Doctor Answers 6
Peer-reviewed reports and physician-experience with topical finasteride
Because of the potential for sexual side effects from oral finasteride (Propecia and generic forms), many patients and physicians are seeking an alternative to the FDA-approved version. The good news is that there ARE some peer-reviewed studies are reporting that there is some efficacy with topical versions of finasteride (see below). In addition, many of these studies also support the theory that there is a lower/absent load of finasteride in the serum, and lower/absent sexual side effects with topical finasteride.
The benefits of oral finasteride are very well known and it would be foolish to think that a topical version wouldn’t have some positive effects. Are there risks? Sure. There are always risks with medications, whether they are FDA-approved, compounded or over-the-counter. As a physician, I try to be a problem-solver and seek out the advice of some very brilliant PCAB-accredited pharmacy compounding chemists when we want to reduce side effects or increase efficacy or both for our patients—like we have had done with Formula 82M Compounded Minoxidil for thousands of patients. Let’s not forget that type-1 5AR is localized primarily in the scalp, so a topical scalp treatment with finasteride does make sense.
With whatever treatment we prescribe, follow-up cross-sectional bundle measurements (aka HairCheck) every 90 days are strongly recommended. Those measurements always determine the course of treatment in the medical management of hair loss. The most popular compounded topical finasteride we prescribe at Bauman Medical contains both minoxidil and finasteride and is called “Finoxidil 82F.” Remember that compounded medications, by default, are not FDA-approved so always discuss with your doctor the potential for known and unknown risks.References:
M Caserini, et. al. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. International Journal of Clinical Pharmacology and Therapeutics, July 30, 2014 (1-8). doi:10.5414/CP202119
BS Chandrashekar, et. al. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. Indian Dermatol Online J. 2015 Jan-Feb; 6(1): 17-20. doi: 10.4103/2229-5178.148925
S Sheikh, et. al. A new topical formulation of minoxidil and finasteride improves hair growth in men with androgenetic alopecia. J Clin Exp Dermatol Res 2015, 6:1. doi:10.4172/2155-9554.1000253
Z Hajheydari, et. al. Comparing the therapeutic effects of finasteride gel and tablet in the treatment of androgenetic alopecia. Indian J Dermatol Venereol Leprol Jan-Feb 2009; 75(1):47-51.
F Mazzarella, et. al. Topical finasteride in the treatment of androgenetic alopecia: Preliminary evaluation after a 16-month therapy course. J Dermatol Treatment 1997;8:189-92.
Price VH, et. al. Changes in hair weight and hair count in men with androgenetic alopecia after treatment with finasteride, 1 mg, daily. J Am Acad Dermatol 2002;46:517-23.
Shapiro J, Kaufman KD. Use of finasteride in the treatment of men with androgenetic alopecia (Male pattern hair loss). J Investig Dermatol Symp Proc 2003;8:20-3.
Topical finasteride may be used by some doctors but there is no evidence it actually works. It is also not FDA approved
John Frank, MD
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In our internal studies, a well compounded topical finasteride of .05-.1% concentration showed high absorption in our permeability studies at the dermal papilla level which is where the enzyme that converts testosterone to DHT is located and is the target for finasteride.
You will need to find a well-compounded solution that does not contain a high amount of propylene glycol for best efficacy. However, a good topical finasteride solution is a good alternative to the oral administration.
My recommendation is to find someone that does compound it, get someone to write you a prescription to compound and try it--all compounding pharmacies have to meet minimum requirements in order TO compound meds, and anything topical will have significantly lower risks and side-effect profiles.
The problem as I see it is that anyone that wants to take this drug approach, needs some confidence that it works reliably. When there is no FDA involved, reliability can not be assured. Commercial companies are required, by law, to prove efficacy and safety. Doctors who mix their own medications have no such requirement because their medical license allows a doctor to mix his/her own medications for their patients.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.