Topical Finasteride Before and After: Real Case Studies

Article Summary

Recent studies show that topical finasteride can significantly improve hair density and slow shedding while reducing the risk of systemic side effects seen with oral use. Learn how to interpret before-and-after results realistically, understand what typical regrowth looks like, and optimize your treatment for long-term success.

Full Article

A rising interest has grown in topical finasteride as a middle ground between oral dihydrotestosterone (DHT) blockers and non-hormonal treatments like minoxidil. This shift is largely driven by individuals seeking similar efficacy to oral finasteride while minimizing the risk of systemic side effects.

Online transformation photos showcasing impressive regrowth have further fueled the trend, but these often highlight the most exceptional cases rather than typical results. As a result, perceptions of topical finasteride’s effectiveness can be skewed by outliers, making it difficult for prospective users to understand what to expect in real-world use.

We’ll take a closer look at this one later.

This article explores how topical finasteride fits within today’s hair loss treatment landscape, clarifying what current evidence supports, how much regrowth is realistically achievable, and how it compares to both oral finasteride and non-DHT-based alternatives like minoxidil.

What is Topical Finasteride?

Topical finasteride is a 5ɑ-reductase type II inhibitor formulated for direct scalp application. It is designed to inhibit DHT locally in the scalp. By blocking DHT conversion in the scalp, the hope is that it will reduce miniaturization and hair loss in androgenic alopecia (AGA) while minimizing the risk of sexual and hormonal side effects seen with oral administration.

Mechanism of Action

Topical finasteride selectively inhibits the type II 5ɑ-reductase enzyme, decreasing local DHT levels. Topical finasteride has been found to reduce serum DHT by approximately 24-48% depending on the dose, which is notably less than the 60-70% reduction seen with oral finasteride. Lower doses primarily inhibit scalp DHT, potentially minimizing systemic side effects.^[1]Caserini, M., Radicioni, M., Leuratti, C., Terragni, E., Iorizzo, M., Palmieri, R. (2016). Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men … Continue reading But, as the data shows, complete elimination of systemic impact is not guaranteed.

Formulations and Dosing

Compound strengths for topical finasteride vary, typically ranging from 0.005% to 0.2% (as Ulo does), with other companies offering doses as high as 2.5%; however, the higher the dose, the higher the risk of systemic absorption.

Why Expectation Setting Matters

Expectation setting is important when starting topical or oral finasteride for hair loss because online forums and before-and-after images tend to spotlight the most extreme results, rather than typical user outcomes. While finasteride has demonstrated high effectiveness on average, regrowth is generally gradual, with noticeable changes taking six months or more and reaching a plateau around 12-18 months.^[2]Piraccini, B.M., Blume-Peytavi, U., Scarci, F., Jansat, J.M., Falques, M., Otero, R., Tamarit, M.L., Galvan, J., Tebbs, V., Massana, E. (2021). Efficacy and safety of topical finasteride spray … Continue reading,^[3]Rossi, A., Magri, F., D’Arino, A., Pigliacelli, F., Muscianese, M., Leonici, P., Caro, G., Federico, A., Fortuna, M.C., Carlesimo, M. (2020). Efficacy of Topical Finasteride 0.5% vs 17ɑ-Estradiol … Continue reading

Overestimating likely results can lead to frustration, disappointment, and ultimately premature abandonment of therapy when expectations are unmatched by personal experience. Conversely, underestimating the drug’s potential may lead individuals to dismiss a therapy that could offer substantial stabilization or regrowth if given enough time and proper use.

Balanced, evidence-based expectations help users remain committed through the plateau period and recognize that slow, steady improvement, rather than dramatic changes overnight, is the most common pattern for most finasteride users.

What’s Possible ≠ What’s Probable

While topical finasteride can occasionally deliver dramatic regrowth, most users should expect moderate thickening and stabilization in hair density rather than extreme transformations. 

Outcomes are best thought of as falling along a distribution curve:

• A small portion of users are “hyper-responders” who achieve big, visible transformations.
• The majority see moderate, steady improvement, such as visible thickening or a reduction in hair loss.
• Some individuals are non-responders with little to no benefit, reflecting the variability in biology and clinical response.

Several factors influence where an individual might fall on this spectrum:

• Duration of hair loss: Early intervention typically yields better results, while longer-standing balding zones respond less robustly.
• Consistency: Adhering reliably to a treatment schedule increases the chances of improvement, as missed doses may lead to suboptimal outcomes.
• Adjunct therapies: Combining topical finasteride with minoxidil or microneedling can enhance benefits, especially in difficult cases.
• Genetic factors: Variations in androgen receptor (AR) gene sensitivity and baseline DHT levels can also help dictate who will be a strong or weak responder.^[4]Wakisaka, N., Taira, Y-I., Ishikawa, M., Nakamizo, Y., Kobayashi, K., Uwabu, M., Fukuda, Y., Taguchi, Y., Hama, T., Kawakami, M. (2005). Effectiveness of finasteride on patients with male pattern … Continue reading

Stronger Evidence = Greater Predictability

Finasteride is one of the most thoroughly studied hair loss medications, with clinical trial data supporting its reliability and predictability. This evidence base translates into a narrower distribution of user responses; most people see consistent moderate results, with fewer extremes compared to newer drugs.

By contrast, topical dutasteride has been studied less, limiting the ability to accurately predict outcomes and resulting in a wider variation of response. Clinical trials consistently show that dutasteride is more potent in DHT suppression and regrowth than finasteride, yet variability in regrowth and side effect profiles remains higher, especially in real-world use due to less standardization and a less robust evidence base.^[5]Almudimeegh, A., AlMutairi, H., AlTassan, F., AlQuraishi, Y., Nagshabandi, K.N. (2024). Comparison between dutasteride and finasteride in hair regrowth and reversal of miniaturization in male and … Continue reading

Finasteride’s consistent results and well-documented safety profile make it the first-line treatment for most men with AGA, as clinicians and users can anticipate a predictable, steady benefit with a lower risk of surprises. This predictability helps set realistic user expectations and avoids over- or under-estimation of results.

Real Case Studies: Topical Finasteride Before and After

Case #1: Male (32), 24 Months on Topical Finasteride 0.025% (1 ml nightly) + Minoxidil 5% Added After 12 Months

This 32-year-old male’s current protocol includes a 0.025% topical finasteride solution, dosed at 1 mL nightly. He incorporated 5% topical minoxidil at month 12. Adjuncts included weekly dermastamping, a conditioner-only washing routine, and occasional argan oil usage. He reported stabilization of hair shedding from months 0-3, strong thickening from months 3-12, and maintained density, improved texture, and shine from months 12-24. He reported no sexual or systemic side effects from topical finasteride. 

Case #2: Male (23) – 3.5 Months on Topical Finasteride 0.025% (Twice Daily) + Minoxidil 5% (twice daily)

This 23-year-old male applied a topical finasteride 0.025% solution compounded with minoxidil 5%, in addition to occasional, inconsistent derma-rolling over 3.5 months. He reported an initial shedding phase at months 1-2 of the protocol, followed by a sudden improvement in hairline density and thickness at month 3. By month 3.5, he noted significant regrowth and richer color and texture along the frontal hairline. The user noted that the topical regimen has been well-tolerated with no systemic side effects. 

Case #3: Male (34) – 12 Months on Topical Finasteride 0.3% + Minoxidil 6% (twice daily)

This 34-year-old male had tried numerous natural and supplement-based approaches (including pumpkin seed oil, saw palmetto, and rosemary) without success before starting pharmacologic therapy. He used a topical finasteride 0.3% spray compounded with topical minoxidil 6%, applied twice daily. He additionally used microneedling (1.5 mm depth) every 10 days. He described the first 2 months as a “rough” period, marked by noticeable shedding and even mild chest tenderness. 

At months 3-6, he noted steady improvement and early thickening, especially near the temples and mid-scalp. By months 7-8, he observed significant progress, and in months 9-12, coverage stabilized, with occasional light shedding cycles. At this point, he transitioned to an oral regimen for convenience. 

Case #4: Male, 8 Months on Topical Finasteride 0.25% (1 mL twice daily) + Minoxidil 8% (1 mL twice daily) + Microneedling 0.25mm (every three days)

This male user reported on his 8-month progress using topical finasteride, minoxidil, and microneedling. He applied a topical finasteride 0.25% solution compounded with topical minoxidil 8% twice daily to the target areas, with 0.25 mm microneedling sessions every 3 days. At month 1, he reported a mild, brief shedding period, and his first noticeable improvement with thicker strands by month 3. From months 4-8, the user continued to show thickening and increased density. He reported no side effects beyond scalp redness attributed to dermarolling. 

Case #5: Male (37) – 4 Months on Topical Finasteride 0.1% + Minoxidil 5% ( 1mL Daily)

This 37-year-old male opted for a topical combination for safety and convenience. The solution contained topical finasteride 0.5% and topical minoxidil 5%, which he applied 1 mL once daily over 4 months, exclusively to the crown. He noted a 4-week shedding phase from week 3 of treatment, followed by continued shedding and apparent thinning at month 2. By month 2.5, shedding ceased, and months 3-4 marked a period of steady regrowth and improved crown density. 

The user reported maintaining consistent adherence despite the discouraging shedding phase and did not report any systemic or local irritation or side effects. While he did not apply the solution outside the crown, he reported slight thickening near the frontal region.

Case #6: Male (23) – 3 Months on Topical Finasteride 0.3% + Minoxidil 6% (4 Sprays Nightly) + Microneedling 1 mm (Weekly)

This 23-year-old male chose a combination therapy of topical finasteride 0.3%/topical minoxidil 6%, which he applied as a spray 4 times nightly for 3 months. Additionally, he used 1 mm dermastamp once weekly, from which he reports mild temporary redness. At month 1, he reported mild shedding, with no change in his appearance. At month 2, he noticed the first signs of regrowth and thickening, especially along the temples. Month 3 was marked by significant visible improvement. The user described his hair as visibly denser and fuller and reported satisfaction after only 3 months of combination therapy.

Case #7: Male (46) – 4+ Months on Topical Finasteride 0.1% (0.5 mL front + 0.5 mL crown twice daily, TrichoSol) + Minoxidil 5% + Dermastamp 0.8–1 mm Weekly

Due to long-standing crown thinning, this 46-year-old male commenced a combination of topical finasteride 0.1% and minoxidil 5%, applied twice daily for 4 months. He complemented with microneedling (initially daily, then weekly), occasional rosemary oil, and regular biotin. He noted an initial skin reaction at the start of therapy, which caused him to stop it for around 4 weeks. He did not note any ongoing side effects since restarting, nor any shedding or unrelated side effects. He noted improvement in the mid-scalp despite limiting the application to that area, suggesting a possible systemic effect or local spread.

Case #8: Male (24), 4 Months on Topical Finasteride 0.3% + Minoxidil 6%

This 24-year-old male started the topical combination of finasteride 0.3% and minoxidil 6%, applied mainly to his hairline and temples via a serum. He did not observe any side effects, save for transient greasiness and a distinct smell from the serum. Between baseline and month 4 of therapy, he reported visible baby hairs and an early fill across his hairline. He did not notice any shedding across the 4 months. 

Case #9: Male, 9 Weeks on Low-Dose Topical Finasteride (0.01–0.02%) + Topical Minoxidil 5% (Daily)

This male documented his results after 9 weeks on low-dose topical finasteride combined with minoxidil. He created a 0.02% topical finasteride solution using crushed finasteride tablets, which he took from month 2 after initially trialing a 0.01% solution. He also applied a 5% minoxidil solution with a standard alcohol-based carrier. He noted a brief shedding phase at week 4 of the protocol, which he interpreted as a positive response indicator. From weeks 6-9, he noted visible regrowth at the front and thickening of the crown. He did not note any systemic or dermatologic adverse events.

Case #10: Male (43), 3 Months on Topical Finasteride 0.025% (1 ml daily) + Topical Minoxidil 5% (daily) + Microneedling 0.75mm (once every two weeks)

This 43-year-old male sought combination finasteride and minoxidil therapy to improve his hair loss. Over three months, he applied a 0.025% topical finasteride solution once daily to the affected areas, along with 5% minoxidil combined with the same solution. Additionally, he applied Dermastamp 0.75 mm every 2 weeks, avoiding topical application on stamping days. Additionally, he supplemented with magnesium, zinc, B-complex, vitamin D3+K2, lecithin, and followed a generally healthy diet with regular exercise.

At months 1-2, he noted early thickening and density improvements, and by month 3, he achieved increased coverage and shaft thickness at the vertex, with no shedding or side effects reported.

Probable Regrowth Timeline

Based on the available data, we’ve created a probable timeline of regrowth.

Months 0-6: No Cosmetic Changes

Most users will see little to no visible improvement in the first six months. During this period, finasteride is actively reducing DHT and stabilizing hair follicles, but hair regrowth is not yet apparent. Some individuals may notice decreased shedding, while others may experience temporary increased shedding as old hairs make way for newer ones.

Months 6-12: First Cosmetic Improvements

Between 6 and 12 months, initial improvements become visible for most responders. Hair density may be noticeably improved, with thicker strands and slower progression of hair loss.^[6]Piraccini, B.M., Blume-Peytavi, U., Scarci, F., Jansat, J.M., Falques, M., Otero, R., Tamarit, M.L., Galvan, J., Tebbs, V., Massana, E. (2021). Efficacy and safety of topical finasteride spray … Continue reading  

Months 12-24: Noticeable Regrowth in Responders

During the second year, responders typically achieve their most significant gains. Hair regrowth becomes more noticeable, and improvements in overall density continue to build. For many, this period yields the best results, though those who started with advanced hair loss may see stabilization rather than dramatic regrowth.^[7]Rossi, A., Magri, F., D’Arino, A., Pigliacelli, F., Muscianese, M., Leonici, P., Caro, G., Federico, A., Fortuna, M.C., Carlesimo, M. (2020). Efficacy of Topical Finasteride 0.5% vs 17ɑ-Estradiol … Continue reading

Months 24+: Maintenance and Plateau

After two years, most responders maintain their gains if they consistently use the medication. Regrowth typically plateaus, with ongoing use required to sustain results. Discontinuation leads to a gradual loss of regained hair within 6-12 months, returning to baseline levels. Some individuals may see marginal further improvement with combination or adjunct therapies. 

For most users, topical finasteride is a long-term commitment with gradual, steady gains and sustained maintenance. The timeline highlights the importance of patience and expectations aligned with clinical reality.

How To Maintain Realistic Expectations

Most topical finasteride users experience visible, but not dramatic, improvements in hair density and preservation. Rather than achieving total restoration, finasteride is more likely to “turn back the clock” by 1-3 years. 

Patience is important as results often take between 6 to 12 months to become noticeable. Initial changes may be subtle, such as reduced shedding or minor thickening, before more visible regrowth stabilizes over the course of a year.

To accurately assess progress, you can track your progress with photographs. However, it’s important to use the same lighting and angles each time you photograph your scalp. This approach reduces bias and helps clearly identify gradual changes that might otherwise go unnoticed day-to-day. Setting and maintaining realistic expectations can improve satisfaction and help sustain adherence to the long-term treatment plan.

Practical Takeaways

• Topical finasteride offers a clinically proven, lower-risk alternative to oral formulations for treating AGA.
• Multiple studies demonstrate that its efficacy is comparable to oral finasteride. 
• The key safety advantage of topical finasteride is its reduced systemic DHT suppression, potentially leading to a lower incidence of sexual and hormonal side effects commonly associated with oral therapy.
• Consistency in application and patience over many months remain the most important predictors of treatment success, as improvements are typically gradual and require ongoing commitment to daily use.

Final Thoughts

When evaluating topical finasteride, it’s important to consider both its proven efficacy and its measured expectations. Clinical studies consistently show that topical finasteride can deliver meaningful stabilization and regrowth with a lower likelihood of systemic side effects compared to oral therapy. However, like all hair loss treatments, results develop gradually and vary between individuals.

By grounding expectations in clinical averages rather than exceptional before-and-after photos, users can better appreciate the steady, cumulative improvements that typically occur over months, not weeks. Patience, consistency, and realistic goal setting are key; most users will experience visible thickening, reduced shedding, and sustained density when topical finasteride is used correctly and maintained long term.

Ultimately, topical finasteride represents a balanced, evidence-backed option in the modern hair restoration toolkit: one that offers both reliability and tolerability for those seeking to preserve and strengthen their existing hair with confidence.