The relationship between female pattern hair loss (FPHL) and androgenic hormones is not well established, but some evidence indicates oral finasteride may be efficacious in FPHL. Use of a topical formulation has been proposed to minimize unwanted effects.
Our objective was to compare the efficacy and safety of topical 0.25% finasteride combined with 3% minoxidil solution and 3% minoxidil solution as monotherapy in the treatment of FPHL.
This was a prospective, randomized, double-blind study in 30 postmenopausal women with FPHL. Each participant was randomized to receive either topical 0.25% finasteride combined with topical 3% minoxidil or topical 3% minoxidil solution as monotherapy for 24 weeks. To determine efficacy, the hair density and diameter was measured and global photographic assessment was conducted at baseline and 8, 16, and 24 weeks. Side effects and serum dihydrotestosterone levels were also evaluated.
By 24 weeks, hair density and diameter had increased in both groups, and finasteride/minoxidil was significantly superior to minoxidil solution in terms of hair diameter (p = 0.039). No systemic side effects were reported. However, serum dihydrotestosterone levels in the finasteride/minoxidil group significantly decreased from baseline (p = 0.016).
A topical combination of 0.25% finasteride and 3% minoxidil may be a promising option in the treatment of FPHL with an additional benefit of increasing hair diameter. Nevertheless, as it may be absorbed percutaneously, it should be reserved for postmenopausal women.
clinicaltrials.in.th; identifier TCTR20160912002.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Olsen EA. Female pattern hair loss. J Am Acad Dermatol. 2001;45(3 Suppl):S70–80.
Birch MP, Messenger JF, Messenger AG. Hair density, hair diameter and the prevalence of female pattern hair loss. Br J Dermatol. 2001;144(2):297–304.
Rojhirunsakool S, Suchonwanit P. Parietal scalp is another affected area in female pattern hair loss: an analysis of hair density and hair diameter. Clin Cosmet Investig Dermatol. 2017;11:7–12.
van Zuuren EJ, Fedorowicz Z. Interventions for female pattern hair loss. JAMA Dermatol. 2017;153(3):329–30.
Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. 2008;59(4):547–66.
Adil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: a systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(1):136–41.
Yeon JH, Jung JY, Choi JW, Kim BJ, Youn SW, Park KC, Huh CH. 5 mg/day finasteride treatment for normoandrogenic Asian women with female pattern hair loss. J Eur Acad Dermatol Venereol. 2011;25(2):211–4.
Iorizzo M, Vincenzi C, Voudouris S, et al. Finasteride treatment of female pattern hair loss. Arch Dermatol. 2006;142(3):298–302.
Oliveira-Soares R, E Silva JM, Correia MP, André MC. Finasteride 5 mg/day treatment of patterned hair loss in normo-androgenetic postmenopausal women. Int J Trichol. 2013;5(1):22–5.
Boersma IH, Oranje AP, Grimalt R, et al. The effectiveness of finasteride and dutasteride used for 3 years in women with androgenetic alopecia. Indian J Dermatol Venereol Leprol. 2014;80(6):521–5.
Price VH, Roberts JL, Hordinsky M, et al. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. J Am Acad Dermatol. 2000;43(5 Pt 1):768–76.
Lee SW, Juhasz M, Mobasher P, et al. A systematic review of topical finasteride in the treatment of androgenetic alopecia in men and women. J Drugs Dermatol. 2018;17(4):457–63.
Mazzarella F, Loconsole F, Cammisa A, et al. Topical finasteride in the treatment of androgenetic alopecia: preliminary evaluations after a 16-month therapy course. J Dermatol Treat. 1997;8(3):189–92.
Tanglertsampan C. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil/0.1% finasteride in male pattern hair loss: a randomized, double-blind, comparative study. J Med Assoc Thai. 2012;95(10):1312–6.
Chandrashekar BS, Nandhini T, Vasanth V, et al. Topical minoxidil fortified with finasteride: an account of maintenance of hair density after replacing oral finasteride. Indian Dermatol Online J. 2015;6(1):17–20.
Sheikh S, Ahmad A, Ali SM, et al. A new topical formulation of minoxidil and finasteride improves hair growth in men with androgenetic alopecia. J Clin Exp Dermatol Res. 2015;6(1):253.
Caserini M, Radicioni M, Leuratti C, et al. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Int J Clin Pharmacol Ther. 2014;52(10):842–9.
Suchonwanit P, Srisuwanwattana P, Chalermroj N, Khunkhet S. A randomized, double-blind controlled study of the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil versus 3% minoxidil solution in the treatment of male androgenetic alopecia. J Eur Acad Dermatol Venereol. 2018. https://doi.org/10.1111/jdv.15171.
Sinclair R, Patel M, Dawson TL Jr, et al. Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness. Br J Dermatol. 2011;165(3 Suppl):12–8.
Seale LR, Eglini AN, McMichael AJ. Side effects related to 5 alpha-reductase inhibitor treatment of hair loss in women: a review. J Drugs Dermatol. 2016;15(4):414–9.
Rushton DH, Norris MJ, Van Neste D. Hair regrowth in male and female pattern hair loss does not involve the conversion of vellus hair to terminal hair. Exp Dermatol. 2016;25(6):482–4.
Kelly Y, Blanco A, Tosti A. Androgenetic alopecia: an update of treatment options. Drugs. 2016;76(14):1349–64.
The authors thank the patients, investigators, and investigational site, whose participation made this study possible.
clinicaltrials.in.th; identifier TCTR20160912002.
No sources of funding were used to conduct this study or prepare this manuscript.
Conflict of interest
PS, WI, and SR have no conflicts of interest that are directly relevant to the content of this study.
This study was conducted in accordance with the principles of the Declaration of Helsinki and in compliance with the International Conference on Harmonization—Good Clinical Practice and local regulatory requirements. The study was reviewed and approved by the appropriate independent ethics committees, and written informed consent was obtained from all subjects prior to study initiation. This study was approved by the MU-IRB (Mahidol University Institutional Review Board) on 16 September 2015 (Protocol number 09-58-20).
About this article
Cite this article
Suchonwanit, P., Iamsumang, W. & Rojhirunsakool, S. Efficacy of Topical Combination of 0.25% Finasteride and 3% Minoxidil Versus 3% Minoxidil Solution in Female Pattern Hair Loss: A Randomized, Double-Blind, Controlled Study. Am J Clin Dermatol 20, 147–153 (2019). https://doi.org/10.1007/s40257-018-0387-0