Things to Consider when Topical finasteride does not work

Topical finasteride at low doses

 
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in the use of topical finasteride.

Question

I am on topical fin 0.025 %. I have been using 2 months and I am still shedding. I measured by dHT in the blood and it has not changed all that much. Do you think this is working?

Answer

Thanks for the great question.

My feeling here is that this is the wrong approach to evaluating hair loss.
Looking at serum DHT in this way is not really a key parameter to track to see if topical finasteride is working. No. If you could measure skin DHT (rather than blood) before and after that would be more relevant. The reality is that you can’t do this easily because it’s not available to the general public (it’s very expensive and used only in research).

For now, you can easily tell if topical finasteride is working by assessing these answers with your doctor after 6 months of treatment:

1) is the shedding less?

2) is the hair density better by photos?

Your topical finasteride concentration is pretty low so be sure to keep close follow up. Most of the time, we don’t use such low concentrations but yes, it’s an option. 0.1 % and 0.25 % are becoming more common.

Shedding can occur in the first two months of starting topical finasteride (or oral) so we can’t say for sure this is a bad sign of a sign things are not working but it’s certainly not looking favourable at the 8 week mark.

Give it a few months if you and your doctors are comfortable with that. Review the literature with your doctors for optimal dosing.