There's been a lot of interest in topical finasteride lately because the theory is that it delivers the drug to the scalp with lower systemic absorption — meaning the same DHT reduction at the follicle level with less impact on serum DHT and therefore fewer systemic side effects.
The evidence: there are a handful of studies now showing topical fin at 0.25% applied daily does reduce scalp DHT effectively. Systemic DHT suppression is lower than oral — some studies show 15-30% systemic reduction vs 60-70% with oral 1mg. Whether this translates to a meaningfully reduced side effect profile is still being studied, but the theoretical rationale is sound.
The shed comparison: in my experience (and from what I've read in the community), topical fin sheds tend to be milder than oral. This tracks with the lower systemic effect. When I switched from oral to topical about a year ago, the transition was smooth — no new shed, similar efficacy.
Downsides of topical: it's harder to source than oral. Most GPs aren't familiar with it. You'll likely need a compounding pharmacy or specialist hair clinic to prescribe it. It's also more expensive than generic oral fin. Application is less convenient than a single daily pill.
Who might prefer topical: anyone who had sides on oral and stopped, or anyone who wants to trial fin with lower systemic exposure first. It's a legitimate option, not just a marketing gimmick.
The Keeps and Hims compounded products in the US now include topical fin in some formulations. There's also a branded topical called Finalo solution available in some markets. Worth looking into if you're in a country where generic oral fin requires a specific prescription pathway.
Switched to topical three months ago from oral 1mg. No side effects on oral to begin with but wanted the lower systemic exposure as a precaution. Can't notice any difference in terms of hair density — still holding steady, no new shedding. Will report back at the 12-month mark.
How do you apply it? Is it a liquid dropper or a spray? I've seen a few different formats mentioned.
Usually a solution in a dropper or pump bottle. Apply to the scalp in the affected areas — part the hair and apply directly to skin. Massage in lightly. You don't need to rinse it out. Most protocols call for once daily. I do mine at night before bed. If you're also using topical minoxidil, apply them at different times (fin in morning, min at night or vice versa) to avoid dilution and ensure both absorb properly.