What is Finasteride, and Which Finasteride is Best?
Finasteride is a drug approved by the FDA to treat benign prostate hyperplasia and androgenic alopecia. It is prescribed as a 1 mg daily tablet for men with androgenic alopecia. It is also prescribed in higher dosages for women suffering from female pattern hair loss. This ranges from 1.0-5.0 mg daily.
Finasteride is available in different formulations. The best option is determined on a patient-by-patient basis.
What Formulations of Finasteride are Available?
There are two main finasteride formulations: oral and topical. Doctors typically prescribe oral finasteride initially, as it’s a time-tested formulation with a high success rate. Many telehealth providers have sprouted up in recent years, offering topical and oral versions of the drug. Topical finasteride has become increasingly popular as more studies confirm its efficacy and relative safety versus oral finasteride.
As concluded in one study:
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. [1]https://pubmed.ncbi.nlm.nih.gov/34634163/#:~:text=Conclusion%3A%20Topical%20finasteride%20significantly%20improves,impact%20on%20serum%20DHT%20concentrations.
Clinical studies have shown that oral and topical formulations improve hair parameters equivalently in target area hair counts. However, topical formulations of finasteride are preferred for individuals concerned about side effects and/or cannot tolerate oral finasteride due to side effects.
Finasteride 1mg Oral Tablets
As mentioned, finasteride is typically prescribed as a once-daily 1mg tablet. Using more than 1mg per day isn’t likely to improve results.
However, it may increase the risk of side effects. Nearly all clinical studies use 1mg, as it’s the gold standard for treating male pattern baldness. 5 mg finasteride is typically used to treat men diagnosed with benign prostatic hyperplasia (under the label Proscar®).
Oral Propecia® is prescribed under its brand name and as a generic formulation under the name of its key ingredient, finasteride. Generic versions of the drug typically deliver similar results at a fraction of the cost.
Finasteride Topical Formulations
Finasteride topicals include gels, liquid solutions, and liquid sprays. Foams are available as well.
A previous post centered on the best topical finasteride dosage determined that finasteride has a highly-sensitive and dose-dependent response curve. 0.01 mg of finasteride barely reduces any DHT, while 0.1 mg reduces almost as much DHT as 5 mg, a much larger dose.[2]https://onlinelibrary.wiley.com/doi/10.1111/jdv.17738 1% topical formulations essentially guarantee systemic absorption.
Those aiming to avoid the side effects may want to consider a formula with lower percentages of the active drug.
Which Finasteride Is Best for Hair Loss?
In determining the right formula, doctors often have patients start with oral finasteride. If side effects occur, they may consider the lowest possible dose necessary to improve results and minimize side effects. If issues persist, other options can be explored.
In other cases, upon the first signs of sexual side effects, the topical form of the drug is introduced—or finasteride use is discontinued altogether, and other treatments are considered.
Many hair loss sufferers opt to begin with topical finasteride to minimize systemic effects.
For those who don’t experience any sexual side effects, long-term use of oral finasteride may be advisable, given its success rate. And for those who experience adverse systemic effects of oral finasteride, or those wary about potential issues with the oral formulation, topical finasteride may be the better option.
Rob English is a researcher, medical editor, and the founder of perfecthairhealth.com. He acts as a peer reviewer for scholarly journals and has published five peer-reviewed papers on androgenic alopecia. He writes regularly about the science behind hair loss (and hair growth). Feel free to browse his long-form articles and publications throughout this site.