Finasteride
Topical Finasteride is a prescription treatment for male pattern hair loss, applied to the scalp so that less of the drug reaches the rest of the body.
Finasteride works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), which plays a key role in hair loss. As such, it is particularly useful in androgenetic alopecia (male and female pattern hair loss), which causes a receding hairline and thinning hair. By reducing DHT levels in the scalp, Finasteride can help to slow thinning and promote regrowth. Taken as a tablet, it treats the whole body to reach the scalp. Applied topically, it is designed to work where you are thinning, whilst keeping much less of the drug in the blood. Because it is a powerful hormonal medicine, Finasteride is prescription-only in the UK and needs to be used under medical supervision to minimise risks and side effects. At City Skin Clinic, topical Finasteride is one of the prescription actives a doctor may include in a hair loss treatment if it suits your health and your pattern of loss.
What Is Finasteride and How Does It Work?
Finasteride is a type of medicine called a 5-alpha-reductase inhibitor. It blocks the enzyme 5-alpha-reductase, which is what converts testosterone into DHT. DHT is the main hormonal driver of male pattern hair loss, so reducing it is the most direct way to slow the condition at its source.
Follicles at the temples and crown are the most sensitive to DHT, which is why hair is usually lost there first. By lowering DHT at the scalp, Finasteride helps protect those follicles from further shrinking, and over several months many men keep the hair they have and regrow some of what was thinning. It does not create new follicles. It works on the ones you still have, which is why starting earlier tends to give more to work with.
How City Skin Clinic Uses Finasteride
We use topical Finasteride in our prescription hair loss treatments for men and for suitable postmenopausal women, as a cream or serum compounded for you. Your doctor decides the strength, the base and whether it works alone or alongside other actives such as Minoxidil, based on your health, your pattern of hair loss and your goals. Most formulas combine Finasteride with Minoxidil in a single serum, because reducing DHT and stimulating the follicles at the same time does more than either alone. It can also be used on its own in a formula where that is the better fit. The treatments we may use topical Finasteride in include:
These are the actives we most often pair it with:
- Minoxidil: the most common partner in our formulas. It stimulates the follicles whilst Finasteride lowers DHT.
- Caffeine: stimulates the follicles and improves blood flow to the scalp.
- Melatonin: supports the hair growth cycle and helps protect follicles from oxidative stress.
- Tretinoin: a retinoid that can improve the absorption of the other actives and may also help stimulate growth.
- Hydrocortisone: calms scalp irritation that some treatments can cause.
How Do You Get Topical Finasteride in the UK?
Finasteride is a prescription-only medicine in the UK, so the only legal way to get it is with a prescription from a doctor or other qualified prescriber. There is no licensed topical Finasteride product in the UK. This means it is prescribed as an unlicensed compounded medicine, made for you individually by a specialist pharmacy. The safe routes are a private dermatologist or medical hair clinic. At City Skin Clinic, you start with an online consultation, by video or form, and a doctor decides on the most appropriate formula for you, including whether topical Finasteride is right for you and at what strength. Our guide to Finasteride walks through the evidence, the strengths, safety and the routes in full.
To start, complete an online consultation form or book a virtual video consultation with one of our doctors. Your doctor will design a custom hair loss treatment that is suitable for you, taking into account your wishes and preferences wherever possible. They will also monitor you throughout your treatment and are available by email at any time.
Personalised Treatment Fees (3 Month Supply)
VIRTUAL CONSULTATION£30
Your will doctor assess your hair, health and your goals to design your treatment. The same doctor looks after you throughout. Cost of consultation fee credited in full against your first treatment.
PERSONALISED HAIR LOSS TREATMENT£120
A 3-month supply of your custom hair loss serum, with delivery and your doctor's ongoing aftercare included.
Treatment Time
15 Minutes
Duration of effect
3-4 Months
Back to Work
Same Day
There is no subscription and no auto-renewal. Each course is a single order you place yourself.
Topical vs Oral Finasteride
Traditional Finasteride is a daily tablet. Topical Finasteride is applied to the scalp instead, and it is designed to act where hair loss happens while keeping less of the drug in the bloodstream than tablets do. In a phase III randomised controlled trial of 458 men, peak blood Finasteride levels were more than 100 times lower with the topical spray than with the tablet, while the improvement in hair count was similar. That is the case for treating the scalp directly rather than the whole body.
It is not a loophole, and it is not risk-free. Topical Finasteride is still absorbed to some degree, and it can still cause the side effects associated with the tablet. What the topical route aims to do is reduce whole-body exposure, but it does not remove it. Your doctor should explain these risks before prescribing.
| Topical Finasteride | Oral Finasteride (tablet) | |
|---|---|---|
| How you use it | Applied to the scalp | Taken daily |
| Where it mainly acts | At the scalp | Throughout the body |
| Blood levels of the drug | Much lower (>100x lower peak in trial) | Higher |
| Evidence for hair regrowth | Similar hair-count gain to the tablet at 24 weeks | Long-established |
| Prescription-only | Yes | Yes |
| Can still cause side effects | Yes | Yes |
| Licensed | Unlicensed | Licensed for men with male pattern hair loss |
What Strengths Does Topical Finasteride Come In?
Because every formula is compounded from scratch, your doctor can prescribe topical Finasteride across a wide range of strengths, from 0.001% up to 0.25%, matched to your hair loss and how your skin tolerates it. The most studied topical strength is 0.25%, but many men can do well starting low and stepping up only if needed. Your doctor then adjusts the strength at each course based on how you have responded. Just remember, whilst lower strengths keep whole-body exposure lower, no strength is risk-free. This is because absorption is never zero. However, your doctor can aim for the lowest strength that works for you rather than a single dose set for everyone.
What Are the Side Effects of Topical Finasteride?
Most men tolerate topical Finasteride well, but it can cause side effects and you should know them before you start. Some of the side effects of Finasteride include:
- Sexual side effects: reduced sex drive, difficulty getting or keeping an erection and problems with ejaculation. In trials these were reported by a small minority. They were less common with the topical than the tablet, but can happen with either.
- Mood changes: low mood, anxiety and, rarely, thoughts of self-harm have been reported with Finasteride. The MHRA strengthened its safety warnings on Finasteride and introduced a patient alert card covering these risks. If your mood changes while using it, stop and speak to your doctor.
- Breast changes: tenderness or enlargement of breast tissue (gynaecomastia) is uncommon. Report any new breast lump, pain or discharge to a doctor.
- PSA and prostate checks: Finasteride can lower PSA, the blood marker used in prostate checks. This can make a reading look more reassuring than it really is. Topical Finasteride puts far less of the drug in the bloodstream than the tablet, but absorption is never zero. So tell any doctor checking your PSA that you use Finasteride, whatever the form.
- Skin reactions at the scalp: because it is applied topically, some men get local irritation, redness or itching where it is used.
For most men the sexual side effects that do occur resolve after stopping the medicine. However, in a small number they can persist even after stopping the treatment. Your doctor should go through your history, assess your suitability and inform you of the risks. They should also provide proper aftercare. Whilst topical Finasteride can be a safe and effective treatment for certain types of hair loss, it is a prescription-only medicine in the UK due to these serious risks. It should only be used under the guidance of your doctor or prescribing healthcare provider.
Who Should Not Use Topical Finasteride?
Topical Finasteride is not right for everyone. Your doctor will not prescribe it if it is not safe or suitable, or if there are better options for you. In particular, it is not suitable for:
- Women who are pregnant, could become pregnant or are breastfeeding: Finasteride can harm a developing male baby, so it is not suitable for women who are pregnant, may become pregnant or are breastfeeding. This makes it unsuitable for premenopausal women. Some postmenopausal women can use it, usually where Minoxidil alone has not been enough after a year of consistent use.
- Anyone living with someone who is pregnant, or couples trying to conceive: Finasteride can be absorbed through skin contact, and pregnant women should avoid handling it or touching treated skin. A pregnancy can begin before anyone knows, so topical Finasteride is not suitable if someone in your household is pregnant or if you and your partner are trying to conceive. Even where neither applies, let it dry fully, wash your hands after applying and keep the treated scalp away from young children.
- A history of depression or anxiety: Finasteride has been linked to low mood and, rarely, suicidal thoughts, so it is not suitable for anyone with a history of depression or anxiety.
- Broken or irritated scalp skin, and allergy: topical Finasteride is applied to the skin, so it is not suitable on broken, infected or significantly irritated scalp skin until that has settled. It is also not suitable for anyone who has reacted negatively to Finasteride before.
- Beards: Finasteride is not suitable for beard growth. DHT drives beard growth, so blocking it would work against the goal.
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Frequently asked questions
Authored by:
Aesthetic Doctor & Medical Director BSC (HONS) MBBS MRCS PHD
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611