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When it comes to the most effective hair retention strategies, few things hold a candle to the two most common treatments: minoxidil and finasteride. (A fancy laser cap helps a ton, too.) And until recently, the primary way to administer these treatments was to apply minoxidil 5 percent (the generic version of Rogaine) locally to the scalp once or twice each day, and to take a daily 1 mg finasteride pill (the generic version of Propecia).
Guys could combine these treatments or choose one, because each medication has its own specific benefits. Minoxidil is known to increase blood flow and nutrient delivery to the follicles, which can drastically improve hair growth and retention around the crown. Finasteride inhibits the conversion of testosterone into its follicle-shrinking byproduct, known as dihydrotestosterone, or DHT.
But lately the tables have started turning, with topical variants of finasteride growing more commonplace. That’s because oral finasteride has produced seriously scary sexual side effects in users; according to studies, some 2 to 4 percent of guys can experience ED while taking oral finasteride, and a small amount of those affected may never recover.
Recent studies provide the optimistic news that topical finasteride is the solution to both problems. “Topical finasteride significantly improves hair count compared to placebo and is well tolerated,” says Christine M. Shaver, M.D., a board-certified dermatologist and medical director of N.Y.C.’s Bernstein Medical Center for Hair Restoration. “Its effect is similar to that of oral finasteride, but with markedly lower systemic exposure and less impact on serum DHT concentrations.” This is why many brands, like the ones below, are unveiling topical solutions—some of which compound finasteride with minoxidil—and the trend is showing no signs of slowing down.
XYON Customized Topical Finasteride Gel
Happy Head Customizable Topical Finasteride and Minoxidil Solution
Hims Topical Finasteride-Minoxidil Spray
Keeps Topical Finasteride and Minoxidil Gel
Still, you’ll need a prescription for these, which all of the brands above are able to provide through their telemedicine services, in addition to monitoring from their on-staff dermatologists. (A local dermatologist can help with prescriptions and supervision, too.)
What Dermatologists Want You to Know About Topical Finasteride
While Shaver confirms that her patients report fewer side effects from topical finasteride when compared to oral finasteride, she remains on the fence about its ability to pack the same hair-retention punch as the oral option, because topical medications aren’t absorbed fully into the bloodstream. After all, testosterone is primarily converted to DHT in the liver, so applying a spray or gel to the scalp won’t exactly halt that production. Instead, it may just combat the issue at the follicles themselves.
“From what we know about the mechanism of action, decreasing blood levels of DHT is extremely important to efficacy,” says Shaver of oral finasteride’s benefit. “When topically applied, the same blood level inhibition of DHT is not seen, and therefore the efficacy will not be as good. Exactly what blood level of DHT is achieved with topical formations is not yet known.” At the very least, studies seem to suggest “similar results.”
Advice for Anyone Starting a Hair Retention Plan
“The combination of finasteride and minoxidil over the course of one year can often bring a patient back to their appearance 2 years before beginning therapy,” Shaver says, noting (again) that she prefers oral options for both medicines. It’s worth noting that oral minoxidil is only now becoming more available. It hasn’t been F.D.A-approved for cosmetic use, so you have to talk to a doctor to get it. The men’s wellness brand Ro is among the first to offer oral minoxidil through telemedicine.
However, finasteride may be the most important factor. “In general, the contribution of finasteride is about five times greater than that of minoxidil,” Shaver adds. “We find that finasteride alone can be quite effective, whereas minoxidil alone will rarely affect the long-term course of a patient’s hair loss.”
How to Maximize Topical Finasteride’s Efficacy
If you’re going the topical finasteride route, there are a handful of things you should do in order to get the most out of it.
First, Shaver says that this is one of those medications where more is not necessarily more. You should apply it evenly and consistently over the same areas just once a day. “It is important to emphasize using it once per day so that patients can focus on applying it well,” Shaver says.” A second daily application is unnecessary since the effects last more than 24 hours from a single application.”
Second, you should always apply it to a clean, hydrated scalp. “Hydration is particularly important and can increase the potency five-fold by making the scalp more porous to the drug,” she adds. The best time to apply [it] is immediately after quickly towel drying the hair after a bath or shower while the scalp is still damp.”
Of course, if you’re not convinced that topical finasteride is going to go far enough to help your case, there’s always surgical hair restoration—but that’s an entirely different set of considerations. Luckily, we’ve outlined all of them here.
