What are the benefits of combined topical finasteride (Finasteride) with dutasteride (Dutasteride) and minoxidil (Minoxidil)?

From the Guidelines

Combining topical finasteride with dutasteride and minoxidil can provide enhanced hair loss treatment results through their complementary mechanisms, as supported by the most recent study 1. This combination addresses hair loss more comprehensively than any single treatment alone. Typically, a formulation might contain 0.1% finasteride, 0.05% dutasteride, and 5% minoxidil applied once daily to the scalp. Finasteride and dutasteride work by blocking DHT (dihydrotestosterone) production—finasteride primarily blocks type II 5-alpha reductase enzyme while dutasteride blocks both type I and II, providing more complete DHT suppression. Minoxidil works differently by increasing blood flow to hair follicles and extending the growth phase of hair. When using this combination, apply to a dry scalp, allow it to absorb for at least 4 hours before washing, and be consistent with daily application. Results typically begin appearing after 3-6 months, with optimal results at 12 months. Some key points to consider when using this combination include:

• The importance of consistent application for optimal results, as highlighted in studies such as 1 and 1.
• The potential for side effects, which are generally minimal with topical application but may include scalp irritation or unwanted hair growth, as noted in 1 and 1.
• The need for women who are pregnant or planning pregnancy to avoid contact with these medications due to potential risks to male fetuses, as emphasized in 1.
• The potential benefits of combining this treatment with other therapies, such as platelet-rich plasma (PRP) or low-level laser therapy (LLLT), as discussed in 1 and 1. Overall, the combination of topical finasteride, dutasteride, and minoxidil offers a promising approach to treating hair loss, with a strong foundation in the most recent and highest-quality evidence 1.

From the Research

Benefits of Combined Topical Finasteride with Dutasteride and Minoxidil

• The combination of finasteride and topical minoxidil has been shown to be more effective than monotherapy for treating androgenetic alopecia, with a significantly higher global photographic evaluation score and more patients experiencing marked improvement 2.
• A study found that a topical solution of 0.25% finasteride admixed with 3% minoxidil was significantly superior to 3% minoxidil solution alone in improving hair density, hair diameter, and global photographic assessment in men with androgenetic alopecia 3.
• Topical finasteride has been found to reduce both scalp and plasma DHT levels, with minimal effect on plasma dihydrotestosterone levels and no systemic adverse events reported 3, 4.
• The combination of topical minoxidil and topical finasteride may enhance efficacy, and topical finasteride may be an alternative for those concerned about the oral formulation's systemic side effects 2, 4.
• However, there is limited research on the specific combination of topical finasteride with dutasteride and minoxidil, and more studies are needed to determine the efficacy and safety of this combination.

Efficacy and Safety

• The efficacy and safety of combined treatment of finasteride and topical minoxidil have been established, with a meta-analysis showing that the combined group had a significantly higher global photographic evaluation score and more patients with marked improvement compared to monotherapy 2.
• Topical finasteride has been found to be well-tolerated, with localized side effects such as scalp pruritus, burning sensation, irritation, contact dermatitis, and erythema 4.
• The combination of topical finasteride and minoxidil has been shown to be safe and effective, with a study finding that 90% of patients treated with the combined solution experienced moderate to marked improvement 3.

Current Guidance and Unmet Needs

• Androgenetic alopecia is a common cause of hair loss in men and women, and traditional treatments such as topical minoxidil and oral finasteride have yielded mixed results 5.
• New treatments such as low-level laser therapy, microneedling, platelet-rich plasma, and others have been extensively studied, and the purpose of a recent review was to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating androgenetic alopecia 5.
• Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients with androgenetic alopecia 5.