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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% (the generic of Rogaine) locally to the scalp once or twice each day, and to take a daily 1mg pill of finasteride (the generic of Propecia).
Individuals could combine these treatments or choose one; minoxidil is known to increase blood flow and nutrient delivery to the follicles and drastically improve hair growth and retention around the crown, while finasteride inhibits the conversion of testosterone into its follicle-shrinking byproduct known as dihydrotestosterone, or DHT. (It is especially effective against recession.) But the tables are turning lately, with topical finasteride growing more commonplace (and readily available), largely due to the fact that oral finasteride can provide some seriously scary sexual side effects in users; according to studies, some two to four 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: the hair loss and the desire to keep one’s sex drive. “Topical finasteride significantly improves hair count compared to placebo and is well tolerated. 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 are unveiling topical solutions—some of them compound drugs that marry finasteride with minoxidil—and it’s showing no signs of slowing.
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 above brands are able to provide through their telemedicine services, in addition to monitoring from their on-staff dermatologists. Your own local dermatologist can help with prescriptions and supervision, too.
A Dermatologist’s Take on Topical Finasteride
For some ground-level insight on topical finasteride and its long-term potential in the hair retention industry, we spoke with board-certified dermatologist Christine M. Shaver of Bernstein Medical Center for Hair Restoration in NYC.
While Shaver confirms that her patients report fewer side effects from topical finasteride as opposed to oral finasteride, she remains on the fence about its ability to pack the same hair-retention punch as the oral option, since the medicine isn’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
Here is Shaver’s most overarching advice for anyone starting their own hair retention regimen—aside from the fact that they should seek tailored advice and supervision from a board-certified dermatologist, of course.
“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,” she says, with a preference towards oral options for both medicines. Note, though, that oral minoxidil is only now becoming more available, too—typically through your doctor’s office as it hasn’t been FDA-cleared for cosmetic use. Men’s wellness brand Ro is among the first to offer oral minoxidil through telemedicine. However, finasteride may be the most important factor, adds Shaver: “In general, the contribution of finasteride is about five times greater than that of minoxidil. 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
For anyone switching from oral to topical options, she offers this advice for maximizing its efficacy: “The medication should be applied evenly and consistently over the same areas once per day. It is important to emphasize using it once per day so that patients can focus on applying it well. A second daily application is unnecessary since the effects last more than 24 hours from a single application. As in all topical medications, they will be more effective when applied to a clean scalp and one that is preferably well-hydrated. Hydration is particularly important and can increase the potency five-fold by making the scalp more porous to the drug. Therefore, the best time to apply the medication is immediately after quickly towel drying the hair after a bath or shower while the scalp is still damp.”