Finasteride Topical vs. Oral: Which Form is Better?

The Fundamental Difference

The most important difference between the two dosage forms lies in how the active ingredient enters the body and acts. For general information on efficacy, see Finasteride: Efficacy & Clinical Studies. With oral administration (tablet), finasteride is absorbed through the gastrointestinal tract, enters the blood, and distributes throughout the body, where it acts systemically and lowers dihydrotestosterone (DHT) in scalp, blood, brain, and prostate. DHT is the main driver of androgenetic alopecia. Application is simple with one tablet daily, with oral finasteride having the longest clinical experience since 1997.

With topical application, finasteride is applied as a solution to the scalp and acts primarily locally at the application site. Systemic absorption is minimal and depends on dosage, enabling targeted treatment of affected areas. The goal of topical application is to maximize DHT reduction where it's needed – on the scalp – while simultaneously minimizing systemic absorption. This should reduce side effects while maintaining efficacy, with application requiring daily topical use.

Efficacy Comparison

Numerous clinical studies have investigated the efficacy of both dosage forms. Research results show a differentiated picture.

Phase III Study Shows Comparable Results

The most important comparative study was published in 2022. ^[2] This randomized, controlled Phase III study compared 0.25% topical finasteride spray with 1 mg oral finasteride over 24 weeks:

Most important finding: Hair count improvement was comparable in both forms, but topical finasteride showed significantly lower systemic DHT reduction and fewer side effects. ^{[1] [2]}

Long-Term Efficacy in the Data

A 16-month study with topical 0.005% finasteride solution showed impressive results. ^[4] 87% of users reported improvement or stabilization, while only 13% showed progressive hair loss. No serious side effects occurred. In comparison, oral 1-mg studies show improvement or stabilization in 90-95% after 12-24 months, while 5-10% show progressive hair loss.

Dosage with Topical Finasteride

A critical point: Not all topical finasteride formulations are equal. Systemic absorption depends on several factors that are crucial for efficacy and side effect profile.

Factors of Systemic Absorption

Systemic absorption depends on several factors: concentration (percent finasteride in solution), volume (amount in milliliters per application), frequency (once or twice daily), and carriers (penetration enhancers in formulation). A study showed the direct relationship of these factors: ^[3]

Recommended Topical Dosages

Based on scientific evidence, two formulations are optimal. Option 1 is ultra-low dose with 0.005% finasteride (2 mL daily), corresponding to a total dose of 0.1 mg per day. This shows minimal systemic absorption and is ideal for beginners and diffuse hair loss. Option 2 is standard dose with 0.2% finasteride (1 mL daily), corresponding to a total dose of 2 mg per day. This leads to moderate systemic absorption with stronger local action. Both formulations show clinical efficacy with significantly reduced side effect risk. ^{[6] [7]}

Detailed Advantages and Disadvantages

Both dosage forms have specific advantages and disadvantages that should be considered in the decision.

For Whom is What Suitable?

The choice between oral and topical application depends on your individual preferences and goals. Detailed information on side effects can be found in our article Finasteride Side Effects.

Oral Finasteride is Ideal for You If

You prioritize maximum efficacy and prefer simplicity. A tablet is easier than application. Oral form is also suitable if you have no concerns about DHT reduction throughout the body. If you had no side effects with previous oral administration, you can continue using this form. Make sure there are no small children in the household.

Topical Finasteride is Ideal for You If

You want to minimize side effects or already took oral finasteride and had side effects. Topical form is also suitable if you want to treat targeted areas, for example only the receding hairline.

If you want to start cautiously and are willing to apply a solution daily, this form is suitable. Topical finasteride is also suitable if you want to reduce long-term systemic absorption.

Individual Approach

The choice of dosage form and dosage should be based on your individual situation. If you want to be cautious or your hair loss is not yet severe, a gentle start can make sense.

Low-dose topical solutions offer the opportunity to test response to treatment. The body is hardly burdened. These can also be well combined with other active ingredients like minoxidil to increase efficacy.

With advanced hair loss or if you're aiming for maximum efficacy, higher-dose topical formulations or oral forms can be considered. Treatment can be adjusted to your needs and tolerability at any time. Regular evaluation after 6-12 months helps you find the optimal balance between efficacy and tolerability.

Combination with Minoxidil

Both oral and topical finasteride can be well combined with minoxidil. Studies show that the combination of finasteride and minoxidil is more effective than treatment with only one active ingredient. ^[5]

Both active ingredients have different mechanisms: Finasteride reduces DHT while minoxidil promotes growth. The combination is well-tolerated. The active ingredients can enhance each other.

Availability in Switzerland

Finasteride has been available in Switzerland as an oral medication for treating androgenetic alopecia since the late 1990s. ^{[1] [2]} Since late 2022, with Fynzur, a topical dosage form has also been approved as a prescription-only finished medicinal product. ^[6]

For hair loss treatment, various oral 1 mg finasteride preparations are available in Switzerland: Finasterid-Mepha Procapil, Propecia, Andropecia, and Biorga. As a topical option, Fynzur Spray is approved, specifically for mild to moderate hair loss in men between 18 and 41 years. ^[6]

Specialized providers like orva also offer individual prescriptions in collaboration with pharmacies. These contain finasteride in various concentrations. They can also be combined with other scientifically effective active ingredients like minoxidil to optimally tailor treatment to your needs.

Conclusion on Choosing the Right Dosage Form

There's no universal answer to the question of the right dosage form. The best choice depends on your individual priorities.

The oral form is particularly suitable if efficacy and simplicity are your priorities. It's also suitable if you have no concerns about effects throughout the body and prefer the most cost-effective option.

Topical application is ideal if side effect reduction is important to you. It's also suitable if you want to start cautiously, already had side effects with oral administration, or are willing to invest a bit more time.

For more information, see our articles on Finasteride Side Effects, Finasteride Efficacy & Studies and Finasteride Prescription Switzerland. You can also start directly with our Online Quiz or learn more about Minoxidil as a complementary treatment.