The Fundamental Difference
The most important difference between the two dosage forms lies in how the active ingredient enters the body and acts.
Oral Finasteride with Systemic Action
With oral administration (tablet), finasteride is absorbed through the gastrointestinal tract and enters the blood. From there it distributes throughout the body, acts systemically, and lowers dihydrotestosterone (DHT) in scalp, blood, brain, and prostate. Application is simple with one tablet daily and has the longest clinical experience since 1997.
Topical Finasteride with Local Action
With topical application, finasteride is applied as a solution to the scalp. It acts primarily locally at the application site with minimal systemic absorption, depending on dosage. This enables targeted treatment of affected areas but requires daily application. The goal of topical application is to maximize DHT reduction where it's needed (scalp) while minimizing systemic exposure. This should reduce side effects while maintaining efficacy.
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:
| Parameter | Topical (0.25%) | Oral (1 mg) |
|---|---|---|
| Hair Count Increase | Comparable | Comparable |
| Serum DHT Reduction | 34.5% | 55.6% |
| Sexual Side Effects | 2.8% | 4.8% |
| Application | Daily application | Daily swallowing |
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.
Efficacy is comparable in both dosage forms. Oral finasteride has minimally higher success rates, but the difference is small. Topical finasteride achieves similar results with reduced systemic burden.
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]
Systemic absorption is dose-dependent: At 0.091 mg daily, no measurable DHT changes in blood are detectable. At 0.273 mg daily, minimal DHT reduction of about 10% occurs. At 2.275 mg daily, DHT reduction is comparable to oral administration. The conclusion is clear: With too high dosage, topical finasteride loses its advantage!
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.
| Criterion | Oral (Tablet) | Topical (Solution) |
|---|---|---|
| Efficacy | Maximum efficacy with longest track record | Comparable efficacy with reduced systemic burden |
| Application | Simplest application with one tablet daily | Daily application required |
| Systemic Effects | DHT reduction throughout body | Lower DHT reduction in blood, primarily local action |
| Side Effects | Higher risk for systemic side effects | Significantly fewer systemic side effects reported |
| Clinical Data | Comprehensive clinical data since 1997 | Shorter clinical experience but growing evidence |
| Treatment Area | No targeted treatment of specific areas possible | Targeted treatment of affected areas possible |
| Practical Aspects | Simple application, caution with desire to conceive (sperm quality) | Can make hair and scalp oily, avoid direct skin contact for pregnant women and children |
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, and for prescription information see Finasteride Prescription Switzerland.
Oral Finasteride is Ideal for You If
You prioritize maximum efficacy, prefer simplicity (tablet instead of application), have no concerns about systemic DHT reduction, had no side effects with previous oral use, and have no small children in the household.
Topical Finasteride is Ideal for You If
You want to minimize side effects, already took oral finasteride and had side effects, want to treat targeted areas (e.g., only receding hairline), want to start cautiously, are willing to apply a solution daily, or want to reduce long-term systemic exposure.
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 without systemically burdening the body. 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 excellently combined with minoxidil. Studies show that the combination of finasteride and minoxidil is more effective than monotherapy. [5] Both active ingredients have different mechanisms: Finasteride reduces DHT while minoxidil promotes growth. The combination is well-tolerated and synergistic effects are possible.
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 with 2.275 mg/ml (equivalent to 114 µg/hub) 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 containing finasteride in various concentrations. These 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, you have no concerns about systemic effects, and you prefer the most cost-effective option. Topical application is ideal if side effect reduction is important to you, you want to start cautiously, you already had side effects with oral administration, or you're willing to invest a bit more time.