From the Research
Topical finasteride generally has fewer systemic side effects than oral finasteride, making it a safer alternative for patients concerned about the side effects of oral finasteride. The most recent and highest quality study, published in 2022 in the Journal of the European Academy of Dermatology and Venereology, found that topical finasteride significantly improved hair count compared to placebo and was well-tolerated, with markedly lower systemic exposure and less impact on serum DHT concentrations compared to oral finasteride 1.
Key Points
- Topical finasteride is applied directly to the scalp, allowing for more localized action and reduced systemic absorption compared to oral finasteride tablets (typically 1mg daily) 2.
- The most common side effects of oral finasteride include sexual dysfunction (reduced libido, erectile dysfunction), depression, and gynecomastia, which are less likely to occur with topical finasteride due to its lower systemic absorption 1.
- Topical finasteride is typically used in concentrations ranging from 0.1% to 0.25% and is often combined with minoxidil for enhanced efficacy, with good tolerability and safety profile 3.
- Some systemic absorption still occurs with topical application, so a small percentage of users may experience mild side effects, such as scalp pruritus, burning sensation, irritation, contact dermatitis, and erythema 2.
Recommendations
- If you're concerned about side effects, starting with a lower concentration topical formulation and monitoring for any adverse reactions is a reasonable approach 2.
- The association of topical minoxidil and topical finasteride may enhance efficacy, with a significantly higher clinical and instrumental efficacy compared to monotherapies, and comparable tolerability and safety profile 3.