You have probably already read about finasteride as a pill. The medication works, but the potential side effects on your libido and erection keep many men from starting it. Lately, an alternative has emerged that is said to be less risky: finasteride that you apply to your scalp instead of swallowing. It sounds attractive. But does it work just as well, and is it really that much safer? We looked into it.
What exactly is topical finasteride
Finasteride is a substance that inhibits the conversion of testosterone into DHT. DHT is the hormone that slowly causes hair follicles to shrink in hereditary hair loss. If you take finasteride as a pill, it works throughout your entire body. With the topical version, you apply the substance directly to the areas where your hair is thinning. The idea is simple: the same effect on your scalp, but less of the substance ends up in your bloodstream.
In practice, this involves a lotion or spray containing finasteride, sometimes combined with minoxidil in one product. You won't find it at your local drugstore or pharmacy as an off-the-shelf product. It is usually compounded, meaning a pharmacy prepares it specifically for you based on a prescription.
Does it work as well as the pill
This is where it gets interesting. Clinical research shows that topical finasteride can clearly increase the number of hairs in the treated area compared to a placebo. In one of the larger controlled studies, the increase in hair count after 24 weeks was comparable between the topical and oral forms. It has also been shown that DHT levels in the scalp decrease, while testosterone in the blood hardly changes.
That is good news for those hesitating about the pill because of systemic side effects. It is not a miracle cure that works faster or better than the oral version. The results are in the same order of magnitude. The advantage lies in the way the substance enters your body, not in a stronger effect.
For example, in a randomized study, the number of hairs in the treated area increased by an average of 20 hairs after 24 weeks with topical finasteride, compared to about 7 with a placebo. In the group that used the oral variant, the increase reached a similar level. Such numbers sound abstract, but they confirm that the agent actually does something and does not just produce a placebo effect.
Fewer side effects, not no side effects
Because less finasteride enters your blood, the chance of side effects such as reduced libido or erectile dysfunction is smaller than with the pill. That is the main reason why men choose it. But less is not the same as zero. A portion of the substance is still absorbed through the skin and enters your bloodstream, even if it is less than with a tablet.
What you see more often with the topical version are local reactions: a dry, irritated, or itchy scalp. Especially in the beginning, and usually mild. If you have sensitive skin or already suffer from a dry scalp, that is something to keep in mind.
Another point: if you combine the product with minoxidil in the same solution, it becomes harder to say which part of a side effect comes from which substance. Discuss this with the doctor who prescribes it.
Where can you get it in the Netherlands
Finasteride is only available by prescription in the Netherlands, including the topical form. You therefore need a doctor to prescribe it, often via an online clinic or GP, after which a pharmacy prepares the formulation for you.
Important to know: topical finasteride is not officially approved in the Netherlands and the rest of Europe for the treatment of hair loss. It is prescribed off-label, which means that doctors may prescribe it based on their own assessment and the available research literature, but the agent has not gone through the same formal approval procedure as the pill. That does not automatically mean it is unsafe. It does mean that there is less long-term data than for finasteride tablets, which have been on the market since the nineties.
What we don't know yet
Studies on topical finasteride usually last 6 to 24 weeks. That is enough to see if it works in the short term, but too short to say anything about what happens after two, five, or ten years. For the pill, we do have that long-term data, including information about rare but persistent side effects in a small percentage of users.
There is also no clear standard for concentration and dosage. Different pharmacies and clinics work with different percentages of finasteride in their formulations, and it is not always clear which concentration provides the best result with the lowest risk.
In short: promising, but not completely researched. If you mainly choose the topical version because you think it is completely risk-free, that picture is not entirely accurate.
Combining with a derma roller: extra caution
Many men use a derma roller to slightly stimulate the skin for better absorption of their serum. With a non-hormonal product such as a growth serum, that is fine. With topical finasteride, it is different. Microneedling makes the skin temporarily more permeable, which means that more of the substance can enter your bloodstream than normal. That can actually increase the risk of side effects instead of reducing it.
If you use topical finasteride, discuss with the prescribing doctor first if, and if so how, you can use a derma roller in addition. With a non-hormonal agent like the Hairborn Derma Roller, that problem does not exist, because there is no medicine that you can systemically overdose on.
Is it for you
Topical finasteride is a reasonable option if you want the effect of finasteride without accepting the full systemic risk of the pill, and if you are willing to visit your GP or specialist a little more often for follow-up. It is less suitable if you prefer to use an off-the-shelf product without a prescription, or if you have a sensitive scalp.
Many men who are still in an early phase of hair loss choose to start with a non-hormonal agent first, such as a serum with ingredients that support the hair growth cycle without interfering with DHT. The Hairborn Growth Serum is an example of this. It is not a replacement for finasteride if you have already more advanced hair loss, but it is a logical first step if you are still doubting whether you want to start medication, or as an addition to your treatment.
Whatever you choose: get well informed by a doctor before you start with finasteride, in any form whatsoever. And give every approach at least half a year before you conclude that it does not work.
Frequently Asked Questions
Can you combine topical finasteride with oral minoxidil?
Yes, you can. The two work through different mechanisms; finasteride inhibits DHT and minoxidil improves blood flow, so the combination is applied more often in practice. Do discuss this with the prescribing doctor.
Is there a difference in effect between a spray and a lotion?
There is no strong research comparing a spray and a lotion with the same concentration of finasteride, it is mainly about the amount of active ingredient and how well it reaches the scalp, not the exact mode of administration.
Can you use it if you already had side effects from the pill?
Discuss this explicitly with a doctor, as the topical form brings less finasteride into the bloodstream but is not completely free of the same risk. In case of previous side effects, extra caution and monitoring is important.
How long does it take before you see results compared to the pill?
The timeline is comparable to the pill; usually, a clear effect is only measured in research after 12 to 24 weeks. The topical form does not work faster, only via a different route.
Can you touch a pregnant partner after application?
Wash your hands after application and let the product absorb well before you have close skin contact, especially with a pregnant partner, as exposure to finasteride can pose risks for a male fetus. Discuss the exact precautions with the prescribing doctor.
Can you combine topical finasteride with a caffeine shampoo?
Yes, that is possible without known problems, as a caffeine shampoo works through a different mechanism and has a short contact time. Do not apply the products at exactly the same time to avoid confusion about any irritation.
Can you have it checked how much finasteride enters your blood through the skin?
Yes, a doctor can have blood values checked to see how much finasteride is systemically present, although in practice this is not done as standard because the topical form is already designed to keep this amount low.
Is topical finasteride covered by health insurance?
No, because topical finasteride is prescribed off-label and is compounded, this generally does not fall under coverage by the basic insurance. The costs are usually for your own account.
Can you order it without a prescription from abroad?
That is discouraged. Without a prescription and without guidance from a doctor, you miss the check on concentration, quality, and the monitoring that is precisely important with a hormonal agent. A prescription via a Dutch doctor remains the safest route.
Is there a difference in effectiveness for a greasy or dry scalp?
There is no strong evidence that skin type determines the effectiveness of topical finasteride, although a greasy scalp could theoretically hinder the absorption of the product slightly. Consistency in application remains the most important factor.
