Oral vs Topical Finasteride

Bespoke Skin MD
Nov 1
4 min read

Oral vs Topical Finasteride: Which Is Better for Hair Growth?

At Bespoke Hair MD in Kingston, Ontario, many patients ask whether oral or topical finasteride is the better choice for hair restoration. Both are proven to slow genetic hair loss (androgenetic alopecia) — but they differ in how they work, their risk profiles, and who they’re best suited for.

Here’s an evidence-based look at how each form works, what the latest research says, and how we help patients decide at Bespoke Hair MD.

💊 What Is Finasteride and How Does It Work?

Finasteride is a medication that blocks 5-alpha-reductase, an enzyme that converts testosterone into dihydrotestosterone (DHT) — the hormone responsible for shrinking hair follicles in people genetically prone to hair loss.

By lowering scalp DHT levels, finasteride can slow hair loss, thicken existing hairs, and promote regrowth.

Finasteride is most commonly prescribed for male pattern hair loss, though off-label use in women may be considered in select cases under medical supervision.

🔹 Oral Finasteride (1 mg tablet)

Oral finasteride (brand name Propecia®, or generic finasteride 1 mg) is taken daily and has been used safely for over 25 years in millions of patients.

Advantages of Oral Finasteride:

Proven efficacy: Clinical studies show a 60–80% success rate in slowing or reversing male pattern hair loss.
Convenient: Once-daily tablet.
Systemic DHT reduction: Consistently lowers DHT levels by about 70% in both scalp and serum.
Long safety record: Extensively studied with over two decades of data.

Drawbacks / Risks of Oral Finasteride:

While well tolerated in most men, oral finasteride can cause side effects in a small percentage of users.

Potential side effects include:

Sexual dysfunction: Decreased libido, erectile dysfunction, or reduced semen volume in 1–3% of users.
Mood changes: Rare reports of anxiety, depression, or brain fog (mechanism unclear).
Post-Finasteride Syndrome (PFS): A controversial, poorly defined condition involving persistent symptoms after discontinuation — rare but important to monitor.
Systemic absorption: Reduces DHT throughout the body, which may not be ideal for patients sensitive to hormonal changes.

Safety note: Finasteride should not be handled by pregnant women due to risk of fetal malformation.

🔸 Topical Finasteride

Topical finasteride is applied directly to the scalp, usually once daily, often compounded with minoxidil (2–5%) to enhance effectiveness.

The goal is to reduce scalp DHT locally while minimizing systemic absorption — offering potential hair benefits with fewer hormonal side effects.

Advantages of Topical Finasteride:

Localized effect: Lowers DHT levels primarily in the scalp.
Reduced systemic exposure: Studies suggest blood DHT levels are reduced by only 20–30%, compared to 70% with oral dosing.
Fewer side effects: Reduced risk of sexual or mood-related side effects.
Combination potential: Can be compounded with minoxidil for dual benefit.

Drawbacks / Limitations:

Less standardized: Compounding formulas vary widely in strength, vehicle, and absorption.
Variable efficacy: While early studies show results similar to oral finasteride, consistency between products is a concern.
Requires consistent use: Missing applications can reduce effectiveness.
May cause scalp irritation: Especially if alcohol-based solutions are used.

🧬 Oral vs Topical Finasteride: What the Research Shows

Comparison	Oral Finasteride (1 mg)	Topical Finasteride (0.25–0.5%)
Mechanism	Systemic 5-alpha-reductase inhibition	Local scalp DHT inhibition
DHT Reduction	~70% systemic and scalp	~25% systemic, ~60% scalp
Efficacy (Hair Count Improvement)	+10–15% after 6–12 months	+8–13% after 6–12 months (comparable)
Side Effects	1–3% sexual, mood-related	<1% mild scalp irritation or local dryness
Ease of Use	Simple daily pill	Daily topical application
Best For	Men comfortable with systemic therapy	Men seeking lower risk of side effects or combination therapy with minoxidil

Key takeaway: Topical finasteride provides similar efficacy with fewer systemic effects, but results depend heavily on product formulation and patient adherence. Oral finasteride remains the gold standard for consistency and long-term data.

⚠️ Risks and Considerations

While finasteride is generally safe, patients should be informed about potential risks and monitored appropriately.

Common concerns include:

Hormonal effects: Reduced DHT can occasionally affect sexual or reproductive health.
Mood or neurological effects: Very rare; discuss promptly if symptoms occur.
Shedding phase: Temporary increase in shedding may occur as follicles reset.
Pregnancy safety: Women who are pregnant or planning pregnancy should not handle finasteride.

At Bespoke Hair MD, all finasteride prescriptions and topical formulations are medically supervised and customized for each patient’s profile, minimizing risk and maximizing results.

🩺 How We Use Finasteride at Bespoke Hair MD

At Bespoke Hair MD, we integrate finasteride therapy into comprehensive, surgeon-directed hair restoration programs that may include:

PRF (Platelet-Rich Fibrin) injections
Exosome or growth factor therapy
Low-Level Laser Therapy (LLLT)
SmartGraft® FUE Hair Transplantation

💬 The Bottom Line

Both oral and topical finasteride are effective tools for preventing hair loss and promoting regrowth — but they differ in risk profile and convenience.

Oral finasteride offers robust, proven results but carries a slightly higher risk of systemic side effects.
Topical finasteride is emerging as an excellent alternative for patients who want targeted action with fewer hormonal concerns.

The best approach is personalized — based on your medical history, goals, and tolerance.

📅 Book Your Hair Restoration Consultation

Ready to find out which treatment is right for you? Book a confidential consultation with Bespoke Hair MD in Kingston, Ontario.

We’ll assess your scalp, review your medical history, and design a hair restoration plan that’s as unique as you are.

📍 Bespoke Hair MD – Regenerative Hair Restoration • Kingston, Ontario📞 (613) 549-7546 | 💻 www.bespokehairmd.com

*** This is not medical advice and is for entertainment purposes only, see your physician***

dr kim meathrel, dr kim meathrel reviews, hair restoration kingston, fue kingston, hair transplant kingston, finasteride, male pattern baldness, androgenic alopecia, dr wes edmunds, kingston hair restor

ation

Oral vs Topical Finasteride: Which Is Better for Hair Growth?

At Bespoke Hair MD in Kingston, Ontario, many patients ask whether oral or topical finasteride is the better choice for hair restoration. Both are proven to slow genetic hair loss (androgenetic alopecia) — but they differ in how they work, their risk profiles, and who they’re best suited for.

Here’s an evidence-based look at how each form works, what the latest research says, and how we help patients decide at Bespoke Hair MD.

💊 What Is Finasteride and How Does It Work?

Finasteride is a medication that blocks 5-alpha-reductase, an enzyme that converts testosterone into dihydrotestosterone (DHT) — the hormone responsible for shrinking hair follicles in people genetically prone to hair loss.

By lowering scalp DHT levels, finasteride can slow hair loss, thicken existing hairs, and promote regrowth.

Finasteride is most commonly prescribed for male pattern hair loss, though off-label use in women may be considered in select cases under medical supervision.

🔹 Oral Finasteride (1 mg tablet)

Oral finasteride (brand name Propecia®, or generic finasteride 1 mg) is taken daily and has been used safely for over 25 years in millions of patients.

Advantages of Oral Finasteride:

Proven efficacy: Clinical studies show a 60–80% success rate in slowing or reversing male pattern hair loss.

Convenient: Once-daily tablet.

Systemic DHT reduction: Consistently lowers DHT levels by about 70% in both scalp and serum.

Long safety record: Extensively studied with over two decades of data.

Drawbacks / Risks of Oral Finasteride:

While well tolerated in most men, oral finasteride can cause side effects in a small percentage of users.

Potential side effects include:

Sexual dysfunction: Decreased libido, erectile dysfunction, or reduced semen volume in 1–3% of users.

Mood changes: Rare reports of anxiety, depression, or brain fog (mechanism unclear).

Post-Finasteride Syndrome (PFS): A controversial, poorly defined condition involving persistent symptoms after discontinuation — rare but important to monitor.

Systemic absorption: Reduces DHT throughout the body, which may not be ideal for patients sensitive to hormonal changes.

Safety note: Finasteride should not be handled by pregnant women due to risk of fetal malformation.

🔸 Topical Finasteride

Topical finasteride is applied directly to the scalp, usually once daily, often compounded with minoxidil (2–5%) to enhance effectiveness.

The goal is to reduce scalp DHT locally while minimizing systemic absorption — offering potential hair benefits with fewer hormonal side effects.

Advantages of Topical Finasteride:

Localized effect: Lowers DHT levels primarily in the scalp.

Reduced systemic exposure: Studies suggest blood DHT levels are reduced by only 20–30%, compared to 70% with oral dosing.

Fewer side effects: Reduced risk of sexual or mood-related side effects.

Combination potential: Can be compounded with minoxidil for dual benefit.

Drawbacks / Limitations:

Less standardized: Compounding formulas vary widely in strength, vehicle, and absorption.

Variable efficacy: While early studies show results similar to oral finasteride, consistency between products is a concern.

Requires consistent use: Missing applications can reduce effectiveness.

May cause scalp irritation: Especially if alcohol-based solutions are used.

🧬 Oral vs Topical Finasteride: What the Research Shows

Key takeaway: Topical finasteride provides similar efficacy with fewer systemic effects, but results depend heavily on product formulation and patient adherence. Oral finasteride remains the gold standard for consistency and long-term data.

⚠️ Risks and Considerations

While finasteride is generally safe, patients should be informed about potential risks and monitored appropriately.

Common concerns include:

Hormonal effects: Reduced DHT can occasionally affect sexual or reproductive health.

Mood or neurological effects: Very rare; discuss promptly if symptoms occur.

Shedding phase: Temporary increase in shedding may occur as follicles reset.

Pregnancy safety: Women who are pregnant or planning pregnancy should not handle finasteride.

At Bespoke Hair MD, all finasteride prescriptions and topical formulations are medically supervised and customized for each patient’s profile, minimizing risk and maximizing results.

🩺 How We Use Finasteride at Bespoke Hair MD

At Bespoke Hair MD, we integrate finasteride therapy into comprehensive, surgeon-directed hair restoration programs that may include:

PRF (Platelet-Rich Fibrin) injections

Exosome or growth factor therapy

Low-Level Laser Therapy (LLLT)

SmartGraft® FUE Hair Transplantation