Can You Take Oral And Topical Finasteride At The Same Time?

It’s been decades since oral finasteride has been approved for use in the treatment of male pattern hair loss. But recently, there has been an increased formulation of topical finasteride to provide better outcomes with lesser risk of side effects. 

In this article, the pharmacist will explain if it is safe to take oral and topical finasteride at the time or use the two concurrently during the course of treatment.

What to Know About Finasteride and Hair Loss.

Finasteride is a prescription-only drug belonging to the drug class – 5-alpha reductase inhibitor. It was approved by the FDA for use in the treatment of both benign prostatic hyperplasia (BPH) just like dutasteride, and male pattern baldness or androgenetic alopecia.

The FDA only approved the oral formulation of finasteride for use in the treatment of both BPH and hair loss. For BPH treatment, it is taken at a dose of 5 mg daily while 1 mg daily is used in androgenetic alopecia. 

Oral Finasteride for hair loss is available by the brand name Propecia and is quite effective in this regard.

All topical finasteride formulations available for use in the treatment of hair loss are not FDA-approved. They are available only as compounded medications. 

Meaning that they are sold as though they were a customized drug that is specially prepared by a pharmacist according to a doctor’s prescription to meet an individual patient’s needs.

As such, you cannot find them over-the-counter in your local pharmacies. To get the drug, you must be prescribed it after a professional assessment.

Both oral and topical finasteride work the same way. They stop hair loss by preventing the conversion of testosterone into dihydrotestosterone (DHT). 

DHT is responsible for pattern hair loss in both males and females. It causes the shrinkage of hair follicles, thereby resulting in shorter and thinner hair [1].

Can You Take Oral And Topical Finasteride Together?

It is not advisable to take both topical and oral finasteride together because of the increased chances of exceeding the maximum recommended dose. This can increase your risk of experiencing some of the awful sexual side effects of this drug. It can also have a negative impact on your hair loss treatment.

If we go by the result of one study that compared the therapeutic effects of both topical and oral finasteride in the treatment of androgenetic alopecia [2]. You will not need to take the two together as either of them can provide sufficient treatment for hair loss. Provided you’re using it as directed by your prescriber. 

In the study, 45 males with alopecia were divided into two groups: topical finasteride and oral finasteride. At the end of the study, it was found that there were no significant differences between the two groups in terms of hair thickness, hair counts, and the size of bald area left after treatment. 

This showed that the therapeutic effects of both forms of finasteride are similar. Hence, there is no need to combine the two dosage forms at once, unless you’re specifically advised by your doctor to do so.

Does topical finasteride work as well as oral?

Research has shown that topical finasteride works just as well as oral tablets, and even better [2,3]. The only difference between the two dosage forms of the drug is that the topical finasteride is applied locally to the scalp while the oral finasteride is delivered into the systemic circulation.

This difference in mode of administration is what also gives the topical dosage form an edge over the oral formulation of finasteride. Oral Finasteride is associated with a handful of side effects. These side effects are often the reason why men with alopecia resort to alternative forms of treatment. 

Its side effects commonly affect sexual health, causing untoward effects like low sex drive, low volume of ejaculate, inability to get or maintain an erection, and enlarged breasts (gynecomastia).

The side effects of oral finasteride are comparatively heightened because the drug is going into systemic circulation. It is carried by blood and circulated to every part of the body where it can bind and activate androgen receptors. 

Topical finasteride, even though very little research has been done on it, is believed to have minimal side effects when compared to the oral dosage form. Common side effects usually include redness of the scalp, itching, irritation, and contact dermatitis.

Topical finasteride having minimal side effects can be attributed to the fact that it is applied locally. And even though some of the active drug gets absorbed into the blood, it will be at a way lesser amount compared to that of oral administration.

Final Thoughts

It is not recommended to take both oral and topical finasteride at the same time because they both contain the same active ingredient but in different dosage forms. Using the two together can result in overdose which can increase your risk of side effects. And can also harm your hair loss treatment outcome. Choosing and sticking to either of the two is totally fine unless you are advised by your doctor to do otherwise.

References

1. Zito PM, Bistas KG, Syed K. Finasteride. [Updated 2022 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 
2. Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51. doi: 10.4103/0378-6323.45220. PMID: 19172031.
3. GF Mazzarella, GF Loconsole, GA Cammisa, GM Mastrolonardo & Ga Vena (1997) Topical finasteride in the treatment of androgenic alopecia. Preliminary evaluations after a 16-month therapy course, Journal of Dermatological Treatment, 8:3, 189-192, DOI: 10.3109/09546639709160517
4. Jerry Shapiro, Keith D. Kaufman, Use of Finasteride in the Treatment of Men With Androgenetic Alopecia (Male Pattern Hair Loss). Journal of Investigative Dermatology Symposium Proceedings. Volume 8, Issue 1, 2003, Pages 20-23. ISSN 1087-0024.