Hair loss is a common problem that affects both men and women. It can be caused by a mixture of age, genetics and hormonal imbalances. A combination treatment that addresses multiple factors could be beneficial. Could a combination of topical finasteride and minoxidil be the answer for you? How does it compare to oral finasteride and minoxidil in side effects, safety and convenience?
In this article, we’ll delve into the science behind the combination of topical finasteride and minoxidil, including the mechanism of how each drug works, its benefits, usage instructions, and potential side effects. So, if you want to find out if a topical finasteride and minoxidil solution could help you to take back control of your hair and your confidence, read on.
What is topical minoxidil and finasteride? How do they work?
Topical finasteride and minoxidil is a hair loss treatment that combines two different hair loss drugs. They work exactly the same way as oral versions of minoxidil and finasteride except that they are applied directly to the scalp.
Minoxidil is an FDA-approved medication for hair loss treatment. Because it causes blood vessels to dilate, it was initially used as an oral medication for hypertension before researchers discovered it to have hair growth properties.1 Minoxidil is believed to promote hair growth by increasing scalp blood flow and oxygen to hair follicles. This leads to better nourishment and regeneration of hair follicles, resulting in thicker and healthier hair. It has also been shown to speed up the resting phase of hair growth and prolong the growth phase. Studies have shown that this leads to increased hair length as well as follicle diameter.2
Finasteride works by blocking the conversion of testosterone to dihydrotestosterone (DHT). DHT binds to androgen receptors in the hair follicle and activates genes responsible for shrinking the follicle and shortening the growth cycle. Initially approved by the FDA as a treatment for an enlarged prostate gland, finasteride works by inhibiting the activity of the enzyme 5-alpha-reductase, which converts testosterone to DHT. Research has shown that finasteride can reduce scalp DHT levels by up to 60%.3
What do studies about combined topical minoxidil and finasteride treatment say? Is it more effective than oral finasteride and minoxidil?
Studies have shown that a combination of topical finasteride and minoxidil is more effective than either medication alone and is just as safe in terms of side effects. Both topical minoxidil and finasteride and a combination of oral finasteride and topical minoxidil have been shown to be effective in human trials.
In a 2015 study, men treated with a combination of oral finasteride (1mg) and topical minoxidil (1 ml of 5% twice/day) showed superior improvement in their hair at 12 months.4 94.1% of men showed improvement on a combination of the two treatments, versus only 80.5% on finasteride and 59% on minoxidil alone.
A combination of topical minoxidil and finasteride is superior to topical minoxidil alone. In a randomized study of 40 men with androgenetic alopecia, photographic assessments of the scalp revealed that men treated with a combination of 3% minoxidil and 0.1% finasteride solution had significantly better results than those who were treated with 3% minoxidil.5
In 2020, researchers performed a systematic review and meta-analysis, which is a statistical study that looks at the results of multiple studies to find correlations between different trials. They found that across different studies, men treated with a combination therapy demonstrated greater improvements in photographic evaluation, had greater significant hair growth, less hair loss and had comparable adverse event rates to those treated with either drug alone. The conclusion was that combined treatment was more effective than minoxidil or finasteride alone.6
How minoxidil and finasteride work in the scalp to treat hair loss.
- Minoxidil shortens the resting phase of the follicle cycle leading to the lengthening of the growth phase
- Minoxidil also dilates blood vessels, which increases the supply of oxygen and nutrients to the follicle
- Normally, DHT binds to androgen receptors in the follicle root and activates genes responsible for hair loss
- Finasteride blocks 5-alpha-reductase, the enzyme responsible for converting testosterone to DHT and prevents step 3 from taking place.
Benefits of a Combination topical finasteride and minoxidil solution versus oral finasteride and topical minoxidil.
Using a combination of topical finasteride and minoxidil can provide greater benefits than using each medication alone and is an effective, safe and convenient alternative to oral preparations. Each drug has a separate mechanism of action (see the image above). When used together they combine synergistically to treat hair loss.
Minoxidil promotes hair growth while finasteride reduces DHT levels, preventing further hair loss. Together, these medications can provide a more effective hair loss treatment.
Combined topical minoxidil + finasteride requires once daily application of one solution, versus oral finasteride and topical minoxidil which requires two different products and avoids having to take the finasteride pill. Topical minoxidil usually requires two applications a day. Additionally, combined topical solutions are generally compounded with less propylene glycol than regular minoxidil such as Rogaine or Kirkland liquid minoxidil. This can reduce irritation to the scalp and means that the solution is less greasy and dries faster.
Safety and side effects
Compared to oral finasteride, topical finasteride can be used at lower doses whilst still having equivalent effects on hair regrowth. Lower doses of topical finasteride are associated with a smaller effect on DHT levels and this reduced the risk of sexual side effects. (See dose and concentration below)
Dose and concentration of topical minoxidil and finasteride solution vs. oral minoxidil and finasteride.
Because topical preparations are applied directly to the scalp, lower doses and concentrations are needed versus oral medications. This means that combined topical minoxidil and finasteride could be an effective treatment option for users who have experienced side effects with oral finasteride.
For male adult patients, Concentrations between 5% to 8% minoxidil are commonly prescribed. A higher concentration of minoxidil may have better efficacy but this is associated with an increased risk of side effects.
In female patients, 1 ml of 2% solution, used twice daily, is commonly used to treat female pattern hair loss. 5% foam, used once a day, has been also been approved by the FDA for use in female pattern hair loss.8
Based on the available data, 1-2mls of a 0.005-0.3%% solution/day are commonly prescribed.
Finasteride concentrations used in trials range from 0.005% to 1%. However, it’s important to remember that higher concentrations can lead to more significant side effects. Research has shown that lower doses are as effective, if not more so than when compared to equivalent oral doses of finasteride.
In a trial of 52 male and female patients, 1ml of 0.005% finasteride used twice daily was found to significantly decrease the rate of hair loss versus a placebo solution over 16 months.9
A trial of 0.25% topical finasteride found that it was significantly better than placebo, with an increase in hair count at the scalp vertex within 12 weeks.10 The researchers used a dose of 1mg oral finasteride as a comparison and found that after treatment the target area hair count of 0.25% topical finasteride was similar. Encouragingly, though the dose of 0.25% was lower, serum DHT levels were only reduced by 33.4% compared to a 55.6% reduction in the oral finasteride group.
Higher finasteride concentration leads to more reduction in DHT level and better hair regrowth. However, it also increases the chance of getting side effects.
Many people who choose topical finasteride are sensitive to finasteride and had side effects with oral finasteride. Thus is it important to keep the topical finasteride concentration and dose as low as possible. 0.1% is believed to be an optimal concentration for most people.
How to use minoxidil/finasteride solution
How to apply
- Starting in the center, apply the solution to the area of the scalp being treated
- Tilt the head back slightly to avoid the solution dripping down the forehead.
- Massage it into the area and wash your hands immediately afterwards
- Allow the solution to dry naturally on the scalp.
- Allow at least four hours after application before showering or swimming.
- Make sure your hair and scalp are completely dry before applying.
- The combined solution can be applied to towel-dried hair or a dry scalp.
- It is not recommended to use the solution on wet hair as this may dilute the product and decrease its effectiveness.
- It is not advisable to blow dry your hair after applying the solution as this can decrease its effectiveness.
- If you miss a dose, apply it as soon as you remember.
- Do not double dose if you miss a dose. If it is close to the time for your next application, skip the missed dose and return to the normal dosing schedule.
- Topical finasteride is not safe for pregnant or breastfeeding women. Avoid sharing your pillow and ensure they do not come into contact with the solution at all.
Spray vs. Dropper Application – which is best?
Both spray and dropper applications are effective. Research into different forms of hair loss treatments has found that foams, sprays and solutions are equally effective at treating hair loss.11, 12
However, using a dropper application may allow for precise application to the desired area of the scalp and may be preferable for those with more localized hair loss. The dropper also allows for precise measurement and dosing.
For those with larger areas of hair loss, a foam or spray application may be seen as a faster and more convenient way to cover a larger percentage of the scalp. However, it may lead to wastage of the product as it is harder to measure the amount used and can miss the target area or become stuck in the hair.
Who can and who can’t use the product?
A combination topical finasteride and minoxidil is recommended for men and women over 18 years old who are experiencing hair loss and may be particularly suitable for those who have experienced sexual side effects using a combination of oral finasteride and topical minoxidil.
It is essential to note that the product is not recommended for pregnant or breastfeeding women or for women who are planning on becoming pregnant. Finasteride can cause birth defects in a developing male fetus, and minoxidil can be absorbed through the skin and enter the bloodstream, potentially causing harm to a developing fetus.
Furthermore, individuals with a history of chronic liver disease, prostate cancer or breast cancer should consult with their healthcare provider before using the product. Finasteride is primarily metabolized by the liver, and individuals with liver disease may not be able to effectively metabolize the medication, leading to an increased risk of side effects.
It should not be taken in combination with any oral 5-AR blockers such as finasteride or dutasteride.
If you are allergic to topical minoxidil, then you should not use this treatment, however, research has shown that oral minoxidil may still be suitable for you13 which may be used in combination with finasteride-only topical solution.
Side Effects of topical finasteride and minoxidil.
The combination of topical finasteride and minoxidil solution may cause side effects like any medication. However, as lower doses are used in topical treatment, the risk of systemic effects is lower than with oral medications and the most common side effects are local, skin-related problems such as scalp irritation, redness, and itching. These side effects typically subside within a few weeks of regular use. Some individuals may also experience an initial shedding phase, where hair loss increases temporarily before regrowth occurs.
Less common side effects of the medication may include dizziness, low libido, and erectile dysfunction. These side effects are more commonly associated with oral finasteride use, but they may still occur with topical use, especially when higher concentrations of the medication are used. It is important to speak with a healthcare provider if any of these side effects occur or if there are any concerns about the medication.
If I switch from oral finasteride and topical minoxidil to topical finasteride/minoxidil, will I experience shedding?
Shedding is a temporary yet worrying side effect of finasteride. It is caused when the DHT-blocking effect of finasteride causes hairs to alter their cycle of hair growth.
After starting finasteride follicles are pushed from the resting phase into the growth phase and begin to create new hair. However, for new hair to develop, resting follicles must shed any existing hair, which falls out. This allows healthy new hair to grow in your dormant follicles. It’s important to be aware of this side effect to avoid prematurely stopping treatment.
However, this is a temporary side effect that only occurs within the first weeks to months of use. So, if you have been on oral finasteride long-term, it’s unlikely that swapping to topical finasteride will lead to a new round of shedding.
How quickly do users see the regrowth of hair?
As with oral finasteride and topical minoxidil, the speed of regrowth with a combined topical solution of minoxidil and finasteride can vary from person to person, but most users can expect to see results within three to six months of regular use. Most combination minoxidil/finasteride trials demonstrated results between 12-24 weeks. It is important to note that the medication’s effects are not immediate and require consistent use for optimal results. Users may experience an initial shedding phase, where hair loss increases temporarily before regrowth occurs.
Hair loss can be a frustrating and challenging experience, leading to a loss of self-esteem and confidence. Fortunately, there are various treatment options available, including a combination of topical finasteride and minoxidil. The combined solution can provide greater benefits than using each medication alone, as minoxidil promotes hair growth, while finasteride reduces DHT levels, preventing further hair loss.
Foam, spray and dropper applications are effective, but a dropper application allows for more precise application to the scalp and may be preferable for those with more localized hair loss.
With regular use, users can expect to see significant regrowth of hair and improved self-confidence. It is essential to speak with a healthcare provider directly if any concerns arise or if there are any questions about the medication. Overall, a combined topical finasteride and minoxidil solution is an effective treatment for individuals looking for a solution to their hair loss.
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- Suchonwanit P, Thammarucha S, Leerunyakul K. Minoxidil and its use in hair disorders: a review. Drug Des Devel Ther. 2019;13:2777-86.
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- Piraccini BM, Blume-Peytavi U, Scarci F, Jansat JM, Falqués M, Otero R, et al. 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. 2022;36(2):286-94.
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