JMIR Publications

ABSTRACT

Background:

Topical minoxidil and oral finasteride are approved by the FDA for the treatment of male androgenetic alopecia (AGA). Concerns about adverse events related to the use of oral finasteride have led to some apprehension about the treatment. Topical finasteride, though not FDA-approved, has demonstrated efficacy and safety in a limited number of clinical trials and may be a promising alternative, such that compounding pharmacies and telehealth companies in the United States now offer access to topical finasteride for patients with AGA.

Objective:

The current real world, retrospective study is to our knowledge the largest to date on patient satisfaction and tolerability associated with novel combinations of topical finasteride and topical minoxidil for the treatment of male AGA.

Methods:

We conducted a retrospective analysis of patient data collected during routine clinical follow-up via the platform between April 1, 2021 and April 30, 2025 to assess the frequency of side effects and other possible medication reactions associated with the use of compounded, topical finasteride and minoxidil available via the Hims & Hers platform. Data were gathered from two sources: 1) a follow-up check-in sent to patients approximately 130 days following the initiation of treatment; 2) unprompted communications sent via in-app or web-based messaging from patients to their care team. Patient satisfaction with treatment, frequency of any side effect, frequency of specific side effects, need for a higher level of care, and treatment discontinuation due to a side effect were extracted from the data sources.

Results:

638,629 male patients with AGA received a prescription for a compounded, topical finasteride and minoxidil product between April 1, 2021 and April 30, 2025. Of 151,352 (23.7%) who completed a follow-up check-in, 121,615 (80.4%) reported being satisfied with treatment and 4,034 (2.7%) reported experiencing a side effect. Of all 638,629 patients, 230 (0.04%) sent their care team a message (outside of check-ins) indicating a side effect or other possible medication reaction. No patients reported seeking a higher level of care or discontinuing treatment due to such an occurrence.

Conclusions:

Patients prescribed novel formulations of compounded, topical finasteride and minoxidil for the treatment of AGA via a national telehealth platform reported satisfaction with treatment and tolerated it well. Future research should include RCTs to assess the efficacy, safety, and tolerability of topical finasteride.