How to get topical finasteride for androgenetic alopecia?

Table of Content:
What is topical finasteride? | How to get a prescription? | Side effects | How to apply it? | Additional tips | FAQs

What is topical finasteride?

Dr. Eric Howell, board-certified dermatologist says that topical finasteride is a medication used off-label to treat androgenetic alopecia (male and female pattern baldness) by applying it directly to the scalp. 

Unlike oral finasteride, which is taken in pill form and has systemic effects, topical finasteride was  designed to decrease systemic effects by targeting the scalp area directly.

Does topical finasteride work?

Clinical studies suggest that topical finasteride is effective for increasing hair count and promoting hair growth with a favorable safety profile. It offers comparable efficacy to oral finasteride but with significantly lower systemic absorption and a reduced risk of systemic side effects, especially sexual side effects.

Topical finasteride inhibits the enzyme 5-alpha reductase and reduces dihydrotestosterone (DHT) levels locally in the scalp, which in turn helps to prevent hair follicle miniaturization and stimulate hair regrowth¹. 

Do you need a prescription for a topical finasteride?

Yes, Dr. Howell says that you need a prescription for topical finasteride. This is because finasteride can have potential side effects on the body, and its use needs to be monitored by a healthcare provider.

How to get a prescription for topical finasteride?

You can get a prescription for topical finasteride via Miiskin. The online consultation is $59 and it will include what the board-certified dermatologist considers will be the best treatment option for you. 

If you want to request a specific treatment plan please mention this to the dermatologist so they can write you a prescription for this medication, if it is adequate for you.  

What are the side effects of topical finasteride?

Topical finasteride is generally well-tolerated, but like any medication, it can cause side effects. Since it is applied locally, the systemic side effects are typically less common and less severe compared to oral finasteride. 

• Redness, itching, or flaking at the application site of the scalp
• Some users may experience mild headaches
• Although quite rare due to lower systemic absorption, topical finasteride may cause decreased libido, erectile dysfunction, hormonal changes or mood changes²
• It is unclear whether topical finasteride can cause birth defects, therefore it is not recommended for women who are pregnant, may become pregnant or nursing³
• It is unclear if topical finasteride can affect sperm count similarly to oral finasteride, therefore inform your dermatologist if you are a male trying to conceive with your partner before starting topical finasteride

How to use topical finasteride?

Dr. Howell says that you should always follow the instructions provided with the medication and your doctor. However, as a general rule, here are some guidelines.

Wash and towel dry your scalp

Before applying topical finasteride, ensure your scalp is clean and dry. Wash your hair and scalp with a mild shampoo and dry your hair and scalp with a towel.

Apply evenly

Part your hair to expose the scalp and apply the measured dose evenly across the affected areas of your scalp. You can use the applicator or your fingertips to spread the medication.

Massage gently

Gently massage the medication into your scalp to ensure it is absorbed. Avoid vigorous rubbing, which can irritate the scalp.

Wash your hands

After applying the medication, wash your hands thoroughly to remove any residual product.

Allow to dry

Let the medication dry completely before using other hair products or going to bed. 

Additional tips when using topical finasteride

Be consistent

Dr. Howell says you should use the medication consistently twice a day to maintain stable levels of the drug in your scalp.

Avoid overuse

Do not apply more than the recommended dose. Overuse will not increase effectiveness and may increase the risk of side effects.

Monitor for side effects

Be aware of potential side effects such as scalp irritation. If you experience any adverse effects, contact your healthcare provider.

Schedule regular check-ups

Schedule regular check-ups with your online dermatologist to monitor your progress and adjust the treatment plan if necessary.

Frequently asked questions about topical finasteride

Can women use topical finasteride?

Dr. Howell says that topical finasteride can be used by women with androgenetic alopecia who are not pregnant and are using effective contraception. However, there are alternative hair loss treatments for women like minoxidil and spironolactone that have a safer profile for women and can be used long term.

Can topical finasteride be applied to dirty hair? 

Dr. Howell says topical finasteride should ideally be applied to a clean, dry scalp for optimal absorption and effectiveness. Applying it to dirty or oily hair can impede its absorption into the scalp, reducing its efficacy. It’s recommended to wash and thoroughly dry your hair and scalp before application to ensure the medication can penetrate the skin properly. 

Is topical finasteride a DHT blocker?

Dr. Howell says topical finasteride is indeed a DHT blocker. It works by inhibiting the enzyme 5-alpha reductase in the scalp, which converts testosterone into dihydrotestosterone (DHT). By reducing the levels of DHT locally, topical finasteride helps to prevent the miniaturization of hair follicles, thereby slowing hair loss and potentially promoting hair regrowth in individuals with androgenetic alopecia. This localized approach aims to minimize systemic side effects compared to oral finasteride.

Why is topical finasteride better than oral finasteride?

Topical finasteride is often considered safer than oral finasteride because it targets the scalp directly, reducing the risk of systemic side effects. By minimizing systemic absorption, topical finasteride can effectively lower DHT levels in the scalp to treat hair loss while decreasing the likelihood of side effects commonly associated with oral finasteride.

What are the issues with topical finasteride?

Dr. Howell says the primary issue with topical finasteride include potential local side effects like scalp irritation, redness, or dermatitis. Additionally, he says that the effectiveness of the treatment depends on a consistent twice a day which may be less convenient for patients who prefer the simplicity of a once-daily pill. 

Does topical finasteride lower testosterone?

Topical finasteride does not significantly lower testosterone levels; instead, it inhibits the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone (DHT). This leads to a reduction in DHT levels without significantly affecting the overall testosterone levels in the body. Therefore, testosterone remains relatively stable while DHT decreases, helping to prevent hair loss.

Can I switch from oral to topical finasteride?

Dr. Howell says you can definitely switch from oral to topical finasteride. It is important to consult with your healthcare provider before making the switch to ensure it is appropriate for your specific situation. They can provide guidance on the transition process and monitor your progress to ensure the topical form is effective in managing your hair loss.

Can you still build muscle on finasteride?

Dr. Howell says that you can definitely build muscle while taking finasteride. Finasteride inhibits DHT without affecting testosterone levels, therefore, taking oral or using topical finasteride should not impede your ability to build muscle through regular exercise and resistance training.

Is topical finasteride better than minoxidil?

Dr. Howell says that finasteride and minoxidil work through completely different mechanisms, so one isn’t necessarily better than the other. Finasteride reduces DHT levels to prevent hair loss, while minoxidil increases blood flow to hair follicles to promote growth. He also added that using both medications together is more effective. 

Why is finasteride so controversial?

Dr. Howell says that oral finasteride is controversial due to the potential side effects it may cause such as sexual dysfunction, depression, and other hormonal effects. However, using topical finasteride reduces the chances of being affected by these side-effects. 

Can you combine topical finasteride and topical minoxidil together?

Dr. Howell says you can definitely combine topical finasteride and topical minoxidil in one formulation. He often prescribes this to treat androgenetic alopecia (male and female pattern baldness). He says these medications have a synergistic effect: finasteride reduces the production of dihydrotestosterone (DHT) to prevent hair follicle miniaturization, while minoxidil stimulates hair growth by increasing blood flow to the hair follicles and prolonging the anagen (growth) phase of the hair cycle.

Using them together enhances the effectiveness in promoting hair regrowth and slowing hair loss. However, it’s important to follow the guidance of a healthcare provider to ensure proper application and to monitor for any potential side effects or interactions⁴.

Can you use topical finasteride and oral minoxidil together?

Dr. Howell says you can also combine topical finasteride and oral minoxidil to treat androgenetic alopecia. This combination can be equally effective since topical finasteride reduces DHT levels locally in the scalp to prevent hair follicle miniaturization, while oral minoxidil stimulates hair growth systemically by improving blood flow to hair follicles and prolonging the growth phase. This dual approach addresses hair loss from different mechanisms, potentially enhancing overall effectiveness. 

Article References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297965/
https://pubmed.ncbi.nlm.nih.gov/35238144/
https://www.ncbi.nlm.nih.gov/books/NBK582707/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495069/