hair miniaturization and future hair loss. It doesn’t ‘grow back’ your hair, but it prevents the loss of more hair. Paired with minoxidil (which prolongs the growth phase and increases the diameter and length of hairs), you have a winning combination to combat hair loss in men and postmenopausal women.
So why mess with a good thing?
Finasteride is the only FDA approved pill to combat hair loss and it works – well. So why are people keen to try the less-tested, topical version?
The upside of topical finasteride
If there’s a universal truth about medications and treatments that really do work, it’s this – for every positive change a medication makes, chances are good there’s a cost involved. That cost comes in the form of potential side effects.
Retin-A, minoxidil, finasteride, hydroquinone – all of these are treatments that successfully work to alleviate a condition, and each one has the potential for significant side effects. That doesn’t make a drug good or bad, it’s a universal truth of physics, biology, and chemistry – everything comes with a cost.
Is the grass greener on the topical finasteride side? It depends – on you and your hair loss.
It should be said that oral finasteride and oral minoxidil are very safe and convenient medications. Many people use oral finasteride with no adverse effects, but as with any medication, there are risks. The one that seems to concern people the most? Sexual dysfunction.
There are a lot of technical terms that go into describing and listing side effects, but in lay terms, taking finasteride can lead to a decrease in libido and potentially erectile dysfunction. It’s a concern for men considering taking finasteride and especially for people who experience those side effects.
Those side effects I just mentioned are systemic, caused by the presence of finasteride in the bloodstream. A way around that? To apply finasteride topically, only where hair loss is occurring. Finasteride is able to block the conversion of DHT directly at the hair follicle, arguably having a similar effect to taking a pill while circumventing those… pesky side effects.
No wonder some men are signing up.
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Topical finasteride is not a magic potion…
Of course, the advantages of topical finasteride come with drawbacks. The first that you need to be aware of is that – though the chance of unwanted side effects associated with oral finasteride are reduced when it’s used topically – they aren’t eliminated. Topical finasteride is absorbed through the skin and into the bloodstream. Studies on blood plasma taken from patients on oral and topical finasteride (respectively) indicate that much less finasteride makes its way into the blood when it’s applied topically, but it is still detectable. We’re also not certain about long term exposure and whether it builds up over time. Because topical finasteride is present in blood plasma, that means (contrary to popular belief) that it’s still possible to experience the same systemic side effects, though (hopefully) to a lesser extent. And, because it’s not as present in the blood, topical finasteride just isn’t as effective as the pill. If you’ve previously been taking oral finasteride, the results may not be as impressive. That’s one of the reasons determining the right dose is crucial with topical finasteride.
Topical application also brings with it the potential for scalp irritation – itching, redness, etc.
Another drawback is convenience. A pill is easy to take (and remember to take!) every day. Topical finasteride needs to be applied to the areas experiencing hair loss, and not everyone will like the feel.
Topical finasteride is a great option, but it also isn’t as convenient as oral finasteride. Consistency is key, as is chemical safety. If you’re doing well on the pill but still want to switch to topical, make sure you’re up for the maintenance.
There’s another safety consideration with topical finasteride and that’s whether you have kids, pets, or a pregnant partner at home. Finasteride is a teratogen, meaning it can cause birth defects, particularly in male fetuses. Because finasteride is absorbed through the skin, you should practice chemical safety – applying in a dedicated room, cleaning hands and utensils thoroughly, making sure the product is dried... Some people do well while others find that the reality of daily application just isn’t for their lifestyle.
If it Ain’t Broke…
If you’re using or considering using finasteride for hair loss, you might be wondering which is better?
Topical finasteride most definitely has its place – for the right patient it can be a really fantastic treatment option (we’ve formulated our own which can be found at feelconfident.com), but you need to do your homework and weigh the benefits and your options. I find that if I have a patient who has had a history of side effects with oral finasteride – or is very anxious about them – then topical can be a great choice. You’ll need to discuss this one with your doctor because, unlike with topical minoxidil, topical finasteride requires a prescription.
And finally, if you’re doing well with oral finasteride? There’s no benefit (or good reason) to switch.
If you’re considering topical finasteride for your hair loss and want to explore prescription hair loss medication, visit us at feelconfident.com to find the hair loss therapy that’s right for you.
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Written by
Kristi Charish
Edited by
Dr. Gary Linkov
