Why isn't topical finasteride more popular?

[bald-and-bearded]

Many reputed doctors recommend its usage and claim that it is effective and yet has no side effects. But why is it not more popular? There are tons of patients who dread the idea of taking Finasteride pills and thus accept baldness while still being extremely bothered by it. Finasteride hesitancy is one of the biggest problems surgeons face when dealing with patients who will have advanced or unpredictable hair loss.

At this stage, we would have expected to have seen a few peer reviewed studies showing its efficacy and side effects profile and at least a few pharma companies manufacturing it at scale if there was a big market potential (which company would miss such a chance?)

The absence of big pharma (like Merck) manufacturing topical finasteride and the absence of well citer peer reviewed studies makes me think that the science behind it is not solid to even warrant a phase 1 trial.

What do you think?

Edited April 5, 2021 by bald-and-bearded

[TorontoMan]

Because the notion that it has "no side effects" isn't accurate. There are a few studies that looked at topical fin but the trials were only a week long and that is far too insignificant to make any judgement. With current formulations, finasteride is still getting absorbed in your body just at a slightly lower amount, but if thats the case you're better off just taking fin orally at a smaller dose. 

There are a couple of companies looking to create a new formulation that uses a vehicle that wouldn't permit finasteride to absorb into the blood stream. 

[bald-and-bearded]

1 hour ago, TorontoMan said:

Because the notion that it has "no side effects" isn't accurate. There are a few studies that looked at topical fin but the trials were only a week long and that is far too insignificant to make any judgement. With current formulations, finasteride is still getting absorbed in your body just at a slightly lower amount, but if thats the case you're better off just taking fin orally at a smaller dose. 

There are a couple of companies looking to create a new formulation that uses a vehicle that wouldn't permit finasteride to absorb into the blood stream. 

So you're saying all topical finasteride we have today are no good compared to oral finasteride? I don't know why some doctors suggest taking it. Maybe it makes patients not imagine the nocebo effects?

[TorontoMan]

1 hour ago, bald-and-bearded said:

So you're saying all topical finasteride we have today are no good compared to oral finasteride? I don't know why some doctors suggest taking it. Maybe it makes patients not imagine the nocebo effects?

In my opinion topical finasteride is neither more effective or offers some substantial decrease in the risk of side effects. Ironically, I think it does more to induce a nocebo effect than oral finasteride as you are constantly planning your time around having to apply it, and knowing consciously that you're taking it topically to try to avoid side effects might be consuming your mind more than its worth. This is just my opinion, and I'm not against it, if someone does have a concern with side effects topical finasteride could slightly reduce the risk of that, but its by no means a side effect free guarantee. Topical finasteride is nonetheless a good starting point for someone starting treatment, and hopefully in the future we'll find ways to reduce our dht in the scalp without it going systemic, advances in the vehicles we use might help us do this. For the time being I haven't seen any convincing formulations of it that suggest you're not still getting absorption, and in that case you're better off taking a small dose of fin orally to test how you tolerate it. 

[Future Hair Doc]

8 hours ago, bald-and-bearded said:

Many reputed doctors recommend its usage and claim that it is effective and yet has no side effects. But why is it not more popular? There are tons of patients who dread the idea of taking Finasteride pills and thus accept baldness while still being extremely bothered by it. Finasteride hesitancy is one of the biggest problems surgeons face when dealing with patients who will have advanced or unpredictable hair loss.

At this stage, we would have expected to have seen a few peer reviewed studies showing its efficacy and side effects profile and at least a few pharma companies manufacturing it at scale if there was a big market potential (which company would miss such a chance?)

The absence of big pharma (like Merck) manufacturing topical finasteride and the absence of well citer peer reviewed studies makes me think that the science behind it is not solid to even warrant a phase 1 trial.

What do you think?

There have been multiple studies showing it's efficacy (just Google it). 

The popularity of topical finasteride has been increasing...it's just hard to find a good source here in the US. My patients have had to buy it from India, China, etc. and they don't truly trust these sources (it could just be a guy putting water in a bottle and saying it's finasteride). 

I think the big pharma companies aren't getting in on it yet due to COVID. I'm gauging if there's enough interest for me to pursue creating a reliable source of topical finasteride/minoxidil to sell. 

Edited April 5, 2021 by Dr. Suhail Khokhar

[Melvin- Admin]

A big reason why big pharma doesn't get involved is because anyone can basically compound finasteride. You don't necessarily need a prescription. Therefore, they cannot patent it. How these pharmaceutical companies make their money is through the patent. For a long time there was no generic Propecia, you either had to get Propecia or Proscar. Having a monopoly on a medication is how they make money. Some pharmaceutical companies can raise the price of a medication by an insane number, and if they're the only ones who can make and distribute the medication the public has no choice. However, over-the-counter supplements are not as lucrative. 

[ciaus]

23 hours ago, bald-and-bearded said:

There are tons of patients who dread the idea of taking Finasteride pills and thus accept baldness while still being extremely bothered by it. Finasteride hesitancy is one of the biggest problems surgeons face when dealing with patients who will have advanced or unpredictable hair loss.

 

The 'tons of patients' are actually a very small and vocal group that you hear from online. Literally millions of prescriptions for oral finasteride are filled each year in the USA alone. The vast majority of us have no problems and therefore no reason to talk about it. 

 

The reason the topical won't ever go mainstream is because

1. It has a very small target market, most guys don't get sides from the pill.

2. Its alot more of a chore to apply a topical daily than to just take a pill. Guys are lazy and/or busy. Think about topical minoxidil and how many guys either never start or eventually slack off and stop using that.

3. Like Melvin said, pharmaceutical companies can't make a decent profit, in part because its off patent now, and also because of reasons #1 and #2.

[bald-and-bearded]

4 hours ago, ciaus said:

 

The 'tons of patients' are actually a very small and vocal group that you hear from online. Literally millions of prescriptions for oral finasteride are filled each year in the USA alone. The vast majority of us have no problems and therefore no reason to talk about it. 

 

The reason the topical won't ever go mainstream is because

1. It has a very small target market, most guys don't get sides from the pill.

2. Its alot more of a chore to apply a topical daily than to just take a pill. Guys are lazy and/or busy. Think about topical minoxidil and how many guys either never start or eventually slack off and stop using that.

3. Like Melvin said, pharmaceutical companies can't make a decent profit, in part because its off patent now, and also because of reasons #1 and #2.

Well you're forgetting about the majority of people who don't even consider taking Finasteride because they have heard that it causes impotence. Maybe what you're saying is true with people who try it for some time, but just about every young bald guy you see out there has pretty much never tried Finasteride and will never even think of it because to him it's a trade off between fertility and hair.

The general public is way more accepting of applying "oils" and "lotions" on the skin but not about consuming pills. Because to their minds, the impact of an oil or lotion is localised to just that area.

As for patents, patents do expire after some time. So while patents help make companies make $$ initially, it's still significant how much money they make after patents expires and they get to sell a lifetime subscription to a large number of patients.

[ciaus]

 

You have a habit of making convenient assumptions and apparent statements of fact without any data to back them up. 

 

45 minutes ago, bald-and-bearded said:

Well you're forgetting about the majority of people who don't even consider taking Finasteride because they have heard that it causes impotence.

How many are in this majority you speak of? You have no way to quantify how many guys are not even trying to take finasteride because they are afraid of side effects. 

 

46 minutes ago, bald-and-bearded said:

just about every young bald guy you see out there has pretty much never tried Finasteride and will never even think of it because to him it's a trade off between fertility and hair.

 

Are you traveling around the country interviewing every young bald guy you see and compiling your results? or know someone that is? Please post those results.

 

[bald-and-bearded]

7 hours ago, ciaus said:

You have a habit of making convenient assumptions and apparent statements of fact without any data to back them up. 
How many are in this majority you speak of? You have no way to quantify how many guys are not even trying to take finasteride because they are afraid of side effects. 

Are you traveling around the country interviewing every young bald guy you see and compiling your results? or know someone that is? Please post those results.

 

Do you have data to prove that most young men who get male pattern baldness go to their doctors,  get a Finasteride prescription, take it, don't get side effects and never look back? You seem very confident that this is the reason why there is no market for topical finasteride.

Have you traveled around the country interviewing every young bald guy to confirm that he is one of those 1% who tried oral finasteride and gave up due to side effects or it just didn't work on him, and he is NOT one of those people who were to afraid to even consider taking such a drug for life?

 

[ciaus]

8 hours ago, bald-and-bearded said:

Do you have data to prove that most young men who get male pattern baldness go to their doctors,  get a Finasteride prescription, take it, don't get side effects and never look back? You seem very confident that this is the reason why there is no market for topical finasteride.

Have you traveled around the country interviewing every young bald guy to confirm that he is one of those 1% who tried oral finasteride and gave up due to side effects or it just didn't work on him, and he is NOT one of those people who were to afraid to even consider taking such a drug for life?

 

 

If you want numbers to back up the online paranoia you've bought into, you're going to need to get those yourself. 

This isn't rocket science, factoring the very low incidence of side effects with the oral pill, millions already taking the pill year after year, and the common observable knowledge that human beings crave convenience, tend to be lazy, and would thus prefer to pop a pill rather than mess with slathering a liquid all over their head every day.

At best, topical formula operations will be small and have to continually calibrate their resources to stay profitable. Because oral finasteride is very cheap and some guys are just going to want to start with the topical to 'ease' their way into taking the pill.  

 

I see the forum moderator started a new thread on this topic. Because he probably saw where this was going. And unlike with you, I believe he is sincerely interested in exploring the topic. Judging by your very negative and overly broad unfounded statements on oral finasteride and men experiencing hairloss, I think your real mission here has been to discourage guys from even trying the topical version.

 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020788s020s021s023lbl.pdf

https://clincalc.com/DrugStats/Drugs/Finasteride

 

[BLE123]

Have we ever had a fin/sides poll on here?

My impression is that it's way above 1-2% purely gauging by posts on here and other hairloss/transplant related forums. 

[bald-and-bearded]

28 minutes ago, ciaus said:

If you want numbers to back up the online paranoia you've bought into, you're going to need to get those yourself. 

This isn't rocket science, factoring the very low incidence of side effects with the oral pill, millions already taking the pill year after year, and the common observable knowledge that human beings crave convenience, tend to be lazy, and would thus prefer to pop a pill rather than mess with slathering a liquid all over their head every day.

At best, topical formula operations will be small and have to continually calibrate their resources to stay profitable. Because oral finasteride is very cheap and some guys are just going to want to start with the topical to 'ease' their way into taking the pill.  

 

I see the forum moderator started a new thread on this topic. Because he probably saw where this was going. And unlike with you, I believe he is sincerely interested in exploring the topic. Judging by your very negative and overly broad unfounded statements on oral finasteride and men experiencing hairloss, I think your real mission here has been to discourage guys from even trying the topical version.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020788s020s021s023lbl.pdf

https://clincalc.com/DrugStats/Drugs/Finasteride

 

Classic ad homimen fallacy. When one cannot argue based on logic, they change the subject and attack the person instead of the topic.

I never said Finasteride is unsafe or anything to that effect. I have read the studies myself and have observed how observed side effects were only marginally higher than placebo.

What I said was that most of the general public is afraid of taking Finasteride orally because of rumour-mongering. This is NOT related to convenience. I agree that oral Finasteride is more convenient than topical but perceived risk is a different topic from convenience. Please don't mix the two.

8 million oral Finasteride prescriptions might seem like a lot but it means nothing unless we know how many of those are given to unique patients and what percentage of the total number of men losing hair it represents. The absolute difference between the number of young people taking Finasteride and the number of young people going through male pattern baldness would represent to a large extent fear of taking the drug. It is my hypothesis that such a fear could be addressed through a topical product.

https://pubmed.ncbi.nlm.nih.gov/9865198/ it states that around 42% of men go through hair loss between 18-49. Considering there are around 60 million men in the US in this age group, that means 25 million people going through hairloss. That implies that a lot of men do not take Finasteride. It's unknown if this is due to disinterest in hair restoration or a fear of side effects. So it's extremely incorrect to assume that the perceived risks of oral Finasteride is not playing a role in deterring people from taking it.

"I see the forum moderator started a new thread on this topic. Because he probably saw where this was going. And unlike with you, I believe he is sincerely interested in exploring the topic."

What does this have to do with me? Why are you comparing me and Melvin? This is just strange. It's always more rational to stick to logic and factual arguments rather people.

[bald-and-bearded]

6 minutes ago, BLE123 said:

Have we ever had a fin/sides poll on here?

My impression is that it's way above 1-2% purely gauging by posts on here and other hairloss/transplant related forums. 

Let's not pivot into this discussion here. Anecdotes on forums are hard to consider with statistical significance.

What is worth discussing is 

a) whether the perceived risk of oral Finasteride is deterring people from taking it and if so will a topical product be more acceptable

b) whether a topical product would in a controlled trial be able to produce lower side effects than Finasteride (as it has been clinically published)

[BLE123]

8 minutes ago, bald-and-bearded said:

Let's not pivot into this discussion here. Anecdotes on forums are hard to consider with statistical significance.

What is worth discussing is 

a) whether the perceived risk of oral Finasteride is deterring people from taking it and if so will a topical product be more acceptable

b) whether a topical product would in a controlled trial be able to produce lower side effects than Finasteride (as it has been clinically published)

Ok, sorry.

a) For me, yes, and for many others I believe this to also be the case. I'm fortunate in that I only have mild recession at this point though so maybe my attitude would be different if I had more aggressive hair loss.

b) I'm not versed enough in the science behind it so I don't know. What has interested though is how some have reported sides on topical fin but then been fine on topical dut, you would have thought that if fin causes issues then dut surely would as well. I guess there's more to their molecular differences than one simply being a stronger form of the other.

[ciaus]

1 hour ago, bald-and-bearded said:

What I said was that most of the general public is afraid of taking Finasteride orally because of rumour-mongering.

The elephant in the room is not rumor mongering that finasteride is going to kill your sex drive, its the still dominate cultural norms that dictate men are supposed to care very little about their physical appearance. But the biological reality is we do. So many just suffer in silence and 'take it like a man.' Especially considering the history of earlier hair transplants that pretty consistently looked bad.

 

1 hour ago, bald-and-bearded said:

What does this have to do with me? Why are you comparing me and Melvin? This is just strange. It's always more rational to stick to logic and factual arguments rather people.

We have a pattern of new accounts that pop up like blazing stars in the sky, revolving around the dark side of finasteride for a few passionate orbits. And then seem to mysteriously go quiet. Kind of like your fresh new account here from last week up to 7 posts now.

Enjoy the rest of your discussion with those that will play along.

Edited April 7, 2021 by ciaus

[Melvin- Admin]

1 hour ago, BLE123 said:

Have we ever had a fin/sides poll on here?

My impression is that it's way above 1-2% purely gauging by posts on here and other hairloss/transplant related forums. 

Yes, @hairlossPAdid one years ago