Remarkable results from Topical Finasteride and Minoxidil combined (photos)

Dr. Rassman’s Comments: The following writing was done at my requests after listening to Dr, Chiara Insalaco’s presentation in the UK Conference this past week. Her experience with 300 consecutive patients with no sexual side effects reported in this small group, show remarkable results in up to 18 months with the combined use of topical finasteride and 2% minoxidil as shown in the three patient examples below this writing. Dr. Insalaco was kind enough to write the following short review of her work for us and supply us three photos of her patients.

Personal Experience with Local Finasteride

Chiara Insalaco, MD, PhD

Plastic and Reconstructive Surgeon

Hair Restoration Specialist

Rome, Italy

June 17, 2019

Finasteride, a synthetic 4-azasteroid compound, is an antiandrogen which acts by inhibiting 5-alpha reductase. This enzyme converts Testosterone to Dihydrotestosterone (DHT). The drug works by blocking the body’s production of the male hormone that causes the prostate to enlarge.

In December 22nd 1997, the FDA approved finasteride (Propecia®) to treat male pattern hair loss. Clinical Studies for PROPECIA® (finasteride 1 mg) in the Treatment of Male Pattern Hair Loss shows that 3,8% of men experienced sexual adverse problems:

1.Decreased libido

2.Erectile Disfunction

3.Ejaculation Disorders

In 2011 the U.S. FDA conducted a post marketing evaluation of reported case of persistent sexual dysfunction after finasteride discontinuation. Of the 2527 cases, from 1997 to 2011, the FDA identified 59 reported cases of Sexual Disfunction that lasted 3 or more (2.3% of patient) months after Finasteride Discontinuation. The FDA has required Merck to revise the Propecia label to disclose the post marketing sexual adverse events. Shortly after Merck revised its label, THOUSANDS ( perhaps hundreds of thousands) of websites claim that Propecia (Finasteride) cause erectile dysfunction and loss of libido

In Italy in order to overcome the problem we came up with a new topical formulation. The aim was to achieve:

Maximum absorption through the epidermal layer of the scalp
Minimize the systemic absorption

The first study about topical finasteride is Italian and it was made in 1997 by: Mazzarella, G., Loconsole, G., Cammisa, G., Mastrolonardo, G. and Vena, G. (1997). Topical finasteride in the treatment of androgenic alopecia. Preliminary evaluations after a 16-month therapy course. Journal of Dermatological Treatment, 8(3), pp.189-192. This was a single-blind, placebo-controlled, 16-month trial carried out in 52 patients with AA using a 0.005% finasteride solution

Results: The clinical outcome, in terms of both hair regrowth and balding areas reduction, seems to be encouraging, in the absence of either any evidence of percutaneous (skin) absorption of finasteride, or local/systemic untoward effects. But in 1997 the FDA approved Propecia® to treat AGA so the study was forgotten!

There are few different compound formulations. These formulations are not 0ver-the Counter drugs available to the general public without a prescription. Only few pharmacies in Italy are able to make it and most pharmacies make them up on a demand basis.

The most common in Italy is the Finasteride Liposomal Gel.? The liposomal vehicle has a high penetration capacity through the epidermis and it’s able to keep the drug locally in the skin for long period of time.

It has a good aesthetic outcome
It doesn’t make the hair greasy

It requires good patient compliance

The Milan University evaluated 300 patients treated with the Finasteride Liposomal Gel. The result was: Systemic Absorption is limited to 1/18 patients compared to the Oral Finasteride.

In my daily practice I combine both Minoxidil and Finasteride in the same lotion in order to have maximum results. Before giving Local Finasteride I always get my patient to get (1) Blood test for DHT and Testosterone and (2) Sperm Counts. So far, no patients experienced any changes in these test results or any side effects.

Some new scientific studies showing that finasteride doesn’t cause Sexual Side Effects and suggest that:

Men with Alopecia may be inherently more susceptible to sexual dysfunction regardless of treatment
Sexual dysfunction is not uncommon in the general population regardless of alopecia status

Dr Chiara Insalaco

www.chiarainsalaco.com