Topical finasteride: is it safer than tablets?
Topical finasteride puts less of the drug in your blood, but not none. Some people say side effects lasted after they stopped. This is called PFS.
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Topical finasteride puts less of the drug into your blood than a tablet, but not none, and the FDA has had reports of sexual problems and depression that continued after people stopped. When symptoms last after stopping finasteride, it’s called post-finasteride syndrome (PFS).
Some people choose a spray because they’ve been told it’s the safe option. That claim rests mainly on blood tests, and no study we could find has followed spray users for months after they stopped.
The story in 3 lines
- A spray puts far less finasteride in your blood than a tablet, but in one trial it still cut the hormone DHT by about a third (trial).
- The FDA has had reports of sexual problems and depression after topical finasteride. Most said they continued after stopping (FDA).
- No study we found followed spray users for more than four weeks after stopping (trial). Patients call lasting symptoms PFS.
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Sumair was 21 when he started topical finasteride, prescribed through an online service. He says he was told side effects were rare and would clear once he stopped. After four applications, he felt an intense burning in his genitals.
The burning eased when he stopped. Over the following weeks and months, things got worse: genital numbness, no sex drive at all, insomnia, trouble with memory. He says a doctor first told him it was probably in his head.
Does topical finasteride get into your blood?
Yes, some of it does. The FDA says finasteride passing “through the skin into the bloodstream is expected” (FDA).
One trial compared a finasteride spray with the tablet and a dummy spray. DHT, the hormone finasteride lowers, fell in the blood by about a third on the spray and more than half on the tablet. It didn’t change on the dummy spray. So the spray’s effect wasn’t limited to the scalp.
How much DHT fell in the blood after 24 weeks
The EU medicines regulator says the body’s exposure to the drug is “markedly lower” with a spray. It adds that this “does not completely exclude the risk” of side effects elsewhere in the body (EMA).
Is topical finasteride safer than tablets?
Nobody knows yet whether the side effects that last are rarer with a spray.
In the same trial, about 3 in 100 men reported a sexual side effect linked to treatment, on the spray and on the dummy spray alike. Because much less of the drug reached the blood, the authors concluded there is “less likelihood” of sexual side effects than with the tablet. That’s the strongest case for calling the spray safer.
The trial was built to show whether hair grew, though. Its last check came four weeks after treatment ended, too soon to know whether a problem lasted for months.
Konrad used topical finasteride for 10 days. He says he understood it to be safe. He describes panic attacks, insomnia and cognitive problems. Almost nobody else can see any of it.
Can topical finasteride side effects last after stopping?
Some people say theirs have. The US has no approved finasteride spray, so the ones sold there are made up by pharmacies, and the FDA has warned about them.
Its warning describes 32 reports of problems, from erectile dysfunction and low sex drive to depression, suicidal thoughts and brain fog. Most said the problems “continued to persist after product discontinuation”.
Some said a prescriber had told them there was “no risk of any adverse event because the product was topical”.
Reports can’t prove the drug caused a problem, or show how often it happens, the FDA says. For tablets, the UK medicines regulator warns that sexual problems have sometimes continued after people stopped (MHRA).
Sawyer used topical finasteride for three months. In his interview, he describes side effects that carried on after he stopped.
If any of this feels close to home, you can call Samaritans free on 116 123 in the UK, at any hour. In the US, call or text 988.
What can I do if something has changed?
These medicines help many people. If you have side effects, that’s a decision for you and your prescriber.
A change in mood is different. For finasteride hair-loss tablets, the UK medicines regulator says to stop straight away and contact your doctor if you develop depression or suicidal thoughts (MHRA). On a spray, see a doctor as soon as you can.
Tell whoever prescribed it what changed and when, and that you used it on your scalp. For example: “Finasteride spray from March 2025, last used June 2025. No sex drive since May.”
If you haven’t started yet, ask first:
Ask for its name and leaflet.
Some sprays add minoxidil.
And who do I tell if they start?
Above all if she could become pregnant.
Report it: it helps everyone
A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.
- No proof needed. A suspicion is enough, even years after stopping.
- Where: the Yellow Card scheme in the UK, MedWatch in the US. Say you used it on your scalp.
- Use the right words. If symptoms continued after stopping, write Post 5-alpha-reductase inhibitor syndrome (MedDRA 10082430).
Our reporting guide walks you through it
What else do people ask about topical finasteride?
Can topical finasteride affect a partner? The FDA says finasteride must not be used in pregnancy, because it may cause abnormalities in a male baby. It warns that a product on the skin carries a “greater potential risk” of passing to others, “specifically females”. It asks prescribers to explain this, so if your partner is or could become pregnant, ask how to avoid passing it on.
Is there a licensed finasteride spray in the UK? We couldn’t find one. The UK medicines compendium, where companies publish their leaflets, lists only finasteride tablets, so a spray offered in the UK may be unlicensed, or made up by a pharmacy. Ask your prescriber which it is.
Can topical finasteride affect mood? Nobody knows yet. The EU medicines regulator found “no evidence linking suicidal ideation” to finasteride sprays, but it also found no study that had looked for it. The sprays’ product information in the EU already warns about the mood changes seen with tablets.
Sumair says he knew side effects were possible, but lasting harm was never really put to him before he started. If something has changed for you, read about PFS and report it.
Sources
- Piraccini BM, Blume-Peytavi U, Scarci F and colleagues. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol 2022;36(2):286-294. 458 men; a 0.25% finasteride spray against the 1 mg tablet and placebo for 24 weeks, with a follow-up visit at week 28. Blood DHT fell by 34.5% on the spray and 55.6% on the tablet, with no change on placebo; peak blood finasteride was more than 100 times lower with the spray. Treatment-related sexual side effects: 2.8% on the spray, 3.3% on placebo, 4.8% on the tablet. Funded by Polichem S.A. and Almirall S.A., the companies developing the spray.
- US Food and Drug Administration, FDA alerts health care providers, compounders and consumers of potential risks associated with compounded topical finasteride products, April 2025. 32 reports to the FDA Adverse Event Reporting System from 2019 to 2024. There is no FDA-approved topical finasteride; compounded drugs are not reviewed by the FDA for safety, effectiveness or quality before they are sold.
- US Food and Drug Administration, FDA Adverse Event Monitoring System (AEMS) Public Dashboard: reports “cannot be used to estimate the incidence” of the events reported.
- European Medicines Agency, PRAC, Finasteride- and dutasteride-containing medicinal products, Article 31 referral: assessment report, EMA/PRAC/55203/2025. Finasteride spray authorised in the EU since 2020; “markedly lower systemic exposure” than tablets; no relevant study of suicidal thoughts with the spray, and no possible or probable case linked to topical use alone; the sprays’ benefit-risk balance “remains favourable”.
- European Medicines Agency, Finasteride- and dutasteride-containing medicinal products: referral overview, 2025. Suicidal ideation confirmed as a side effect of finasteride 1 mg and 5 mg tablets; a patient card added to packs of 1 mg tablets.
- MHRA, Finasteride: reminder of the risk of psychiatric side effects and of sexual side effects (which may persist after discontinuation of treatment), Drug Safety Update, 29 April 2024.
- MHRA, Finasteride and dutasteride: updated safety warnings for psychiatric side effects and sexual dysfunction, Drug Safety Update, 11 May 2026. Advice for finasteride 1 mg: “stop finasteride 1mg immediately if you develop depression or suicidal thoughts and contact your doctor as soon as possible”. Neither update mentions sprays.
- Electronic Medicines Compendium, search for finasteride, checked 10 October 2026: ten products, all tablets.
- Videos: Moral Medicine interviews with Sumair (written up in Sumair’s story), Konrad (4 August 2025; Konrad’s story) and Sawyer (27 June 2024; Sawyer’s story).
This information does not replace medical advice. Talk to your doctor before you make any decision about your treatment.
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