No matter when in life it occurs, male pattern hair loss can be extremely distressing for many men.
Although the condition is extremely common, affecting two thirds of all American men by the age of 35 and approximately 85 percent of men by the age of 50, hair loss is still associated with shame and embarrassment, particularly when it occurs at a young age.
An estimated 25 percent of men who experience male pattern baldness begin losing their hair before the age of 21.
Finasteride, a prescription medication taken orally, has been shown to stop hair loss and promote hair regrowth in many men, but it can also have some unpleasant sexual side effects such as erectile dysfunction.
Recently, topical formulations of finasteride have been explored as a treatment option for men who do not tolerate oral finasteride well but still want to address their hair loss.
The question is, does topical finasteride work?
Finasteride is a prescription medication that is best known as a hair loss treatment for male pattern baldness, also known as androgenic alopecia.
However, the medication is also used for the treatment of enlarged prostate (benign prostatic hyperplasia).
Finasteride was first developed as a treatment for benign prostatic hyperplasia, but during clinical trials, researchers noticed that the medication seemed to stop hair loss and promote hair regrowth in men suffering from male pattern baldness.
Finasteride is sold as an oral medication (tablet) and as a topical medication (cream), and is available in both brand name and generic forms.
How does finasteride work?
Finasteride is a 5-alpha-reductase inhibitor; 5-alpha-reductase is an enzyme that is responsible for converting testosterone into androgen dihydrotestosterone (DHT).
High scalp DHT levels cause hair loss by shrinking the size of the hair follicle, causing the hair to fall out in both men and women.
High levels of DHT in the body in general can cause the prostate to increase in size.
DHT has been found to be the culprit causing hair loss in men suffering from androgenetic alopecia, also known as male pattern baldness.
Taking finasteride helps to lower the level of DHT in the scalp by up to 60 percent, which stops the shrinking of hair follicles, preventing further hair loss, and encourages hair restoration. Currently, lowering the levels of DHT in the scalp is the only clinical study-proven way to stop hair loss.
The most obvious difference between oral finasteride and topical finasteride is that oral finasteride is ingested each day in the form of a tablet, while topical finasteride involves daily application to the scalp.
Both medications work to prevent hair loss and promote hair regrowth by lowering the levels of DHT in the scalp, but there are some key differences between the two.
Oral finasteride is approved by the U.S. Food and Drug Administration (FDA) for hair loss and can be purchased at any commercial pharmacy with a prescription.
Topical finasteride is not FDA-approved for hair loss and is not commercially available. Patients who want to use topical finasteride will need to purchase the treatment from a compounding pharmacy, which creates a formula based on the directions of the prescribing physician.
Topical finasteride comes in a variety of different strengths and formulas; for example, topical finasteride is sometimes sold as a formula that combines topical finasteride with topical minoxidil (commonly known as Rogaine), and some formulas may also include dutasteride as part of the formula.
One of the biggest differences between oral finasteride and topical finasteride is the side effects the medications cause.
Although oral finasteride is generally well tolerated and has proven therapeutic effects, some men experience side effects of sexual dysfunction that make the medication intolerable for them, forcing them to choose between living with hair loss or experiencing side effects. Mild side effects associated with oral finasteride use include:
- Decreased sex drive
- Ejaculation disorder
- Skin rash
- Trouble getting or keeping an erection
- Increase in breast size and tenderness
Most side effects caused by oral finasteride subside over the course of a few days or weeks as the body adjusts to the medication, but some patients will experience the side effects in a more severe form or over a prolonged period of time.
In these cases, patients should follow up with their healthcare provider for further medical advice. Additionally, while finasteride does affect sexual function, it has not been linked to infertility.
Some side effects or oral finasteride can be more serious and can potentially be life threatening. Patients experiencing any of the following side effects should contact a doctor right away and should contact 911 if their symptoms feel life threatening.
- Swelling of your lips, tongue, throat, or face
- Nipple discharge
- Lumps or pain in your breasts
The side effects caused by the use of oral finasteride result from lower levels of DHT in the body.
As a result, topical finasteride, which also lowers the levels of DHT in the body, also has the potential to cause the same side effects.
However, topical finasteride primarily lowers the levels of DHT in the scalp and has a substantially lower impact on serum DHT in the body, which makes it less likely to cause side effects than oral finasteride.
Men who are particularly sensitive to a drop in their levels of DHT may find that topical finasteride is a viable option that may help avoid systemic side effects that affect the conversion of testosterone.
Another difference between topical and oral finasteride is the cost of the medications. Oral finasteride is FDA-approved and commercially available at any pharmacy, and it is often covered by baseline health insurance plans, particularly in its generic form.
Because oral finasteride is FDA-approved, it also can be purchased using a pharmacy discount card to save on the medication.
Topical finasteride is not FDA-approved and is therefore not covered by health insurance; pharmacy discount cards cannot be used on the medication.
Topical finasteride must be purchased at a compounding pharmacy and may vary in price depending on the specific formula. As a result, it is more expensive than oral finasteride.
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We already know that oral finasteride is effective at stopping hair loss and encouraging hair regrowth without the need for hair transplant or other more intensive measures.
Numerous studies have been conducted on oral finasteride that prove its effectiveness, including a study conducted in 1999 which showed that taking 1 mg of finasteride orally each day promotes a significant increase in hair growth in 48 percent of study participants in one year and up to 66 percent in two years.
The study found that the medication was even more effective in stopping hair loss; after two years, 83 percent of participants receiving finasteride showed no further hair loss compared to 28 percent of those receiving the placebo.
However, oral finasteride is more likely to cause side effects, so researchers have begun examining whether topical finasteride might offer an equally effective option.
Several studies have been conducted on topical finasteride, and a literature review has also been conducted.
The literature review from 2018 found that seven different studies demonstrated that topical finasteride caused a significant decrease in the rate of hair loss, increased total and terminal hair counts, and promoted positive hair growth assessment. The topical finasteride caused a decrease in both scalp and plasma DHT but did not cause changes in serum testosterone.
A study conducted in 2015 examined the effects of using a solution that contained 5% topical minoxidil fortified with 0.1% finasteride after patients were treated initially with the 5% topical minoxidil solution and oral finasteride over the course of two years.
The study found that approximately 84 percent of the participants who were continuously treated for hair loss maintained good hair density with use of the topical formula containing both minoxidil and finasteride.
Several patients discontinued treatment with oral finasteride early and then began using the topical formula; four out of five of these patients demonstrated good improvement in hair density when they began treatment with the topical solution.
Based on the studies and literature review, topical finasteride has been shown to be effective in stopping hair loss and promoting hair regrowth in men suffering from male pattern baldness.
The medication can be used following treatment with oral finasteride for patients who do not want to take oral finasteride in perpetuity to prevent hair loss.
Topical finasteride has been shown to be effective in stopping hair loss and promoting hair regrowth in men suffering from male pattern baldness, and it has been found to cause fewer side effects than oral finasteride.
Topical finasteride can be purchased at a compounding pharmacy but is not commercially available, as it is not yet FDA-approved for hair loss.
As a result, topical finasteride solutions are not uniform and may be more expensive than oral finasteride.
References, Studies and Sources:
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