Topical Finasteride (0.025% Concentration) did not lower my DHT at all. Does that mean it's not working?

Question

I started topical Finasteride on 8/1/2022 at a concentration of 0.025%. Before starting treatment, I tested my DHT levels, and it was 40 ng/dl. After 8 weeks, I tested it again, and it was at 41 ng/dl. I'm still shedding over 250 hairs a day like I was before starting treatment. Does this mean that it is making no impact?

Epameinondas Bonaros, MD · Answer

Topical finasteride was explicitly developed to not lower serum DHT to avoid systemic side effects.Topical finasteride significantly improves hair count compared to placebo and is well tolerated. Its effect is similar to oral finasteride but with markedly lower systemic exposure and less impact on serum DHT concentrations.

Jeff Donovan, MD, PhD · Answer

Looking at serum DHT in this way is not really a key parameter to track to see if topical minoxidil is working. No. If you could measure skin DHT before and after that would be more relevant. The reality is that you can’t do this easily because it’s not available to the general public (very expensive and used only in research). For now, you can easily tell if topical finasteride is working by assessing these answers with your doctor after 6 months of treatment: 1) is the shedding less? 2) is the hair density better? Your topical concentration is pretty low so be sure to keep close follow up. Shedding can occur in the first two months of starting topical finasteride (or oral) so we can’t say for sure this is a bad sign of a sign things are not working but it’s certainly not looking favourable at the 8 week mark. Give it a few months if you and your doctors are comfortable with that. Review the literature for optimal dosing.

Topical Finasteride (0.025% Concentration) did not lower my DHT at all. Does that mean it's not working?

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