Oral finasteride vs topical finasteride: What's the difference?

Finasteride is a medication used to treat male pattern baldness. It can be taken as a daily tablet or applied directly to the scalp as a topical hair loss treatment.

Both topical and oral finasteride reduce levels of dihydrotestosterone (DHT), the hormone responsible for shrinking hair follicles, but they differ in how they are used, how much evidence supports them, their risk of side effects, and their licensing in the UK.

Here we explain the differences between oral and topical finasteride in more detail and help you choose the right one for you.

What’s the difference between oral and topical finasteride?

How do oral and topical finasteride work?

Both oral and topical finasteride treat hair loss by reducing levels of dihydrotestosterone (DHT), the hormone responsible for shrinking the hair follicles in men with male pattern baldness (1). By lowering DHT levels, finasteride stops further hair loss and may even support regrowth.

Because oral finasteride is taken as a pill, it lowers DHT levels throughout the body, including the scalp. In comparison, topical finasteride is applied directly to the scalp and mainly works at the follicle level, though a small amount of the medicine still enters the bloodstream.

Which is the most effective for hair loss?

Some studies suggest that topical and oral finasteride can produce similar short-term improvements in hair count (2-3). However, oral finasteride is still generally considered the more effective and reliable option for most men (3).

This is mainly because it has been studied for much longer. Clinical trials going back to the 1990s show that taking a finasteride tablet daily can significantly increase hair count and slow further loss in the majority of men, especially when treatment is started early (4).

In comparison, topical finasteride is a newer treatment. Early research is encouraging, but most studies have followed patients for only a few months (3). Longer-term evidence is still limited compared with oral finasteride.

Which one gives faster results?

Finasteride works gradually, and both oral and topical treatments follow a similar timeline. Most men notice that shedding reduces after around 3 to 6 months of continued daily use, and hair continues to thicken over the next 12 to 24 months, before reaching its maximum effect.

The main difference between oral and topical finasteride is not how quickly they work, but how much evidence there is that these results can be maintained. Stopping treatment is associated with hair loss within several months, so finasteride is usually continued long-term.

In long-term studies of oral finasteride, more than 80% of men maintained their existing hair over five years of treatment, and many experienced further improvement with time (5). Evidence also suggests that ongoing treatment reduces the likelihood of further hair loss in most men (6).

While topical finasteride is expected to provide similar maintenance as long as the medicine is continued, there are fewer studies that establish the long term relationship, so this has not been confirmed to the same extent.

How do side effects compare?

Both oral and topical finasteride are generally well tolerated, but the risk of side effects is one of the main reasons some men choose one option over the other.

Side effects of oral finasteride

Because oral finasteride works throughout the body, a small number of men experience side effects related to reduced DHT levels. These can include (7):

• Reduced sex drive (1 in 100 people)

• Erectile dysfunction (1 in 100 people)

• Reduced semen volume (1 in 100 people)

• Breast tenderness or swelling (1 in 1,000 people)

• Mood changes (1 in 1,000 people)

Most men take finasteride without experiencing these side effects. But the MHRA recently strengthened safety advice for finasteride after some patients reported suicidal thoughts (8). As a precaution, oral finasteride might not be suitable for people with a history of mental health problems, and it’s advised to speak to a doctor and stop treatment if you notice any mood changes.

Rarely, some men experience persistent side effects after stopping, known as Post-Finasteride Syndrome (PFS). However, for most men, side effects resolve completely once treatment stops.

Side effects of topical finasteride

As topical finasteride is applied to the scalp, less of the medicine enters the bloodstream. Early studies suggest this may lower the risk of sexual side effects and PFS compared with tablets (3,9).

Possible side effects of topical treatment tend to be more localised to the scalp and include:

• Scalp irritation

• Itching

• Dryness or redness at the application site

For this reason, topical finasteride may be a better option if you’re worried about side effects or have a history of sexual dysfunction or mental health conditions.

If you’re experiencing side effects while taking finasteride tablets, it is also possible to switch to a topical application. Most men will see an improvement in side effects without losing their progress.

Is a tablet or topical treatment easier to use?

Whether a tablet or topical treatment is “easier” comes down to personal preference.

Oral finasteride is the more convenient option for many men, as it is much quicker to swallow a tablet than to apply a solution to the scalp every day. But while more time-consuming, some men forget to take a daily pill and find it easier to remember to apply topical treatment.

As with any hair loss treatment, consistency and long-term use are important for maintaining results. When choosing between topical and oral, the best option is usually the one you feel most comfortable using regularly.

Can you use oral and topical finasteride together?

No, it’s not usually recommended to use oral and topical finasteride together. Both treat hair loss by lowering DHT levels, so combining them increases the amount of finasteride in the body, potentially worsening side effects without evidence of any extra benefit.

If you want to try combining hair loss treatments, consider taking finasteride with minoxidil. Minoxidil treats hair loss by improving blood flow to the scalp and lengthening the growth phase of the follicles. As it targets different pathways to stimulate hair growth, it can be safely taken alongside finasteride.

There are a few different ways to combine these two evidence-based treatments:

• Oral finasteride taken alongside topical minoxidil (10)

• Combination sprays that contain topical finasteride and minoxidil (11)

• Oral finasteride and oral minoxidil (12)

Regardless of the method of delivery, studies have repeatedly shown that combining finasteride with minoxidil improves hair count and thickness compared with using either treatment alone (10-12).

Supportive haircare products like Alpecin C1 Shampoo or Sons DHT Blocking Shampoo and Conditioner can also improve the appearance of hair alongside medical treatment.

How can you get oral or topical finasteride in the UK?

Both oral and topical finasteride require a prescription to make sure the treatment is safe and suitable. However, the NHS does not prescribe finasteride for treating hair loss (13). Instead, you’ll have to get a private prescription following an in-person or online consultation.

Many private clinics and prescribing pharmacists, including Oxford Online Pharmacy, can prescribe both oral and topical formulations, but only oral finasteride is licensed in the UK for male pattern hair loss (14). This means that it has been formally approved as safe and effective for this condition.

That’s not to say that topical finasteride is unsafe or ineffective. It purely means it has not yet gone through the full regulatory approval process for use as a hair loss treatment, so prescriptions of finasteride solutions, gels, and sprays are considered “off-label.”

Which option is right for you?

Oral finasteride is usually recommended first because it has the strongest long-term evidence and is licensed in the UK for treating male pattern hair loss. But topical finasteride may be a better option for some people if you're concerned about systemic side effects, have had previous bad experiences with the pill but want to restart, or just prefer this method of administration.

The right treatment depends on your medical history, treatment goals, and personal preferences. Through our online doctor service, our independent UK clinicians can help you decide whether oral or topical finasteride is most suitable for you and discuss whether combining treatment with options like minoxidil may improve results.

Visit our Hair Loss Hub for more advice or start a consultation to see what’s suitable for you.

References

1. NHS. Common questions about finasteride [Internet]. nhs.uk. 2023.

2. Nestor MS, Ablon G, Gade A, Han H, Fischer DL. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of Cosmetic Dermatology. 2021 Nov 6;20(12).

3. Piraccini BM, Blume‐Peytavi U, Scarci F, Jansat JM, Falqués M, Otero R, et al. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. Journal of the European Academy of Dermatology and Venereology. 2021 Oct 25;36(2):286–94.

4. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Journal of the American Academy of Dermatology [Internet]. 1998 Oct 1;39(4):578–89.

5. Kim J, Song SY, Sung JH. Recent Advances in Drug Development for Hair Loss. International Journal of Molecular Sciences. 2025 Apr 8;26(8):3461.

6. Kaufman KD, Rotonda J, Shah AK, Meehan AG. Long-term treatment with finasteride 1 mg decreases the likelihood of developing further visible hair loss in men with androgenetic alopecia (male pattern hair loss). European journal of dermatology: EJD [Internet]. 2008;18(4):400–6.

7. NHS. Side Effects of Finasteride [Internet]. nhs.uk. 2023.

8. MHRA. Safety review of Finasteride Public Assessment Report [Internet]. MHRS. 2024.

9. Gupta AK, Talukder M, Keene SA, Bamimore MA. Is the Safety of Finasteride Correlated With Its Route of Administration: Topical Versus Oral? A Pharmacovigilance Study With Data From the United States Food and Drug Administration Adverse Event Reporting System. International Journal of Dermatology. 2025 Jul 15;

10. Chen L, Zhang J, Wang L, Wang H, Chen B. The Efficacy and Safety of Finasteride Combined with Topical Minoxidil for Androgenetic Alopecia: A Systematic Review and Meta-analysis. Aesthetic Plastic Surgery. 2020 Mar 12;44(3):962–70.

11. Rossi A, Caro G. Efficacy of the association of topical minoxidil and topical finasteride compared to their use in monotherapy in men with androgenetic alopecia: A prospective, randomized, controlled, assessor blinded, 3‐arm, pilot trial. Journal of Cosmetic Dermatology. 2023 Oct 5;23(2):502–9.

12. Johnson H, Huang D, Clift AK, Ângela Bersch-Ferreira, Guimarães GA. Effectiveness of Combined Oral Minoxidil and Finasteride in Male Androgenetic Alopecia: A Retrospective Service Evaluation. Cureus [Internet]. 2025 Jan 16;

13. NHS. About finasteride [Internet]. nhs.uk. 2023.

14. MHRA. MHRA Products database. Accessed 26 Mar 2026.