Topical Finasteride Side Effects: ED, Absorption and Safety

Key facts

• Compounded topical finasteride is not FDA-approved and has no FDA label.
• The FDA says absorption of finasteride through the skin into the bloodstream is expected.
• The FDA counted 32 adverse event cases between 2019 and 2024, including erectile dysfunction, decreased libido, depression and suicidal ideation. Most reports said the events continued after the product was stopped.
• Some people told the FDA a prescriber had said there was no risk because the product was topical. A topical does not remove the risk.
• Studies of research solutions found less finasteride in the blood than with the tablet. Lower is not the same as none, and DHT in the blood still fell.
• The FDA warns that a topical can transfer to others. Finasteride is not for use by women who are or may become pregnant.

Does topical finasteride go systemic?

Yes. The FDA says absorption of finasteride through the skin into the bloodstream is expected. A topical does not keep finasteride on the scalp.

Published studies measured this. In a short study of a research solution, finasteride levels in the blood were lower than with the tablet, yet DHT in the blood fell by a similar amount. In a longer phase III trial of a spray, finasteride levels in the blood were far lower than with the tablet and blood DHT fell less, but it still fell. Dose-ranging work found the smallest effect on blood DHT with the smallest amounts of solution.

So the amount that reaches the blood changes with how much is used, which is one reason your provider sets the prescription. Those studies tested research solutions, not a compounded product, so their results do not describe one.

What did the FDA's 2025 alert say?

In April 2025 the FDA alerted health care providers, compounders and consumers to potential serious risks with compounded topical finasteride. The alert covers finasteride alone and finasteride combined with other actives, such as minoxidil. Men's Hair Solution is a product of that kind.

The FDA said 32 cases were reported to its adverse event system between 2019 and 2024. It said the events were consistent with those reported with approved oral finasteride, and it named:

• Erectile dysfunction and decreased libido
• Testicular pain
• Anxiety and depression
• Suicidal ideation
• Brain fog, fatigue and insomnia

Most of the reports said the events continued after the product was stopped. Consumers said they wished they had been told about the possible side effects. Some described severe depression and pain. Others said a prescriber told them there was no risk because the product was topical.

The FDA recommends that health care providers educate patients on these risks, and that consumers ask their health care providers and compounders about them before starting.

Does topical finasteride cause erectile dysfunction?

It may. Erectile dysfunction is among the events reported to the FDA after compounded topical finasteride. The alert gives no rate, so it does not show how often this happens.

The FDA label for Propecia®, the oral tablet, lists decreased libido, erectile dysfunction and ejaculation disorder as side effects of that tablet. It also reports sexual dysfunction that continued after treatment stopped, and it says voluntary reports like these cannot always establish how often something happens or what caused it.

In the phase III trial of a topical spray, sexual side effects were reported at a rate similar to placebo. The authors said the lower blood levels they measured do not exclude systemic side effects. That trial tested one spray for a matter of months and does not describe a compounded product.

If you notice any sexual change, tell your provider rather than waiting to see if it passes.

How do topical side effects compare with oral finasteride?

The FDA says the events reported with compounded topical products are consistent with those reported with the approved oral products. It also names two further risks of a topical:

• Reactions on the skin: irritation, redness, dryness or scaling, stinging and burning
• Greater potential to expose others, specifically females, through transfer of applied product

The authors of the phase III trial reported a trend toward fewer sexual side effects with the spray than with the tablet, and said such effects are less likely with the spray. Sexual function questionnaire scores were similar for the spray and the tablet. That is one trial of one spray, funded by the company behind it. The FDA's reports are the reason not to read it as no risk.

The full comparison of topical and oral finasteride goes further.

What does the oral finasteride label warn about?

Topical finasteride has no FDA label. The FDA says it poses other risks in addition to the safety concerns in the oral labeling. The FDA label for Propecia®, the oral tablet, lists these for that tablet:

• Decreased libido, erectile dysfunction and ejaculation disorder, including less semen
• Depression, and suicidal ideation and behavior
• Testicular pain, male infertility or poor semen quality, and blood in the semen
• Breast tenderness and enlargement, and reports of male breast cancer. Report any lump, pain or nipple discharge.
• Allergic reactions, including rash, itching, hives and swelling of the lips, tongue, throat or face
• Lower PSA results, which can affect prostate cancer screening. Tell any clinician ordering a PSA test.
• A warning that drugs in this class may increase the risk of high-grade prostate cancer

If you have thoughts of harming yourself, call or text 988 now. Tell your provider about any change in mood. Get emergency help for swelling of the lips, tongue, throat or face.

What are the side effects of minoxidil?

The FDA drug facts label for Men's Rogaine® foam says to stop use and ask a doctor if any of these occur:

• Chest pain, rapid heartbeat, faintness or dizziness
• Sudden, unexplained weight gain
• Swelling in your hands or feet
• Scalp irritation or redness
• Unwanted facial hair growth

The label adds that some people have changes in hair color or texture. It covers that product, not a compounded topical. The safety information for Men's Hair Solution lists scalp irritation, contact dermatitis and initial hair shedding during early use.

Can topical finasteride affect a partner or a pregnancy?

It can if the product transfers. The FDA says a topical carries a greater potential risk of exposing others, specifically females. The FDA label for Propecia®, the oral tablet, rules finasteride out in pregnancy because it may cause abnormalities of the external genitalia of a male fetus.

Approved tablets have a coating that prevents contact during normal handling. The FDA notes that compounded topical products do not have one. The tablet label says a woman who is or may be pregnant and touches crushed or broken tablets should wash the area right away with soap and water. No label covers a topical. The FDA warns of a greater risk of exposure to others, specifically women, through transfer of the applied product. Anyone who is or may become pregnant should not handle it. Ask your provider how to avoid transfer.

Is topical finasteride safe?

There is no FDA finding that it is. Compounded drugs are not FDA-approved, which the FDA says means it has not evaluated their safety, effectiveness or quality before marketing. The agency also says there are potential serious risks with these products.

Published data on compounded products is thin. One large analysis looked back at men prescribed compounded topical finasteride with minoxidil through a telehealth company. That company funded it, it had no control group, and its authors say it cannot confirm cause. They call for randomized trials.

A provider weighs these risks against your health history and decides what fits. Before you start, ask about the risks, as the FDA advises.

Frequently asked questions

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Sources

1. FDA alert: potential risks associated with compounded topical finasteride products (April 2025)
2. Propecia® (finasteride) oral tablets: FDA label (DailyMed)
3. Men's Rogaine® (minoxidil) foam: FDA drug facts label (DailyMed)
4. FDA: compounding and the FDA, questions and answers
5. Piraccini et al.: phase III trial of a topical finasteride spray (Journal of the European Academy of Dermatology and Venereology, 2022)
6. Lee et al.: systematic review of topical finasteride in androgenetic alopecia (Journal of Drugs in Dermatology, 2018)
7. Sexual dysfunction associated with 5-alpha reductase inhibitors in androgenetic alopecia: a systematic review (Frontiers in Medicine, 2026)
8. Off-label therapies for male androgenetic alopecia: systematic review with network meta-analyses (Medicina, 2026)
9. Men prescribed compounded topical finasteride via a telehealth platform: retrospective analysis (JMIR Dermatology, 2026)
10. American Academy of Dermatology: what is male pattern hair loss, and can it be treated?
11. American Red Cross: medication deferral list
12. SAMHSA: 988 Suicide and Crisis Lifeline
13. FDA: MedWatch safety information and adverse event reporting program

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