Finasteride is one of the most commonly prescribed medical treatments for androgenetic alopecia, with decades of clinical use and ongoing research supporting its role in hair loss management.
The drug is available in both topical and oral forms; understanding their nuances is critical in making an informed decision best suited to your needs.
This article provides an evidence-based overview of oral and topical Finasteride, including mechanisms of action, clinical outcomes, safety considerations, and practical differences between formulations.
Topical vs. Oral Finasteride: Quick Comparison
Understanding Finasteride
Finasteride is a medication that plays a pivotal role in treating baldness in males and females. How does it work?
DHT is a hormone that contributes to the hair loss problem by shrinking hair follicles, leading to thinner hair and, eventually, baldness.This medication’s primary purpose is to inhibit the conversion of androgen testosterone to DHT.1
This medication is in two forms: oral and topical.
- the oral form is a daily pill,
- the topical form is a solution or a gel applied directly to the scalp.
Both formulations aim to reduce scalp DHT levels, which may help slow hair loss progression and, in some patients, support partial regrowth.
However, while it is a potent tool, it’s essential to understand that everyone’s body responds differently to medications. Therefore, individual results may vary, and it’s crucial to consult a healthcare provider before starting any treatment.
What Is Oral Finasteride?
Oral Finasteride, often recognized under Propecia, is available in tablet form.
How is Oral Finasteride Taken, and What’s the Dosage?
Oral Finasteride is taken as a once-daily tablet, with or without food. For androgenetic alopecia, the commonly prescribed dose is 1 mg per day, as established in FDA-approved clinical trials and long-term studies.2
Dosage and treatment duration should always follow the guidance of a licensed healthcare provider. If a dose is missed, patients are generally advised to continue with the next scheduled dose rather than taking an extra tablet.
Even if you miss a dose, it’s advised not to take a double dose to make up for it but rather continue with your regular schedule.
Benefits of Oral Finasteride
One comparative study has shown that 80% of men who take oral Finasteride experience either stabilization of hair loss or measurable increases in hair density over time, particularly at the crown. It is a long-term solution, with most men seeing significant results after continued use for three to six months.3
Side Effects and Considerations
Despite its effectiveness, it isn’t without its potential side effects. Some men have reported experiencing post-Finasteride syndrome, sexual side effects, such as:
- reduced libido and loss of sexual desire,
- ejaculation disorder
- or decreased ejaculatory volume,
- erectile or sexual dysfunction,
- or decreased semen volume.4
These side effects stem from lowered DHT levels, often resolving after discontinuation or within the first year of use, though rates may normalize versus placebo after 2-4 years.5
Other side effects include:
- breast tenderness or enlargement,
- nipple discharge,
- or testicular pain.
If you experience any of these side effects, seek immediate medical attention.
Moreover, pregnant women or women planning pregnancy should not handle crushed or broken tablets due to the risk of a specific congenital disability.
Discussing these potential side effects with your healthcare provider before starting the treatment is essential. They can provide a more comprehensive understanding of the risks and benefits, helping you make an informed decision.
Will Finasteride Affect My Libido?
Sexual and neuropsychiatric side effects have been reported in a subset of patients. While many symptoms resolve after discontinuation,5 there is ongoing debate and research regarding persistence in rare cases.
A large pharmacovigilance analysis of the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS), published in 2024, examined reports of post-finasteride syndrome (PFS)-like adverse events associated with oral versus topical finasteride.
The study found that signals for sexual and neuropsychiatric adverse events were detected less frequently with topical finasteride than with oral finasteride, both before and after PFS became widely reported.6
Importantly, the authors noted that many reported adverse events, such as erectile dysfunction and depression, are highly prevalent in the general population and may be influenced by factors such as age, psychological stress, underlying health conditions, and nocebo effects.
The FAERS database also lacks detailed clinical information, including hormone levels, genetic predisposition, and family history, which limits the ability to establish direct causation.
As a result, sexual side effects cannot be completely ruled out, though reported rates appear lower with topical than with oral therapy.
Importantly, individual sensitivity varies. Patients with a history of hormone-related side effects should discuss risks carefully with a healthcare provider before starting treatment.
What Is Topical Finasteride?
Topical Finasteride is an alternative formulation of the traditional oral medication used to treat the problem.
It’s typically available as a solution or gel directly applied to the scalp where thinning or balding occurs. This method aims to maximize the medication’s impact on the scalp while minimizing systemic absorption, thereby reducing potential side effects.
How Is Topical Finasteride Applied, and What’s the Dosage?
Topical Finasteride is prescribed as a scalp-applied solution or gel intended for use in areas affected by androgenetic alopecia. In clinical and compounding practice, formulations commonly range in concentration, with 0.1% solutions among those most frequently studied.
Application frequency and dosing protocols are determined by a healthcare professional, taking into account individual factors such as pattern and stage of hair loss, treatment goals, and tolerance. Because topical Finasteride still results in some systemic absorption, its use should be medically supervised rather than self-directed.
Benefits of Topical Finasteride
One of the main benefits of topical finasteride is its targeted action. Because it’s applied directly to the scalp, it delivers a concentrated dose of the medication to the areas that need it most.
Moreover, topical finasteride is often combined with other treatments like minoxidil, potentially boosting its efficacy. Such combinations are usually well-tolerated and can provide a more comprehensive approach to managing hair loss.7
Side Effects and Considerations
While topical Finasteride minimizes systemic absorption and reduces side effects, some systemic absorption still occurs. It means side effects similar to oral Finasteride can still happen, although they may be less common or severe. These can include sexual side effects like reduced libido or erectile and ejaculatory dysfunction.
Skin irritation at the application site is another potential side effect specific to topical Finasteride. If you notice redness, itching, or swelling, it’s advisable to consult with your healthcare provider.
Just like oral Finasteride, pregnant women or those planning to become pregnant should avoid handling topical Finasteride, as it can potentially lead to congenital disabilities.
Oral Finasteride vs. Topical Finasteride
Effectivity
A pivotal phase III, randomized, double-blind, controlled clinical trial, published in the Journal of the European Academy of Dermatology and Venereology in 2021 by Piraccini et al., directly evaluated the efficacy and safety of a topical finasteride spray solution in men with androgenetic alopecia.
The study included 458 adult male participants across 45 European centers and compared topical finasteride with placebo, while also analysing systemic exposure relative to oral finasteride.
By week 24, patients using topical finasteride demonstrated a statistically meaningful improvement in target area hair count compared with placebo.
- Patients treated with topical finasteride showed an adjusted mean increase of 20.2 hairs, compared with 6.7 hairs in the placebo group (P < 0.001).
- Improvements were also observed as early as week 12, and investigator-assessed hair growth outcomes at week 24 further supported these findings.
Importantly, the study found that hair count improvements with topical finasteride were numerically similar to those observed with oral finasteride, suggesting comparable clinical effectiveness in terms of hair growth outcomes over the study period.8
Clinical Case Example: Topical Finasteride Use
Case type: Single-patient case study
Treatment: Topical finasteride only
Age: 25
Hair loss pattern: Norwood 2V
Treatment duration: 116 days of consistent daily use
In this case, a 25-year-old patient with early but aggressive androgenetic alopecia presented with hair loss significant enough that surgical intervention was not initially recommended. Given the patient’s age and progression pattern, the primary clinical goal was to stabilise further loss before considering any procedural options.
After approximately 116 days of consistent daily topical finasteride use, follow-up evaluation showed measurable improvement in hair check metrics alongside visible cosmetic changes. Both quantitative assessment and visual inspection suggested improved hair density and reduced progression during the observation period.
Important note:This is a single case study and should not be interpreted as representative of typical outcomes. Individual responses to finasteride vary based on genetics, pattern and severity of hair loss, treatment adherence, and other health factors.
Results are not guaranteed, and medical therapy should always be undertaken under the guidance of a qualified healthcare professional.
Side Effects
While both forms of Finasteride can be effective, they also have potential side effects. Taking Finasteride orally may lead to sexual side effects in some men, including decreased libido and erectile dysfunction.
Some men also report changes in mood. However, it’s important to remember that not everyone experiences these side effects, and they usually disappear once male patients stop taking finasteride.
Topical finasteride aims to reduce these systemic side effects by limiting absorption into the bloodstream. The risk of side effects may be lower, but they can still occur. Additionally, topical finasteride may cause local irritation at the application site, a side effect not associated with the oral form.
Suitability for Different Types of Hair Loss
Oral and topical finasteride is primarily used to treat male pattern hair loss, also known as androgenetic alopecia. It is a condition when one loses hair at the temples and crown of the head—both forms of finasteride work by reducing levels of DHT, the hormone responsible for androgenic alopecia.
For other types of hair issues, such as alopecia areata or telogen effluvium, finasteride may not be the best treatment option. These conditions have different underlying causes that are not solved by reducing DHT levels.
Cost
The cost of treatment can also factor into the decision between oral and topical finasteride. Generic oral finasteride is typically more affordable and covered by insurance, and topical finasteride is usually more expensive and may not be covered by insurance since compounding pharmacies formulate it.
Over the years, oral savings compound: a 30-pill generic bottle might total $300/year versus topical’s $1,200+, plus potential shipping from specialty pharmacies. Compounding adds variability in pricing by pharmacy, strength, and add-ins like minoxidil, but no standardized rebates apply.
Therefore, cost considerations may be necessary for long-term treatment.
Speed of Results
Both oral and topical finasteride require patience, as the results are not immediate. Typically, it may take anywhere from three to six months to observe noticeable changes with either form.
Lifestyle Considerations
Lifestyle preferences and treatment comfort can influence whether oral or topical finasteride is more suitable for an individual.
Oral finasteride may appeal to patients who prefer a simple, once-daily medication and are comfortable with systemic therapy. Because it is taken by mouth, adherence is generally straightforward and does not require daily scalp application.
Topical finasteride may be preferred by individuals who wish to limit systemic exposure or who prefer not to take oral medication. As a scalp-applied treatment, it allows localized delivery to affected areas, although consistent application is required, and treatment routines may be less convenient for some patients.
Flexibility in Combining Treatments
Combination therapy is commonly considered in the management of androgenetic alopecia, particularly when targeting hair loss through multiple mechanisms.
In clinical practice, finasteride is often used alongside topical minoxidil. While finasteride works by reducing dihydrotestosterone (DHT) activity, minoxidil promotes hair growth through non-hormonal pathways, such as prolonging the anagen phase of the hair cycle.9 Using both treatments together may be appropriate for some patients, depending on individual response and tolerance.
Both oral and topical finasteride formulations can be combined with minoxidil under medical guidance. Some patients may prefer treatment plans that rely on topical applications alone, while others may prioritize simplicity or adherence when selecting between oral and topical regimens.
Factors to Consider When Choosing Finasteride Formulation
When selecting between oral and topical finasteride, certain factors should be taken into account.
Personal Comfort and Convenience
Choosing between a pill and a topical application can hinge on your lifestyle and preferences. Oral finasteride might suit those who prefer a quick, no-fuss approach, while topical finasteride may appeal to those who enjoy a more hands-on, ritualistic aspect of care.
Severity and Type of Hair Loss
Your specific type and stage of hair loss can also influence the choice. Both forms are effective for male pattern baldness, but if your hair loss is more advanced, you should discuss which option could provide optimal results with a healthcare provider.
Individual Health Conditions and Potential Side Effects
Your overall health and potential side effects are paramount considerations. If you have a history of hormonal imbalances, liver disease, or a serious allergic reaction, or you’re planning to conceive, ensure to discuss these factors with your healthcare provider to determine the most suitable and safe form of finasteride for you.
Frequently Asked Questions
Is finasteride FDA-approved for hair loss?
Oral finasteride (1 mg) is approved by the U.S. Food and Drug Administration (FDA) for the treatment of male androgenetic alopecia. Topical finasteride formulations are not currently FDA-approved as standalone products but are commonly prescribed through compounding pharmacies and have been evaluated in clinical trials for efficacy and safety.
Does topical finasteride work as well as oral finasteride?
Clinical evidence, including a large phase III randomized controlled trial, indicates that topical finasteride can significantly improve hair count compared to placebo and produce hair growth outcomes similar to oral finasteride over the study period. ( Piraccini et al.) However, long-term comparative data remain limited, and individual responses may vary. Oral finasteride remains the most extensively studied formulation.
Will topical finasteride affect my libido?
Sexual side effects have been reported with finasteride use and are an important consideration for patients. Pharmacovigilance analyses using FDA adverse event data have found that reports of sexual and neuropsychiatric adverse events occur less frequently with topical finasteride than with oral finasteride, although some systemic absorption still occurs.
Individual sensitivity varies, and sexual side effects cannot be completely ruled out. Patients with concerns about sexual function should discuss risks and benefits with a healthcare provider before starting treatment.
How long does it take to see results from finasteride?
With both oral and topical finasteride, clinical studies suggest that several months of consistent use are typically required before changes in hair density or shedding patterns can be evaluated. Treatment response is gradual, and outcomes should be assessed over time rather than on short-term changes.
Can finasteride stop hair loss completely?
Finasteride is designed to slow or stabilize hair loss associated with androgenetic alopecia by reducing the effects of dihydrotestosterone (DHT). While many patients experience reduced shedding or improved hair density, results vary, and finasteride does not guarantee complete prevention of hair loss or full regrowth.
Is finasteride suitable for all types of hair loss?
Finasteride is primarily used to treat androgenetic alopecia. It is not effective for hair loss caused by other conditions, such as alopecia areata, telogen effluvium, or scarring alopecias. A proper diagnosis by a healthcare professional is essential before starting treatment.
Final Thoughts
Hair loss is a deeply personal experience, and the approach to its treatment should be just as personalized. Expert guidance is key in this process. Whether it’s the well-established oral finasteride or the newer topical option, you should decide in consultation with professionals well-versed in this field.
Contact healthcare professionals or hair loss experts who can provide tailored advice based on your unique situation.
Exploring Non-Drug Options for Hair Loss
Hair loss treatment is not one-size-fits-all. While finasteride remains a cornerstone therapy for androgenetic alopecia, some individuals may prefer or require non-drug alternatives, such as Tricopat, which does not involve systemic medication.
A specialist consultation can help determine whether pharmacological, non-pharmacological, or combined approaches are most appropriate.
Medical Disclaimer
This article is intended for educational and informational purposes only and does not constitute medical advice. Finasteride, in both oral and topical forms, is a prescription medication and may not be appropriate for everyone. Treatment decisions should be made in consultation with a qualified healthcare professional, who can assess individual medical history, risk factors, and treatment goals.
The information presented here is based on published clinical research and general medical knowledge at the time of writing but does not replace personalized medical evaluation, diagnosis, or treatment.
Resources:
- Zito, Patrick M., et al. “Finasteride.” PubMed, StatPearls Publishing, 2021.
- PROPECIA. PROPECIA ® (Finasteride) Tablets for Oral Use.
- Arca E, Açikgöz G, Taştan HB, Köse O, Kurumlu Z. An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology. 2004;209(2):117-25. doi: 10.1159/000079595. PMID: 15316165.
- “Finasteride (Propecia, Proscar): Uses, Side Effects, Interactions, Pictures, Warnings & Dosing – WebMD.” Webmd.com, 2024, www.webmd.com/drugs/2/drug-1548-167/finasteride-oral/finasteride-oral/details#sideeffects. Accessed 12 Dec. 2025.
- Tacklind J, Fink HA, Macdonald R, Rutks I, Wilt TJ. Finasteride for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2010 Oct 6;2010(10):CD006015. doi: 10.1002/14651858.CD006015.pub3. PMID: 20927745; PMCID: PMC8908761.
- Gupta, Aditya K, et al. “Is the Safety of Finasteride Correlated with Its Route of Administration: Topical versus Oral? A Pharmacovigilance Study with Data from the United States Food and Drug Administration Adverse Event Reporting System.” International Journal of Dermatology, 15 July 2025, https://doi.org/10.1111/ijd.17957. Accessed 12 Dec. 2025.
- Chen L, Zhang J, Wang L, Wang H, Chen B. The Efficacy and Safety of Finasteride Combined with Topical Minoxidil for Androgenetic Alopecia: A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2020 Jun;44(3):962-970. doi: 10.1007/s00266-020-01621-5. Epub 2020 Mar 12. PMID: 32166351.
- Piraccini BM, Blume-Peytavi U, Scarci F, Jansat JM, Falqués M, Otero R, Tamarit ML, Galván J, Tebbs V, Massana E; Topical Finasteride Study Group. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol. 2022 Feb;36(2):286-294. doi: 10.1111/jdv.17738. Epub 2021 Oct 25. Erratum in: J Eur Acad Dermatol Venereol. 2023 Feb;37(2):452. doi: 10.1111/jdv.18750. PMID: 34634163; PMCID: PMC9297965.
- Badri, Talel, et al. “Minoxidil.” PubMed, StatPearls Publishing, 2020.
