Topical Finasteride vs. Oral: Which Is Better for Hair Loss?

Want to avoid the side effects of finasteride? Try going topical.

Finasteride has long been recognized as a gold-standard treatment for androgenetic alopecia (AGA), commonly known as male pattern hair loss. As a 5-alpha-reductase inhibitor, finasteride works by reducing levels of dihydrotestosterone (DHT), the hormone responsible for follicle miniaturization and progressive hair thinning. The oral form is FDA-approved and widely prescribed—but it comes with potential systemic side effects that make many patients wary, with good reason!

A growing body of research suggests topical finasteride may offer comparable efficacy to its oral counterpart with significantly fewer systemic effects, offering a solution to these hesitations.

Oral Finasteride & Hair Loss

Oral finasteride (1 mg/day) has been shown to improve hair count and slow the progression of AGA. In a pivotal randomized trial, patients using oral finasteride experienced a 30% increase in hair count over 12 months compared to placebo (Kaufman et al., 1998). However, this systemic route of administration affects DHT levels throughout the body—not just at the scalp.

The catch—effective...but with Trade-Offs

Reported side effects of oral finasteride include:

• Decreased libido

• Erectile dysfunction

• Ejaculatory disorders

• Mood changes and, in rare cases, depressive symptoms (Irwig, 2012)

Although these adverse effects occur in a minority of users, they are significant enough to prompt some patients to discontinue treatment—or avoid it altogether.

The Case for Topical Finasteride

Topical finasteride aims to target DHT locally in the scalp, minimizing systemic absorption and related side effects. Several studies support its effectiveness and improved tolerability profile.

In a 2018 randomized, double-blind study by Caserini et al., topical finasteride 0.25% once daily was found to be non-inferior to oral finasteride 1 mg/day in promoting hair growth over 24 weeks. Importantly, plasma DHT suppression was lower in the topical group, suggesting reduced systemic exposure (Caserini et al., 2018).

A 2021 meta-analysis echoed these findings, concluding that topical finasteride shows similar efficacy to oral treatment with a lower incidence of sexual side effects (Mysore et al., 2021).

Why Compound Topical Finasteride?

Topical finasteride is not currently available as a standardized commercial product, which means it must be specially prepared by a compounding pharmacy. This allows for customized concentrations and vehicles, often tailored to reduce irritation or optimize absorption.

Additionally, compounded formulations may combine finasteride with synergistic agents like:

Minoxidil – to improve blood flow and prolong the anagen phase

Ketoconazole – to address inflammation and scalp conditions

Caffeine or tretinoin – to further stimulate follicle activity

At Cottonwood Compounding, we collaborate with healthcare providers to craft personalized topical finasteride formulations that fit each patient’s hair restoration goals—while minimizing systemic risk.

So, Is Topical the Better Option?

If you’re hesitant about oral finasteride due to its side effect profile, compounded topical finasteride offers a promising alternative. With comparable clinical outcomes and reduced systemic absorption, it may provide the best of both worlds—efficacy and safety.

Speak with your provider about whether a customized topical formulation might be right for you.

References

Caserini, M., Radicioni, M., Leuratti, C., Annoni, O., & Marrè Brunenghi, G. (2018). Comparison of Finasteride 1 mg Oral and Finasteride 0.25% Topical in Male Androgenetic Alopecia: A Randomized, Double-Blind, Controlled Study. Dermatology and Therapy, 8(3), 493–506. https://doi.org/10.1007/s13555-018-0278-6

Irwig, M. S. (2012). Persistent sexual side effects of finasteride: Could they be permanent?. Journal of Sexual Medicine, 9(11), 2927–2932. https://doi.org/10.1111/j.1743-6109.2012.02846.x

Kaufman, K. D., Olsen, E. A., Whiting, D., Savin, R., DeVillez, R., Bergfeld, W., … & Finasteride Male Pattern Hair Loss Study Group. (1998). Finasteride in the treatment of men with androgenetic alopecia. Journal of the American Academy of Dermatology, 39(4), 578–589. https://doi.org/10.1016/S0190-9622(98)70222-1

Mysore, V., Shashikumar, B. M., & Lankupalli, A. (2021). Topical finasteride in the treatment of androgenetic alopecia: A systematic review and meta-analysis. Journal of Dermatological Treatment, 32(8), 896–902. https://doi.org/10.1080/09546634.2020.1721454