Topical Finasteride For Hair Loss: How to Use and Where To Get It

Summary

In Episode 34 of The Hair Loss Show, Dr. Vikram Jayaprakash and Dr. Russell Knudsen discuss the topical version of Finasteride, a treatment for hair loss. They compare it to the oral version, which has been in use since 1997 and has known side effects. Topical Finasteride is applied directly to the scalp to minimize systemic side effects, with typical concentrations of 0.1% to 0.25%. The podcast highlights the ongoing debate about its effectiveness and side effects, emphasizing the need for more scientific research beyond anecdotal evidence. The doctors also stress the importance of proper compounding for topical Finasteride.

Takeaways

• 👨‍⚕️ Dr. Vikram Jayaprakash and Dr. Russell Knudsen discuss hair loss treatments, focusing on Finasteride.
• 💊 Finasteride was released in the U.S. in 1997 for oral use to treat hair loss, with 23 years of experience.
• 🔎 Side effects of oral Finasteride have been discussed in previous podcasts, including episode number four.
• 🧪 Topical Finasteride has been developed to apply medication locally and potentially reduce side effects.
• 🧠 The original theory for oral Finasteride was to block 5 Alpha Reductase Enzymes in the liver to reduce DHT levels systemically.
• 🚦 Finasteride partially blocks the enzyme, lowering DHT by about two-thirds, not completely.
• 🧴 Topical Finasteride is typically dosed at 0.1% or 0.25% and is applied daily to thinning areas, not bald spots.
• ⚖️ There's ongoing debate about whether topical Finasteride completely eliminates side effects, as some patients still experience them.
• 🔄 Topical Finasteride must be compounded by a professional to ensure a stable and reproducible solution.
• 📉 Doctors generally prefer oral Finasteride but will consider topical alternatives for patients concerned about side effects.
• 🔬 Future research is needed for controlled studies on topical Finasteride to provide more scientific evidence.

Q & A

What is the primary topic discussed in The Hair Loss Show Episode 34?

The primary topic discussed in The Hair Loss Show Episode 34 is the use of topical Finasteride as a treatment for hair loss in both men and women.

Since when has oral Finasteride been used to treat hair loss in the U.S.?

Oral Finasteride has been used to treat hair loss in the U.S. since 1997.

What is the theory behind using oral Finasteride instead of topical treatments like Minoxidil?

The theory behind using oral Finasteride is that 5 Alpha Reductase Enzymes exist in the liver, and by taking it orally, it can block the enzyme in the liver, reducing the amount of DHT delivered to the scalp.

How does Finasteride work in the context of hair loss?

Finasteride works by inhibiting the 5 Alpha Reductase Enzyme, which converts Testosterone into Dihydrotestosterone (DHT). By lowering DHT levels, it helps prevent hair follicles from miniaturization and hair loss.

What is the proposed advantage of topical Finasteride over oral Finasteride?

The proposed advantage of topical Finasteride is that it is applied directly to the scalp, which may reduce the risk of systemic side effects by keeping the effect localized.

What are the typical concentrations of Finasteride used topically?

Typical concentrations of Finasteride used topically are around 0.1%, although in some cases, it can be as high as 0.25%.

Why is it important to compound topical Finasteride properly?

Topical Finasteride needs to be compounded properly to ensure a stable and reproducible solution that can be consistently used over time.

What is the current stance of the doctors on the podcast regarding the use of topical Finasteride?

The doctors on the podcast prefer patients to use oral Finasteride as the first choice, but they are willing to prescribe topical Finasteride for those who are concerned about or experiencing side effects from oral use.

Are there any reported side effects from using topical Finasteride?

Yes, there are reports of side effects from using topical Finasteride, even at low doses, indicating that some patients may still be susceptible to side effects.

What is the difference between a scientific study and an anecdotal study as mentioned in the podcast?

A scientific study is a controlled and systematic investigation that provides evidence-based results, whereas an anecdotal study is based on personal accounts or individual experiences, such as 'Joe tried it and it worked,' without rigorous scientific methodology.

What is the future outlook for research on topical Finasteride according to the podcast?

The podcast hosts express hope that more research, specifically controlled scientific studies, will be conducted in the coming years to provide more definitive information on the effectiveness and side effects of topical Finasteride.

Outlines

00:00

💊 Topical Finasteride for Hair Loss Treatment

Dr. Vikram Jayaprakash and Dr. Russell Knudsen discuss the topical version of Finasteride as a treatment for hair loss in both men and women. They explain that Finasteride, which has been available orally since 1997, is now being used topically to potentially reduce side effects. The theory is that applying it directly to the scalp could localize its effect and minimize systemic exposure. The doctors also touch upon the original rationale for oral Finasteride, which was to block the 5 Alpha Reductase Enzyme in the liver to reduce DHT levels systemically. They discuss the typical dosages for topical Finasteride, which are around 0.1% to 0.25%, and the importance of compounding the medication properly for stability and reproducibility. The conversation also includes the ongoing debate about the effectiveness of topical Finasteride in eliminating side effects, with some patients still experiencing them even with low doses.

05:03

🔬 The Future of Topical Finasteride Research

The doctors express a desire for more research on topical Finasteride to provide controlled studies rather than relying on anecdotal evidence. They emphasize the importance of finding the minimum effective dose to reduce DHT levels without causing side effects. The summary highlights the need for scientific studies to validate the efficacy and safety of topical Finasteride in the coming years. The conversation concludes with the doctors' intention to keep their audience updated on new research findings and their thanks for watching the episode.

Keywords

💡Hair Loss

Hair loss, also known as alopecia, is the shedding of hair until new growth does not happen. It is a common concern that affects both men and women and can be caused by various factors including genetics, hormonal changes, and medical conditions. In the video, hair loss is the central theme as the hosts discuss medical and surgical treatments to address it.

💡Finasteride

Finasteride is a medication originally developed to treat benign prostatic hyperplasia (BPH) but is also used to treat male pattern hair loss. It works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), a hormone that can lead to hair follicle miniaturization and hair loss. The video discusses both oral and topical forms of Finasteride.

💡Topical Finasteride

Topical Finasteride refers to a form of the medication applied directly to the scalp. The idea is to apply it locally to reduce systemic side effects. The script mentions that topical Finasteride is a recent development and is being explored as an alternative to oral Finasteride to potentially reduce side effects.

💡Side Effects

Side effects are unintended effects of a medication that occur at doses used in humans for prophylaxis, diagnosis, or therapy. The discussion in the video revolves around the side effects of oral Finasteride, which has led to interest in the topical version as a potential alternative.

💡5 Alpha Reductase Enzymes

5 Alpha Reductase Enzymes are a group of enzymes that convert testosterone to dihydrotestosterone (DHT). The script explains that these enzymes are present in the liver and hair follicles, and Finasteride works by inhibiting these enzymes to reduce DHT levels, which can help prevent hair loss.

💡Dihydrotestosterone (DHT)

Dihydrotestosterone (DHT) is a hormone derived from testosterone and is considered a primary factor in male pattern baldness. The video explains that DHT causes hair follicles to shrink, leading to hair loss, and Finasteride's mechanism of action involves reducing DHT levels.

💡Male Pattern Hair Loss

Male Pattern Hair Loss, also known as androgenetic alopecia, is the most common type of hair loss in men. It is characterized by a receding hairline and thinning at the crown. The video discusses how DHT contributes to this type of hair loss and how Finasteride can be used as a treatment.

💡Compounding

Compounding in the context of pharmacy refers to creating customized medications for individual patients. Topical Finasteride needs to be compounded, as it is not available in a standard, ready-to-use form. The script emphasizes the importance of proper compounding to ensure a stable and effective topical solution.

💡Titration

Titration in medicine refers to the careful adjustment of a drug's dosage to achieve the best therapeutic effect while minimizing side effects. The video mentions titration in the context of finding the minimum effective dose of Finasteride that can prevent hair loss without causing side effects.

💡Anecdotal Studies

Anecdotal studies are accounts of personal experiences or observations that are not based on scientific research methods. The hosts express a desire for more controlled scientific studies on topical Finasteride, rather than relying on anecdotal evidence, to better understand its effectiveness and side effect profile.

Highlights

Introduction to The Hair Loss Show: Episode 34 with Dr. Vikram Jayaprakash and Dr. Russell Knudsen.

Topical Finasteride is discussed as an alternative to oral treatment for hair loss.

Oral Finasteride was released in the U.S. in 1997, with 23 years of experience and known side effects.

The theory behind topical Finasteride is to apply it locally to reduce side effects.

Finasteride works by blocking the 5 Alpha Reductase Enzyme, which converts Testosterone into DHT.

DHT is responsible for miniaturizing hair follicles, leading to hair loss.

Finasteride partially blocks the enzyme, reducing DHT by about two-thirds.

Research on topical Finasteride has been conducted with doses around 0.1% to 0.25%.

Topical Finasteride is applied daily to thinning areas, not bald areas.

There is a debate on whether topical Finasteride completely abolishes side effects.

Some patients have experienced side effects even with low-dose topical Finasteride.

Dr. Knudsen prefers patients to use Finasteride orally but acknowledges the option of topical formulation.

Topical Finasteride needs to be compounded properly by an experienced pharmacist.

Dr. Jayaprakash does not consider topical Finasteride as the first choice for most patients.

The doctors discuss the importance of titrating the dose to find the minimum effective dose.

The need for more research and controlled studies on topical Finasteride is emphasized.

The podcast concludes with a call for more scientific studies in the coming years.

Transcripts

relating to hair loss and the medical and surgical treatment of hair loss in

both men and women.

Hi everyone and welcome to The Hair Loss Show: Episode number 34. My name is Dr.

Vikram Jayaprakash - I'm Dr. Russell Knudsen, welcome - Right

well, today's topic, this one is, we've had a lot of requests for, a lot of

people have asked about this. You know, our podcast on Finasteride and

side-effects of Finasteride have been very, very popular but today we're going

to talk about the topical version of Finasteride and just a little bit about

that as well - Okay so Finasteride orally to treat hair loss was released

in the U.S. in 1997. So to put that in context, we basically have 23 years of

experience with it. We know there have been patients with side effects, we see

them in our own practice and we've discussed it in detail in other podcasts.

So if you want more depth about oral Finasteride, go and have a look at those,

for example, the episode number four is devoted to the side effects of

Finasteride. But in recent, couple of years people started using topical

Finasteride and the theory behind topical Finasteride is that if you only

apply it locally to the area, you should keep the effect relatively local and

therefore lessen the risk of getting side effects. Now let me put this back in

context. The original theory behind using Finasteride and using it orally rather

than topically like Minoxidil was that the 5 Alpha Reductase Enzymes also exist

in the liver and so, if you are converting Testosterone into DHT in the

liver and the blood supply from the liver is going through your scalp, you're

delivering DHT to the scalp. So the original philosophy was, you take the

tablet orally so you could block the enzyme in the liver as well and make

sure that the DHT, the less amount of DHT was being delivered to the

susceptible hair follicles - Basically just going through that again,

Testosterone gets converted into Dihydrotestosterone or DHT and then

there's the 5 Alpha Reductase Enzyme that causes that,

causes a conversion and so, if you have a lot of that in the system or certainly a

lot of that at the level of the hair follicle, then it causes the

hairs to miniaturize and fall out and that's what causes Male Pattern Hair Loss - and let's just

remind people that it's a partial block of the enzyme, its lowers DHT by about

two thirds, okay, so it doesn't knock it completely out, it lowers it by

two thirds. But because of people either getting side-effects from using it

orally or being worried about getting side-effects from using orally, the

theory was if we use topical Finasteride, we could avoid the side-effects but get

the effect. So this has been, there's been a bit of research being done on this in

the last few years and the dosing percentages for Finasteride topically

applied typically err around about 0.1 of a percent but in some cases 0.25 of a

percent. So the idea is to use a low dose and again on a daily basis, topically, to

the thinning area. There's no point putting it on a bald area, that's not going to work,

put it on a thinning area and see if you can get the effect without the side

effect. There's a bit of dispute at the moment about whether it really does

abolish the side effects because it appears that there are some patients who

were even susceptible to low-dose topical Finasteride to get the side effects. So I

think that if, my general feeling is I would prefer patients to be on it than

not. If they won't contemplate doing it orally, I'm happy to prescribe it in

a topical formulation but I don't promise them that there's no risk

of side effects, we're still going to find out whether that's going to be

something that's going to work for them - So the other thing to mention is that

unlike Finasteride which is, you know, you can get generic forms etc, topical

Finasteride needs to be compounded so you - and it needs to be compounded properly

which means that it has, you have to go to someone who's experienced at

the compounding to make sure that you've got a stable solution, a reproducible

solution that you could use going forward. So yes, it's a variation

that we can use if, as I said, if the patient really doesn't want to use oral,

I'm going to go to topical but I don't think that

topical is my first choice for most patients - No that's right, so generally speaking, we

would start people on a oral version of Finasteride and see how they got,

got on and if they, you know, were concerned about side effects or were

experiencing side effects and really had this inclination to switch to a

topical version, then we could get that compounded and trialing that and

but as you said, you know, we've had people on, you know, a small dose, 0.25%

Finasteride that are getting side effects with that. So it again, it is

about titrating, much like with the oral dose, you've got to titrate to find what

is that minimum effective dose that is going to, you know, lower that level

enough but not, you know, getting the side effects associated with that - Okay so,

hopefully some more research will be performed over the next couple of years

and we'll be able to report back to you with some controlled studies rather than

anecdotal studies and anecdotal study means oh Joe tried it and it worked.

That's not a scientific study. So hopefully we'll have some scientific

studies performed the next couple years that we report on - Thanks again very

much for watching, I hope this has helped explain the current interest in

topical Finasteride and we look forward to talking to you next time - See you next

time, thank you very much - Bye.