Free Online Assessment
CALL US
WHATSAPP
- Dr Suhail Alam
- Reading Time: 5 Mins
Finasteride stands as one of the most effective treatments for male pattern baldness. Studies show approximately 90% of men experience improvements in hair loss after using this medication.
While oral finasteride has long been the standard, topical formulations have recently gained popularity. Both aim to combat hair loss, but they work differently and come with distinct considerations.
Let’s explore how these two forms compare, looking at effectiveness, side effects, and who might benefit most from each option.
Key Takeaways
- Oral finasteride is well-researched, convenient (one daily pill), and MHRA-approved, but may cause systemic side effects, including sexual dysfunction in some men.
- Topical finasteride shows comparable effectiveness to oral forms with potentially fewer systemic side effects, making it suitable for those concerned about sexual side effects or women with hair loss.
- The choice between forms depends on personal factors. Oral is better for those wanting simplicity and proven results, while topical may be preferable for those concerned about sexual side effects.
Table of Contents
What is Finasteride?
Finasteride works as a 5-alpha reductase (5AR) inhibitor. This enzyme converts testosterone into dihydrotestosterone (DHT), the hormone primarily responsible for male pattern baldness.
DHT attaches to receptors in hair follicles, causing them to shrink until they stop producing hair. By blocking the 5AR enzyme, finasteride reduces DHT levels and helps protect your follicles from this harmful effect.
This protection can halt hair loss and even stimulate regrowth in many cases.
Key Differences Between Topical and Oral Finasteride
While both forms contain the same active ingredient, they differ in several important ways:
Application Method
Oral finasteride comes as a 1mg tablet taken once daily. It’s straightforward; just swallow with water and you’re done.
Topical finasteride is applied directly to your scalp using a dropper or spray. Concentrations typically range from 0.005% to 1%, though there’s no standardised strength since it’s not yet formally licensed for hair loss.
How They Affect Your Body
When you take a finasteride tablet, it enters your bloodstream and reduces DHT throughout your entire body. This systemic approach can be effective but might cause unwanted effects elsewhere.
Topical application aims to target your scalp directly. Studies show it can reduce scalp DHT levels by up to 70%, compared to about 50% with oral finasteride.
Regulatory Status
Oral finasteride is licensed by the Medicines and Healthcare Products Regulatory Agency (MHRA) specifically for hair loss treatment. Topical formulations remain unlicensed, though research supports their effectiveness.
Professional Backing
The International Society of Hair Restoration Surgeons strongly favors oral finasteride, with 69.1% of members recommending it regularly versus just 17% for topical versions. (Source)
Here’s a comprehensive comparison of the key features of both finasteride formulations:
| Feature | Topical Finasteride | Oral Finasteride |
|---|---|---|
| Typical dosage | 0.005% to 1% solution | 1mg tablet daily |
| DHT reduction in scalp | Up to 70% | Up to 50% |
| Application method | Applied directly to the scalp | Swallowed as a tablet |
| Treatment frequency | 1-2 times daily | Once daily |
| Licensing status | Unlicensed (off-label use) | MHRA-approved |
| Suitable for | Men and women | Men only |
| Professional recommendation rate | 17% of ISHRS members | 69.1% of ISHRS members |
| Main side effects | Scalp irritation, redness | Potential sexual dysfunction |
| Systemic absorption | Limited | Complete |
How Effective is Oral Finasteride vs Topical Finasteride?
Clinical studies show oral finasteride stops hair loss in approximately 83% of men with crown hair loss and 70% with frontal balding. Beyond just preservation, moderate regrowth occurs in 61-66% of men with crown thinning and 37% with receding hairlines.
These impressive numbers explain why 69.1% of hair restoration surgeons regularly recommend oral finasteride to their patients.
While newer to the scene, topical finasteride is showing promising results. A comprehensive review of seven studies concluded it was “non-inferior” to oral finasteride in treating hair loss.
Research indicates topical application can significantly increase hair count and density, particularly when combined with minoxidil. This combination approach appears especially effective for maintaining results after a course of oral treatment.
One study found topical application reduced scalp DHT levels by 70%, compared to 50% with oral finasteride. This suggests topical delivery might even be more effective directly at the hair follicles.
One advantage of topical application is that it may be suitable for women with female pattern hair loss, unlike the oral version, which is only approved for men.
Side Effect Comparison
The side effect profiles represent perhaps the most significant difference between these two treatment options.
Oral Finasteride Side Effects
Because oral finasteride affects DHT levels throughout your body, it can cause systemic side effects, including:
- Erectile dysfunction
- Decreased sex drive
- Ejaculation problems
- Testicular discomfort
- Skin rashes
- Temporary hair shedding
Though these effects occur in only a small percentage of users, they remain a concern for many men considering treatment.
Topical Finasteride Side Effects
Topical application typically causes fewer systemic side effects because less of the medication enters your bloodstream. Side effects are usually limited to the application area:
- Itchy or burning scalp
- Skin irritation
- Contact dermatitis
- Redness (erythema)
This localised profile makes topical finasteride an attractive option for those concerned about sexual side effects.
How to Use Each Form
Using Oral Finasteride
Take one 1mg tablet daily, ideally at the same time each day. You can take it with or without food. Consistency is key for best results, which typically begin to appear after about three months of regular use.
Remember that the effects only last while you’re taking the medication. If you stop, any new hair growth will likely be lost within a year.
Using Topical Finasteride
Apply the solution directly to your scalp using the dropper or spray applicator provided. Make sure your scalp is clean and dry before application. Gently massage the solution across the thinning areas to ensure complete coverage.
Most formulations require application once or twice daily, depending on your doctor’s recommendations and the specific product concentration.
Can You Combine Oral and Topical Finasteride?
While technically possible, combining oral and topical finasteride requires professional guidance. Using both simultaneously might exceed recommended dosages, potentially increasing side effect risks without proportional benefits.
Some patients transition from oral to topical to maintain results with fewer systemic effects. This approach shows promise, with one study reporting 84.4% of men maintained good hair density after switching.
Topical vs Oral Finasteride: Which Form Is Right For You?
Your ideal choice depends on several personal factors:
Consider Oral Finasteride If:
- You’re a man with male pattern baldness
- You prefer a simple, once-daily tablet
- You want a treatment with extensive research behind it
- You’re comfortable with a small risk of systemic side effects
- You prefer using MHRA-approved treatments
Consider Topical Finasteride If:
- You’re concerned about potential sexual side effects
- You’re a woman with female pattern hair loss
- You take other medications that might interact with oral finasteride
- You want to maintain hair density after completing a course of oral finasteride
- You prefer applying treatment directly to the affected area
The Bottom Line
Both oral and topical finasteride can effectively combat hair loss. Oral finasteride offers convenience and extensive research support, while topical application may reduce systemic side effects while delivering comparable results.
Your personal preferences, medical history, and comfort with potential side effects should guide your decision. Many patients start with one form and later switch to the other based on their experience.
For personalised advice, consult with a hair loss specialist who can assess your specific situation and recommend the most appropriate treatment path for your needs.
Remember that consistency matters more than the specific form you choose. Whichever option you select, regular use over time provides the best chance for maintaining and potentially regrowing your hair.
About the Author
