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The Food and Drug Administration approved the use of finasteride in 1997 for the treatment of male pattern hair loss, otherwise known as androgenetic alopecia.
This approval brought significant relief to individuals who had been battling baldness for quite some time. Treatment for hair loss with finasteride has been successful since then, and many patients report positive results.
The popularity of finasteride in the treatment of hair loss is increasing every year. The year 2016 saw finasteride rise as it became the 75th most prescribed medication in the United States. According to the latest data, about 9 million finasteride prescriptions are made every year, leaving it the 86th most prescribed drug in the US.
Propecia® Annual Sales Revenue in 2003-2015, $M
Despite a rapidly increasing number of prescriptions for finasteride, the branded form of the drug, Propecia, was steeply declining in sales. This meant that people were switching to the generic form of finasteride, as it is known to be about 3-5 times cheaper.
However, patients have recently started to use the topical solution of this drug as well. The results of topical finasteride results seem to be similar, but with fewer side effects.
Read on for a detailed discussion about finasteride:
What is finasteride?
Finasteride is a pharmacological medication that falls under the drug class 5-α reductase inhibitors. It was first patented in 1984. However, it was first approved for medical use in 1992.
Based on its chemical structure, finasteride is a synthetic steroid. It can be viewed as an analog of natural androgenic steroid hormones such as testosterone and dihydrotestosterone (DHT). It works as an anti-androgen.
How does finasteride treat hair loss?
Hair loss caused by androgens is mainly due to the effects of the hormone DHT. It usually manifests in individuals who are genetically susceptible to hair loss. DHT is synthesized from testosterone.
DHT binds to specific receptors in the hair follicle, causing the hair follicles to shrink, weaken, die and eventually fall off.
Studies have highlighted that an increase in the DHT receptors on the scalp is responsible for male pattern alopecia. For DHT to be formed in the body, the critical enzyme for this process is called 5-α reductase. This enzyme breaks down testosterone to form DHT, the byproduct.
This is where finasteride comes in:
Finasteride, being one of the 5-α reductase inhibitors, will prevent the conversion of testosterone to DHT. This mechanism helps delay and alleviate the progression of androgenetic alopecia.
The beneficial aspect of using finasteride in the treatment of hair loss is that, unlike other medical treatment of hair loss, finasteride doesn’t interfere with the levels of testosterone in the body. Therefore, you are not at risk of suffering from additional hormonal complications that would occur if you deplete your testosterone.
Testosterone on its own doesn’t have any significant influence on hair loss. Researchers have found that finasteride slows down hair loss and also increases hair growth over the scalp.
Until recently, oral finasteride was the go-to formulation for treating hair loss. However, topical finasteride has got more attention now.
Oral vs. topical formulation
While people were marveling about the beneficial mechanisms of oral finasteride, researchers realized that they could come up with ideas that can help lessen the side effects of finasteride.
Consequently, it was decided to develop a topical formulation with equally beneficial results and fewer side effects, to replace the oral medication. The idea was welcomed because the potential side effects of oral finasteride could be so adverse, that they prompted the user to stop taking the medication.
When the topical formulation was being developed, it was hoped that it would deliver the same 5-alpha-reductase inhibiting effect, albeit with little to no side effects.
Was the idea successful? What does the research say about the effectiveness of topical finasteride?
A recent study sought to compare the treatment of hair loss with both topical and oral finasteride.
The study which started with 45 initial subjects was a double-blind study – meaning, neither the participants nor the researchers knew the treatment being used for each patient. This helped eliminate any bias with the results.
Here is how the study was done:
The patients were randomly divided into two: topical finasteride (A) and oral finasteride (B) groups. Topical finasteride group (A) received a topical gel of 1 % finasteride and placebo tablets, while the oral finasteride group (B) received finasteride tablets (1 mg) and gel base (without drug) as a placebo for 6 months.
The patients were followed by clinical observation and recording of side effects prior to the treatment and at the end of the first week, and then by a monthly follow-up. The size of the bald area, total hair count, and terminal hair were studied.
As expected, there was a significant increase in hair growth and a reduction in the loss of hair among those taking the finasteride tablet or the 1 % finasteride gel.
According to the results obtained, the overall effect was moderate. There was a 54.5 % hair growth rate among those using finasteride gel and a 56 % hair growth rate among those taking the oral formulation with 1mg finasteride. From this study, it is clear that the topical finasteride is almost equally as effective as the oral formulation.
Another study further explored the effectiveness of finasteride gel when used as a maintenance treatment for hair loss.
This study involved 50 patients, aged between 20 and 40 years, who had been diagnosed with androgenetic alopecia. These participants had been on treatment with minoxidil and oral finasteride for two years prior to the study period.
During the study, the participants were subjected to the maintenance of treatment with topical minoxidil that was fortified with finasteride. The aim was to determine the effectiveness of these gels when used simultaneously as one treatment.
This study showed that topical finasteride gel could also be effective when used as a maintenance treatment to support and maintain hair growth results that had been achieved by previous treatments, irrespective of the medicines used.
Lastly, another study compared how oral and different strengths of topical finasteride affected DHT levels in the scalp and serum. Lower levels are needed in the blood to reduce the chances of side effects.
DHT Reduction in Scalp and Serum (blood) / Oral vs. Topical finasteride
Firstly, as we can see, oral finasteride has the lowest DHT reduction in the scalp – even 0.4 ml daily of 0.2275 % concentration topical finasteride has shown more favorable results. But the most important thing is that the latter decreased DHT in Serum 1.4 times less compared to the oral formulation, which means that the topical solution is less likely to cause side effects!
Now if you are currently using oral formulation and do not experience any side effects, there is some good news for you: switching to 1ml (0.25%) topical solution would produce the same reduction of DHT in Serum. So for you, it’s still no side effects.
But the reduction of DHT in Scalp would increase from -51.1 % to -71.2 %. That means you can expect much better results regarding your hair loss.
Indeed, or so, topical finasteride is equally as effective as oral finasteride for overall DHT inhibition. However, the oral formulation still has worse results when compared statistically with the topical formulation in terms of DHT inhibition in the scalp.
The downside of the oral formulation is that it has more side effects than the topical formulation. This doesn’t mean that the topical formulation is free of side effects.
Here are some of the side effects of topical finasteride that you should be worried about:
Side effects of topical finasteride
The reason why topical finasteride is preferred to oral finasteride tablets is that topical finasteride directly influences the amount of DHT at the level of the hair root. It was initially thought that topical finasteride would not find its way into the bloodstream and affect the levels of androgen in plasma.
However, the side effects of topical finasteride occur when the dose is high enough to enter the bloodstream.
Although studies report that the amount of topical finasteride that can get absorbed into the bloodstream is low, this small amount is very relevant in individuals who are extremely sensitive to even the weakest fluctuations of serum DHT.
Studies agree that finasteride pills reduce the amount of serum DHT by about 70%. And even though the amount of DHT reduced in serum by topical finasteride is slightly lower than that of oral finasteride, it is very significant.
So, what happens when finasteride gets into your bloodstream to alter the amount of serum DHT?
Despite the fact they are not common, you may experience symptoms such as:
You should note that these side effects are more pronounced when you use oral finasteride. It is less likely with topical finasteride. The risk is small, however, it cannot be ignored.
Clearly, it is not that there are zero side effects when you use topical finasteride. The reality is that there is a small chance that you may experience a few side effects. However, the side effects will be significantly lower than those you would experience with oral finasteride.
Chemical constituents such as liposomes not only augment the recovery of hair loss but also goes a long way to prevent the absorption of topical finasteride into the bloodstream.
What this simply means is that the topical finasteride you buy at one pharmacy may not be the same as the topical finasteride purchased by another patient at a different pharmacy.
Therefore, you should stop generalizing the medication as topical finasteride but instead, be specific with the formulation and say something like 1% liposomal finasteride or 0.1% finasteride in water, soy phosphatidylcholine, ethanol, etc.
Where can I buy topical finasteride?
Topical finasteride is relatively new in the market. As a result, only a few companies are currently producing it. The supply is way lower than the demand.
These companies may manufacture topical finasteride as a single medication or in combination with minoxidil gel. Popular sellers of topical finasteride are MinoxidilMax and Hasson & Wong.
Currently, oral finasteride tablets are the most common in the treatment of hair loss. Topical treatment is rapidly catching up.
In terms of effectiveness, the topical formulation has not been studied extensively. However, the little information available reveals that topical treatment is equally as effective as oral finasteride tablets and better in terms of scalp’s DHT inhibition.
One thing that differentiates the two is the potential side effects. The topical formulation is not void of side effects, though, the risk for serious side effects is lower when compared to the oral formulation. On this basis, I would recommend the topical finasteride formulations for the treatment of hair loss.