As far as hair loss treatments go, it’s hard to beat the level of clinical evidence for finasteride. Many patients choose finasteride to help improve visible signs of hair loss and boost self-esteem and in most cases, taking finasteride is a straightforward process. It’s typically prescribed as an oral tablet that’s taken once a day, but other forms of finasteride also exist. If you're leaning towards finasteride for its hair regrowth potential but are worried about potential sexual side effects like erectile dysfunction, topical finasteride could be an option that allows you to have the best of both worlds. Not all topical finasteride formulas are created equal, but XYON’s compounded Topical Finasteride and Minoxidil with SiloxysSystem™ Gel was specifically designed to minimize unnecessary exposure to medication while still being effective.
Worried about side effects from finasteride? Meet topical finasteride.
XYON's topical finasteride is designed to maximize effectiveness while lowering the risk of side effects.
Is topical finasteride effective?
Based on available research and data, topical finasteride can be just as effective as the oral form of the medication (Hajheydari et al., 2002). Delivery through the skin instead of by mouth generally results in reduced absorption of drug while still having a therapeutic effect and could mean the difference between a patient being able to take finasteride and having to consider other treatment options.
The efficacy of topical finasteride comes down to the active ingredient in these formulations, finasteride, which targets production of dihydrotestosterone (DHT), a hormone that causes hair follicles to shrink in genetically susceptible men. Finasteride helps by lowering DHT levels in the body, prolonging the lifespan and productivity of hair follicles. The biggest differences between oral finasteride and topical finasteride are how much drug is delivered (this can vary greatly between topical formulations) and how it reaches the hair follicles (through the skin).
Remember, topical finasteride is not an FDA-approved treatment. It’s an example of a compounded treatment, which means that it deviates from the approved drug in both format and strength. The FDA-approved form of finasteride is a 1mg oral tablet. In contrast, topical finasteride can come in various forms including sprays, lotions, solutions or gels, in a range of concentrations to meet the needs of patients. Delivery method and concentration do have an impact on efficacy, but let’s consider the efficacy of topical finasteride, in general.
One double-blind, randomized clinical trial was conducted in 45 male patients and compared treatment with a 1% topical finasteride gel to oral placebo tablets and 1mg oral finasteride tablets. The study found that both topical finasteride and oral finasteride resulted in increased hair counts, with no significant difference between these treatment groups (Hajheydari et al., 2002). A separate study comparing treatment with a 0.25% topical finasteride solution to the 1mg oral tablet also confirmed that the topical treatment was non-inferior to the oral treatment and that the former also resulted in decreased serum (blood) concentrations of finasteride (Caserini et al., 2014).
A more recent 2022 multi-center trial that tested a 0.25% topical finasteride spray against a placebo reported that changes in hair count compared to baseline were significantly greater in the topical finasteride group compared to the placebo group and similar to patients treated with oral finasteride (Piraccini et al., 2021). Unfortunately, there is a lack of research directly comparing different topical formats of finasteride to each other, but as it rises in popularity as a treatment for pattern hair loss, we may expect some head-to-head trials in the future.
Can topical finasteride cause erectile dysfunction?
Topical finasteride can cause erectile dysfunction, but the risk is believed to be lower compared to oral finasteride. No medication or treatment is a hundred percent risk-free. When it comes time to make a decision between oral or topical finasteride, it’s about choosing the option that comes with a level of risk that you’re comfortable with.
According to a 2021 study of the efficacy and safety of a 0.25% topical finasteride spray, the percentage of participants that reported side effects (including sexual side effects) was similar to the placebo group and lower than that of the oral finasteride group—about 10% (Piraccini et al., 2021). Sexual side effects (sexual dysfunction, erectile dysfunction, decreased libido or loss of libido) were reported by 2.8% of participants taking topical finasteride vs 4.8% taking oral finasteride. Researchers also asked participants to complete questionnaires to measure the impact of sexual dysfunction and there were no significant differences in average scores for any items between the topical finasteride and placebo groups.
If you’re also wondering about the impact of topical delivery on finasteride concentrations in the body after 6 months of treatment, the study measured this, too. The treatment group that received topical finasteride was found to have a blood concentration of finasteride of 48.0 ± 87.2 pg/mL which was compared to a value of 5029 ± 4182 pg/mL in the oral finasteride group. If you're curious about how well our own topical delivery system helps keep finasteride out of the bloodstream, check out our writeup on the laboratory tests we did on topical finasteride with SiloxysSystem™ Gel. Based on an independent small-scale study, topical finasteride gel resulted in 92% less drug absorption compared to the oral tablet despite having a higher concentration of finasteride.
Can I switch from oral finasteride to topical finasteride to avoid sexual side effects like erectile dysfunction?
Possibly. If you’re concerned about possible sexual side effects associated with the oral form of finasteride, topical finasteride could help lower your risk. Topical finasteride is a compounded treatment, so you will need a doctor’s prescription to obtain it. Your doctor will consider a variety of factors including your medical history and current medications (if any) to determine whether it’s the best option to treat your hair loss.
Whenever you change hair loss treatments, there is a risk of a temporary period of increased shedding that usually starts within the first month of trying a new medication. Because many hair loss treatments, including finasteride, can cause changes in the hair growth cycle, patients can anticipate losing some hair as hair follicles adjust to a new growth cycle. In many cases, this shedding resolves after several weeks without additional intervention.
It’s important to understand that topical finasteride won’t eliminate the risk for erectile dysfunction completely, but it can make a difference in terms of reducing systemic exposure to the medication and minimizing the drug’s impact on other parts of the body that may be sensitive to hormonal changes.
Ultimately, there are some patients who will be more strongly affected by changes in hormone levels. We encourage patients to have an open dialogue with their prescribing doctor about any changes in their bodies. It’s not unusual for doctors to recommend a modified dosing schedule or alternative treatments if patients are having a difficult time tolerating a medication.
Is erectile dysfunction after taking finasteride permanent?
It’s rare, but there have been some reports of permanent erectile dysfunction after taking finasteride. The existence of long-term or permanent side effects following the use of finasteride remains a controversial topic within the medical community, but we believe that side effects should be taken seriously and investigated when they do occur. After all, erectile dysfunction is a complex medical issue with many possible physiological and psychological causes.
One of the most highly publicized studies on sexual dysfunction following finasteride use was conducted by Irwig and Koluka (2011). The study involved interviews with 71 healthy males 46 years of age or younger, who reported new symptoms of sexual dysfunction that lasted for at least 3 months after stopping treatment. Symptoms included decreased libido, erectile dysfunction and problems achieving orgasm lasting up to 40 months from the time treatment was stopped. The study found that participants had fewer sexual encounters on average per month and that total sexual dysfunction scores increased (indicating greater impairment). However, there were several limitations to the study including the possible impact of self-selection and recall bias and the lack of investigations into the effect of finasteride on hormone levels.
Another study recruited participants who reported experiencing side effects for at least three months after stopping finasteride from the website Propeciahelp.com, a help site for finasteride sufferers (Ganzer and Jacobs, 2014). The study found that the majority of participants experienced an overall decrease in sexual drive (93% of men), intermittent erectile dysfunction (83%), or a loss of spontaneous morning erections (89%) along with a host of other sensory and functional changes. Study limitations here also included self-selection and recall bias, lack of a control group and did not consider any external factors such as social or socioeconomic factors that may have contributed to symptoms.
Other studies have observed that patients who persevere with treatment can experience symptom relief. Kaufman showed in one long-term finasteride study that drug-related sexual side effects such as erectile dysfunction stopped when men discontinued the medication or if they simply continued with therapy (2002). Moinpour et al. showed in their large-scale Prostate Cancer Prevention Trial that even when taken at a higher oral dose of 5mg, finasteride increased the risk for sexual dysfunction only slightly and that like the Kaufman trial, these effects subsided over time (2007).
What does this mean for patients? If you think you may be experiencing erectile dysfunction after taking finasteride, it’s important to inform your doctor. Take note of when it started and whether it worsens over time. If you're comfortable doing so, you can also include details about what might be going on in your life that could have an impact on sexual performance. Depending on your case, your doctor may recommend switching over to a topical form of finasteride to try to minimize the impact of the medication on other parts of the body or consider other treatment options to manage your hair loss.
Takeaway: topical finasteride and erectile dysfunction
If you’re interested in trying finasteride but are worried about the possibility of developing erectile dysfunction, topical finasteride might be an option. It’s important to understand that even amongst oral finasteride users, the incidence of erectile dysfunction is relatively low, but for some men, it can have a serious negative effect on quality of life. Additionally, in recent years, there have been several reports of long-lasting or permanent erectile dysfunction in young men taking oral finasteride. While the jury is still out on whether these long-term effects are directly caused by finasteride, the good news is that there are ways to reduce your risk.
One possible solution is to opt for compounded topical finasteride instead of oral finasteride. Available data from preliminary studies shows that it is generally as effective as oral medication, with fewer reports of systemic side effects. The reason? Topical formats of finasteride usually result in reduced body-wide exposure to the medication, which can be advantageous for men who are sensitive to the hormonal changes that finasteride can cause. When you start a hair loss consultation through the XYON platform, you’ll have access to knowledgeable doctors who can help determine whether topical finasteride is right for you.
References:
Caserini, M., Radicioni, M., Leuratti, C., Annoni, O., & Palmieri, R. (2014). A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. International Journal of Clinical Pharmacology and Therapeutics, 52(10), 842–849. https://doi.org/10.5414/cp202119
Finasteride Male Pattern Hair Loss Study Group (2002). Long-term (5-year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia. European Journal of Dermatology: EJD, 12(1), 38–49.
Ganzer, C. A., & Jacobs, A. R. (2016). Emotional Consequences of Finasteride: Fool’s Gold. American Journal of Men’s Health, 12(1), 90–95. https://doi.org/10.1177/1557988316631624
Hajheydari, Z., Akbari, J., Saeedi, M., & Shokoohi, L. (2009). Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian Journal of Dermatology, Venereology and Leprology, 75(1), 47. https://doi.org/10.4103/0378-6323.45220
Irwig, M. S., & Kolukula, S. (2011). Persistent Sexual Side Effects of Finasteride for Male Pattern Hair Loss. The Journal of Sexual Medicine, 8(6), 1747–1753. https://doi.org/10.1111/j.1743-6109.2011.02255.x
Moinpour, C. M., Darke, A. K., Donaldson, G. W., Thompson, I. M., Jr, Langley, C., Ankerst, D. P., Patrick, D. L., Ware, J. E., Jr, Ganz, P. A., Shumaker, S. A., Lippman, S. M., & Coltman, C. A., Jr (2007). Longitudinal analysis of sexual function reported by men in the Prostate Cancer Prevention Trial. Journal of the National Cancer Institute, 99(13), 1025–1035. https://doi.org/10.1093/jnci/djm023
Piraccini, B. M., Blume‐Peytavi, U., Scarci, F., Jansat, J. M., Falqués, M., Otero, R., Tamarit, M. L., Galván, J., Tebbs, V., & Massana, E. (2021). Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. Journal of the European Academy of Dermatology and Venereology, 36(2), 286–294. https://doi.org/10.1111/jdv.17738
