For four years, I depended on oral finasteride as one of my trusted hair loss treatments. But the recent popularity of an alternative application, topical finasteride, has lured me away from the method that has kept my hair as full as it is. With this new treatment, I had to make a decision between topical finasteride vs. oral.
I was on the fence. Admittedly, I’m less confident in a topical solution, despite a National Library of Medicine study showing it is just as effective. But it’s no secret that medication ingested orally will have less margin of error, and also, having long hair makes it harder to spray finasteride evenly around my head. I do believe the studies, though, so I made the switch for good reason along with some other adjustments as extra assurance.
For context, finasteride is the generic version of Propecia, which is the drug that inhibits the conversion of testosterone into dihydrotestosterone (DHT). DHT is the culprit for shrinking and suffocating hair follicles, so inhibiting this conversion is one of the best ways to preserve a hairline and follicular density.
Whereas oral finasteride manages this internally, topical finasteride targets the actual site where DHT becomes a threat — right on the scalp. The medication is absorbed right there and can still take effect inside the body, but the dome concentration prevents it from impacting other biological processes as much, hence, a lessened amount of side effects (more on those below).
It’s worth adding that the other best method of hair retention is minoxidil, the generic version of Rogaine, which prolongs hair growth cycles and boosts nutrient delivery to each follicle.
Topical Finasteride vs. Oral Finasteride
The big downside to oral finasteride is the impact it can have on one’s libido and sexual performance. It’s known to potentially decrease the ability to get an erection. Numerous studies prove this, but only in about 1-2% of users. Even at that point, many cases of sexual side effects are a placebo effect, given the user’s knowledge of them in advance — it’s an easy thing to blame.
Typically, anyone who experiences those side effects can cease taking finasteride. Most of the time, the lowered libido/performance issues will subside, although in some cases, guys will never recover. Again, this is a fraction of that original fraction, but the risk is there. Finasteride is largely safe, but it must be monitored by your dermatologist. While minoxidil is now an OTC drug, finasteride remains prescription-only.
Before I ultimately made the switch from oral finasteride to topical finasteride, I was unsure if I was experiencing the above side effects. There aren’t any major details to share, but I’m 36 and understand that things just aren’t going to be as, uh, supercharged as they were in my 20s. That’s a fact of life.
Still, with the availability of topical finasteride becoming more prominent, and studies proving it has far fewer effects on one’s sex life, I decided to make the switch. Providers like Hims and Happy Head sell a topical solution of finasteride and minoxidil, which combines both of these key medicines into one. These are the two I’ve been alternating between in the interim:
I’m now six months removed from the daily pill, and can report that my hair seems just as full as it did before. I do find this solution a little sticker than topical finasteride on its own, which makes it slightly less optimal with one’s hair styling regimen. As such, I stick with bedtime applications and just rinse or wash things out in the morning.
But because I wanted to double down on my hair retention efforts as a result of switching off oral finasteride, here are the other things I am using on a daily basis to ensure that my hairs stay thick and anchored.
Other Supplemental Hair Retention Efforts
Since I am now using topical finasteride (in a joint solution with minoxidil), I still feel confident in the drugs’ ability to retain my hair. But given that any switch from a successful remedy (like what oral finasteride was for me), I want to supplement the transition with a full-court press of other efforts to keep my mane. Here’s what I recommend:
Targeted Oral Supplements
There are dozens of supplements out there that promise to help with hair strength, scalp balance, DHT mitigation, and so forth. Among the most common “nutraceuticals” is Nutrafol, one of the absolute best multivitamins that fortify hair and counters the biological factors which lead to hair loss.
I have to admit, hair retention can get expensive and you have to start picking and choosing the things you want to spend your money on. Nutrafol, while being my clear favorite, is one victim of my budgeting.
So, I took an audit of the best nutrients men should ingest in order to supplement hair retention. Remember, it is merely a supplement. These can help a lot, but they will rarely be the thing that creates overall success; leave that to the finasteride and minoxidil.
The key nutrients are as follows:
- Saw palmetto: Which is proven to counter DHT and improve hair quality, tested at 100-320mg per day.
- Pumpkin seed oil: For the same reason, tested at 400mg daily, but most options out there will grossly exceed this value as overdosing side effects are rare.
- Zinc: While zinc supplements won’t do much for most individuals, low zinc levels can greatly impact hair shedding. So, a supplement can ensure you aren’t deficient. Men should aim for 11mg per day.
- Copper: Similarly, copper peptides are often believed to increase the size of hair follicles and stimulate hair growth. You only need about 1.3mg per day.
- Selenium: Selenium is a mineral you only need trace amounts of, but one that’s important in hormone regulation and scalp balance; a deficiency, albeit rare, can cause hair loss. You only need 55 micrograms per day.
- Magnesium: Helps regulate hair growth and effective turnover between growth cycles. The daily recommendation is 400mg, and it’s easy to obtain in a healthy diet.
- Ashwagandha: This stress adaptogen lowers cortisol levels in the body, which can significantly improve your hair’s health and retention. A daily intake of 300-500mg is sufficient.
In addition to these, the common everyday vitamins (A, B, C, D, E, etc.) benefit bodily functions in a billion ways, including hair retention and scalp balance. Biotin is in there, too, as Vitamin B7. So, I take a broad-reaching multivitamin each day—one that gives me enough zinc and selenium to prevent deficiency but never enough to overdose me (since I can still get additional amounts of these minerals from my diet).
However, because my daily multivitamin lacks saw palmetto, pumpkin seed oil, and ashwagandha, I also get these through additional oral and topical supplements. I’ve crunched the numbers and am still pacing well ahead of my beloved Nutrafol cost, especially given that those bottles last but a month and my supplements can last upwards of 6.
Now, I live in Germany, so I’ve got different brands to choose from here than in the US. But here are the supplements that I would buy in the US, each with the essential values of the above vitamins and minerals, without overdoing it on certain minerals like selenium, copper, and zinc. For example:
Hair care starts with scalp care. That’s one grooming message that has grown louder in the past few years, and thank goodness for it. We spend so much time focusing on the health of the dead hairs that have already grown up out of our skull, and as much effort needs to go into maintaining a calm, balanced scalp at the same time — both for your own sanity and for your follicles’ wellbeing.
While things like dandruff, itching, and inflammation will never be cited as culprits behind hair loss, they are very much creating an undesirable environment up there. And continued agony can lead to scarring and stunted growth. So, with a dry, dehydrated, and unclean scalp, you might lose some hairs faster than you otherwise would have lost them to biological processes.
One treatment I’m using right now is the daily peptide-powered scalp serum from The Ordinary, since peptides can calm inflammation and simultaneously fortify protein production in the follicle, yielding stronger, thicker, fuller hair. It also stimulates circulation with caffeine, which gives my minoxidil efforts a nice bolster.
Secondly, I use an anti-dandruff shampoo at least once a month when my scalp otherwise feels balanced (like, not too oily, never itchy, no flakes), or once a week when I do notice any problems (like seasonal flakes).
Find one with an active ingredient, but don’t use these as your regular shampoo unless you are treating a severe case. That’s because they can dry out the hair and scalp if used too much; I find that especially the case with common active ingredients ketoconazole and pyrithione zinc. I love products with those ingredients for their effectiveness, but since I maintain a good balance, I stick with a salicylic acid shampoo, namely this one from OUAI.
Yes, it’s more drying than their other options, but again, it’s a once-monthly solution for me, and ad hoc as needed (like after a really sweaty workout). I always time my hair masks and other conditioning measures after any anti-dandruff treatments, as well as scalp serums like The Ordinary’s above.
A Hard Water Filter + Trusted Conditioner
If your city or building has mineral-filtered water, then lucky you. If not, then you know how pesky it is to have calcium buildup around the glass or tile, not to mention dryer skin, more frequent hangnails, and unfortunately, dryer and more brittle hair. Continued mineral buildup on the strands leaves them far more prone to breakage, and I’m not exactly looking to minimize the potential of my precious hairs. So, while I’m not worried about permanent hair loss with hard water, I am concerned about the longevity of my hair (which are down to my shoulder, at least the ones lucky enough to have grown that long).
Just this week, I had a thought: Have I changed my water softener in the past year? I’m supposed to do it every six months, but my hair has been breaking midway through much more than usual. Sure enough, after I swapped in a new filter, I have been noticing far fewer hairs coming out with the brush, the strands been far more responsive to my styling products and less so to the cold dry air, and on top of that, all of my hangnails have disappeared. (Curse this German water. Never have I had more hangnails in my life).
In summary: I can’t recommend enough the value of having a water softener in your shower. If you’re going to put in the effort to preserve follicles, then you need to do your utmost to value the strands that grow from them, no matter how long or short.
Here’s the water softener I use, available in the US:
On top of that, you need a good conditioner that follows each shampoo and keeps those hairs stronger for longer. I’ll go to my grave singing the praises of Olaplex — I’m very much part of that cult. Every day I use it, I feel like I’m ready to step into a hair care commercial with my shiny, light-catching strands. I even follow it with a couple of drops of the brand’s bonding oil when I style my hair—especially if I’m blow-drying it, since I’m not about to endure any heat damage and risk breakage or split ends.