The year was 1997, when the Food and Drug Administration approved the use of finasteride in the treatment of male pattern hair loss, otherwise called androgenic alopecia.
This approval brought significant relief to individuals who had been battling hair loss for quite some time. Treatments for hair loss with finasteride have been successful since then, and many patients are reporting positive results.
However, recently patients started to move towards the topical solution – topical finasteride results seem to same as good, but with fewer side effects.
The popularity of finasteride in the treatment of hair loss is increasing each year. The year 2016 saw finasteride rise to the ranks as the 75th most prescribed medications in the United States. In that year, about 10 million finasteride prescriptions were made.
Propecia® Annual Sales Revenue in 2003-2015, $M
Despite a rapidly increasing number of prescriptions for finasteride, the drug with the brand name Propecia was steeply declining with its sales, meaning people were more often switching to generic finasteride form as it is known to be 3-5 times cheaper.
Thus, it can be concluded that patients are shifting from the brand name Propecia to drug’s generic form – finasteride. However, recently, as a result of high frequency and severity of side effects from oral form, patients started moving to its topical formulation.
Read on and explore 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 the year 1984. However, it was not for sale until 1992 when it was approved for medical use.
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 manifests mostly in individuals who are genetically susceptible to hair loss. DHT, as an androgen, is synthesized from testosterone.
To those susceptible to hair loss, 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 amount of DHT in the body can significantly increase your risk of suffering from hair loss. 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. (1)
This is where finasteride comes in:
Finasteride, being one of the 5-α reductase inhibitors, it will prevent the conversion of testosterone to DHT. This mechanism helps delay and alleviate the progression of androgenic 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. (2)
Testosterone on its own doesn’t have any significant influence on hair loss. According to a Study from PubMed, the researchers found out that finasteride could slow hair loss and also increase hair growth. (3)
Until recently, oral finasteride was the go-to finasteride formulation for treating hair loss. The oral formulation is the most popular, hitherto. However, topical finasteride has gotten more attention recently.
Oral vs. topical formulation
While people were still marveling about the beneficial mechanisms of oral finasteride, researchers soon realized that they could come up with ideas which can help lessen the side effects of finasteride.
Consequently, it was decided that a topical formulation with equally beneficial results, though with fewer side effects, be developed to replace the oral medication. The idea was much welcome because the potential side effects of oral finasteride can be so adverse that they prompt 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 research say about the effectiveness of topical finasteride?
A study published in the Indian Journal of Dermatology, Venereology and Leprology in the year 2009 sought to compare the treatment of hair loss with both topical and oral finasteride. (4)
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 test subjects were to take a tablet once daily, every day for the entire duration of the study. Being a double-blind study, the tablet was either 1% finasteride or a placebo.
For those taking the topical formulation, the gel was massaged onto the scalp twice per day for the entire period of study. Besides, the gel either contained 1% finasteride or was a placebo. None of the participants nor the researchers knew what was administered.
As expected, there was a significant increase in hair growth and a reduction in the loss of hair among those taking the tablet and the gel with the active 1% finasteride.
According to the results obtained, the overall effect was moderate. There was a 54.5% hair growth rate among those taking active finasteride gel and a 56% hair growth rate among those taking the oral formulation with 1% finasteride. From this study, it is clear that the topical finasteride is almost equally as effective as the oral formulation.
Another 2015-year study published in the Indian Dermatology Online Journal 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 androgenic alopecia. Previously before the study was commenced, these participants had been on treatment with minoxidil and oral finasteride for two years. (5)
During the study, these 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.
Although this study wasn’t meant to attest for the ability of finasteride to grow hair, it 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 analyzed two randomized pieces of research which compared how oral and different strengths topical finasteride affected DHT levels in both, scalp – which we strive for and serum (blood) – which we want lower as it is a reason for infamous side effects. (6)
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 0.025% concentration topical finasteride has shown more favorable results. But the most important thing is that the latter decreased DHT in Serum 3x less compared to the oral formulation, that means the topical solution is way less likely to cause sides 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 percent to -75.9 percent. 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 remedy 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 remedy is 100% 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 hair root. It was initially thought that topical finasteride could not find its way into the bloodstream and affect the levels of androgen in plasma.
However, much of the side effects of finasteride occurs when the topical doses find their way into 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%. Comparatively, topical finasteride can reduce the amount of serum DHT by up to 25%.
This amount is slightly lower than that of oral finasteride, though 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 heightened when you use oral finasteride pills. It very unlikely that they become adverse with topical finasteride gel. The risk is small, though the risk can’t be ignored.
Clearly, this article is not of the opinion that there are zero side effects when you use topical finasteride. The reality is that there is a chance that you experience specific side effects. Moreover, the side effects are shallow and significantly lower than those you’d experience when you take oral finasteride.
An advice that I would like to give you, my readers, is that there is no such thing as standard topical finasteride. Certain pharmacies develop finasteride that can easily be absorbed into the bloodstream. Others add certain chemicals in their finasteride formulations to inhibit the absorption of finasteride into the bloodstream.
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.Check the price
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.