You’ve probably already read about finasteride as a pill. The drug works, but the potential side effects on libido and erection deter many men from starting it. Lately, an alternative has emerged that is said to be less risky: finasteride applied to the scalp instead of swallowed. Sounds appealing. 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 to DHT. DHT is the hormone that causes hair follicles to gradually shrink in cases of hereditary hair loss. If you take finasteride as a pill, it works throughout your entire body. With the topical variant, 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 entering your bloodstream.
In practice, it involves a lotion or spray containing finasteride, sometimes combined with minoxidil in one product. You won't find it at regular drugstores or pharmacies as a ready-made product. It is usually compounded magistrally, 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 significantly increase hair count 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 to reduce DHT levels in the scalp, while testosterone in the blood changes very little.
This is good news for those hesitant about the pill due to systemic side effects. It's 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 how 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 with topical finasteride after 24 weeks, compared to approximately 7 with a placebo. In the group using the oral variant, the increase was at a comparable level. Such numbers sound abstract, but they confirm that the drug genuinely works and doesn't just produce a placebo effect.
Fewer side effects, not no side effects
Because less finasteride enters your blood, the risk of side effects such as reduced libido or erectile dysfunction is lower than with the pill. That is the main reason men choose it. But less is not the same as none. Some of the substance will always be absorbed through the skin and enter 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 consider.
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 prescribing doctor.
Where do you get it in the Netherlands?
Finasteride is only available by prescription in the Netherlands, including in topical form. So you need a doctor to prescribe it, often through an online clinic or general practitioner, after which a pharmacy prepares it for you.
Important to know: topical finasteride is not officially approved for the treatment of hair loss in the Netherlands and the rest of Europe. It is prescribed off-label, which means that doctors may prescribe it based on their own assessment and available research literature, but the drug has not undergone the same formal approval procedure as the pill. This does not automatically mean it is unsafe. It does mean that there is less long-term data than with finasteride tablets, which have been on the market since the 1990s.
What we don't know yet
Studies on topical finasteride usually last 6 to 24 weeks. This 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. With the pill, we do have that long-term data, including information on rare but persistent side effects in a small percentage of users.
There is also no clear standard for concentration and dosage yet. Different pharmacies and clinics work with different percentages of finasteride in their preparations, and it is not always clear which concentration yields the best result with the lowest risk.
In short: promising, but not fully researched. If you primarily choose the topical version because you believe it is completely risk-free, that perception 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's fine. With topical finasteride, it's different. Microneedling temporarily makes the skin more permeable, which means that more of the substance can enter your bloodstream than usual. This can actually increase the risk of side effects rather than decrease it.
If you use topical finasteride, consult with the prescribing doctor first about whether, and if so, how, you can also use a derma roller. With a non-hormonal product like the Hairborn Derma Roller, this problem does not arise, because there is no medication that you can systemically overdose.
Is it for you?
Topical finasteride is a reasonable option if you want the effects of finasteride without accepting the full systemic risk of the pill, and if you are willing to visit your GP or specialist more often for follow-up. It is less suitable if you prefer a ready-to-use product without a prescription, or if you have a sensitive scalp.
Many men who are still in the early stages of hair loss first choose to start with a non-hormonal product, 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 substitute for finasteride if you have more advanced hair loss, but it is a logical first step if you are still unsure whether you want to start medication, or as a supplement to your treatment.
Whatever you choose: make sure you are well informed by a doctor before starting finasteride, in whatever form. And give any approach at least six months before concluding that it doesn't 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 more frequently applied in practice. However, discuss this with the prescribing physician.
Is there a difference in efficacy between a spray and a lotion?
There is no strong research directly comparing a spray and a lotion with the same concentration of finasteride; it primarily concerns the amount of active substance and how well it reaches the scalp, not the exact form of administration.
Can you use it if you have already experienced side effects from the pill?
Discuss this explicitly with a doctor, as the topical form introduces less finasteride into the bloodstream, but is not entirely free of the same risk. For previous side effects, extra caution and monitoring are important.
How long does it take to see results compared to the pill?
The timeline is comparable to the pill; usually, a clear effect is measured in research only after 12 to 24 weeks. The topical form does not work faster, only through a different route.
Can you touch a pregnant partner after application?
Wash your hands after application and allow the product to absorb thoroughly before close skin contact, especially with a pregnant partner, as finasteride exposure can pose risks to a male fetus. Discuss exact precautions with the prescribing physician.
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 precisely the same time to avoid confusion about potential irritation.
Can you have the amount of finasteride absorbed into your blood through the skin checked?
Yes, a doctor can order blood tests to check how much finasteride is systemically present, although this is not standard practice since 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 compounded magistrally, it is generally not covered by basic health insurance. The costs are usually borne by the individual.
Can you order it without a prescription from abroad?
That is not recommended. Without a prescription and without guidance from a doctor, you miss out on control over concentration, quality, and the monitoring that is crucial for a hormonal agent. A prescription through a Dutch doctor remains the safest route.
Is there a difference in effectiveness with oily or dry scalp?
There is no strong evidence that skin type determines the effectiveness of topical finasteride, although an oily scalp could theoretically slightly hinder product absorption. Consistency in application remains the most important factor.
