Topical finasteride is gaining interest among patients. The oral form of finasteride has been approved by the FDA since 1997 at a dosage of 1 mg daily. Patients feel that it is an easy form of treatment as a daily pill. Additionally, it is probably the most effective drug for hair loss in men. Studies show that 90% of men taking the medication maintain their native hair or increased hair growth. 42% of men reported no change or further loss of hair compared to their baseline, and only 10% of people lost hair compared to baseline. When compared to the placebo (sugar pill), only 6% of patients reported an increase in hair growth, 19% reported that their hair was maintained at the baseline level, and 75% of patients reported a decrease in the amount of hair compared to the baseline. These results were statistically significant meaning they were validated scientifically.
Finasteride and Hair Restoration
So why the interest in topical finasteride for hair loss or hair restoration? Unfortunately, there are potential side effects associated with every medication – fortunately for finasteride, the side effects are uncommon but noteworthy. With finasteride, the results showed that 3.8% of men taking the medication experience some sort of sexual dysfunction compared to the placebo where only 2.1% experienced side effects of sexual dysfunction – again statistically significant. These side effects were decreased libido (0.3%), erectile dysfunction (0.3%), and decreased volume of ejaculation. In most people who either continued the medication or discontinued the medication, the side effects went away. There are a small number of people who report that they have persistent sexual dysfunction after discontinuing the medication – this is called “post-finasteride syndrome.” Because of the risk or incidence of side effects, or patients who have experienced side effects, the interest in topical finasteride has soared because of the reported decrease in sexual dysfunction.
In 2022, BM Piraccini in Bologna, Italy, conducted a very nice study on the efficacy and safety of topical finasteride for male androgenetic alopecia. He studied 458 people for the study by comparing the use of topical finasteride, to oral finasteride to placebo for 24 weeks which has been the end-point used in many finasteride studies. He found that patients who were using topical finasteride 0.25% (1 to 4 sprays per day) showed similar results to the oral medication of 1 mg daily. The data showed that the Total Area Hair Count [TAHC] was 20.2 hairs compared to the placebo of 6.7 hairs per area. This was similar to the oral finasteride of 21.1 hairs per TAHC. Again, this was scientifically significant. Unfortunately, the results did not show any statistical increase in hair weight or thickness of the hair. The results also showed a lower risk of sexual dysfunction compared to oral finasteride [see my next blog].
These results are certainly encouraging for patients who want to use finasteride, but have experienced sexual dysfunction or are nervous about the use of it due to the potential of developing sexual dysfunction. Clearly, more research needs to be performed on a larger number of patients to fully understand the impact of topical finasteride on the efficacy of male pattern hair loss and the potential risk profile. It must be mentioned that the use of topical finasteride is off-label and has not been approved by the FDA for the treatment of male pattern hair loss. I feel a challenge will be finding suitable solutions to manufacture the topical finasteride for consistency and proper absorption through the scalp. Many compound pharmacies have preparations for topical finasteride either by itself or with an agent to help the absorption, with or without topical minoxidil. Overall, I feel the results are promising and I look forward to future developments of this medication.
Reference: Piraccini BM, Blume-Peytavi U, Scarci F, Jansat JM, Falqués M, Otero R, Tamarit ML, Galván J, Tebbs V, Massana E; Topical Finasteride Study Group. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol. 2022 Feb;36(2):286-294.