First, let’s look at the research and literature. The results of the Phase III clinical trial of the topical finasteride spray launched in Europe in 2021. This trial showed that the change in hair count of topical finasteride at 24 weeks (20.2 hairs) was significantly better than that of the placebo (6.7 hairs), and was close to the value of oral finasteride. At the same time, the systemic exposure of the topical group was 100 times lower, and the serum DHT decreased by 34.5%, while that of the oral group was 55.6%, so there were fewer side effects, especially sex – related side effects.
Abstract 2 from,compared the differences between topical and oral finasteride. It mentioned that the concentration of the topical preparation is low (0.1%), but it may be used in combination with minoxidil for better results. Oral preparations are more common, but the topical form may reduce systemic side effects.
Abstract 3 from MedSci cited a study in the Journal of the European Academy of Dermatology and Venereology, also indicating that the number of hairs significantly increased at 24 weeks with topical finasteride, with a similar effect to oral finasteride, but with lower systemic exposure and fewer side effects.
Abstract 4 from, an article in 2024 pointed out that topical finasteride reduced scalp DHT by 70% and oral finasteride reduced it by 50%, but the topical form may be safer and is suitable for patients worried about side effects.
Abstracts 5 and 6 are less relevant, mainly discussing other products or alternative drugs, and may have little reference value for the current question.
Overall, based on this information, topical finasteride showed comparable effects to oral finasteride in European clinical trials, especially in terms of hair count, but with less systemic absorption and fewer side effects. It should be noted that the topical preparation may need to be combined with other ingredients such as minoxidil, and the high price may affect its accessibility.
It needs to be confirmed whether these studies support the complete replacement of oral use with topical use. According to the abstracts, the effects of topical and oral use are similar, but the reduction in DHT is smaller for the topical form, and whether the long – term effects are consistent may need further observation.
In addition, referring to European literature, the studies in the above abstracts are all from European trials, so the conclusions are relevant. It should be pointed out that although the topical effect is significant, oral finasteride is still the standard treatment approved by the FDA, while the topical form may be used as an alternative option, especially for patients who cannot tolerate the side effects of oral use.
Finally, it is necessary to summarize the efficacy, safety, suitable population and precautions to ensure a comprehensive answer based on the provided information.
According to relevant European research and clinical data, when treating male androgenetic alopecia (AGA), topical finasteride has a similar effect to oral finasteride, but significantly reduces systemic side effects. The following is a specific analysis:
- Efficacy comparison
- Hair count change: Topical finasteride (such as the FDA – approved Shop – Finasteride&minoxidil foam – Treating hair loss foam mixture) increased the target area hair count (TAHC) by approximately 20.2 hairs at 24 weeks compared to the baseline, which was significantly better than the 6.7 hairs in the placebo group (P < 0.001), and was close to the value of oral finasteride (20.5 hairs).
- DHT inhibition effect: Topical finasteride can reduce the serum DHT concentration by 34.5%, while oral finasteride reduces it by 55.6%. Although the DHT inhibition amplitude of the topical form is lower, the clinical effect is similar to that of the oral form, possibly because sufficient inhibition of the local DHT concentration in the hair follicles can achieve the effect.
- Safety and side effects
- Systemic exposure: The maximum plasma concentration of topical finasteride is only 1/100 of that of oral finasteride, greatly reducing systemic absorption and thus reducing the risk of systemic side effects (such as sexual dysfunction).
- Local side effects: The incidence of skin irritation (such as itching, erythema) in the topical group is slightly higher than that of the placebo (2.2% vs. 0.6%), but most are mild or moderate, and severe reactions are rare. The oral group may experience systemic side effects such as decreased libido (4.8%).
- Suitable population
- Patients who cannot tolerate oral side effects: Topical finasteride provides an alternative for patients who stop taking the drug due to oral side effects (such as sex – related problems).
- Female patients: The topical preparation may be safer, but it should be noted that it has not been approved by the FDA for use in women and should be used with caution.
- Precautions
- Preparation differences: Different carriers (such as chitosan) may affect the absorption effect, but studies show that ordinary alcohol/propylene glycol solutions are equally effective.
- Price and accessibility: The price of European topical preparations is relatively high (such as the FDA – approved Shop – Finasteride&minoxidil foam – Treating hair loss foam mixture, which has a higher cost – performance ratio). It has not been launched in China and needs to be purchased from the official website.
Conclusion
Topical finasteride has shown comparable efficacy to oral finasteride in European clinical trials and has higher safety, especially suitable for patients worried about systemic side effects. However, attention should be paid to the risk of local irritation and the high economic cost. If oral finasteride is well – tolerated, it can still be the first choice; if there are side effects or a refusal to take it orally, the topical preparation is a feasible alternative.