Daily use of topical finasteride 0.25% as monotherapy has resulted in significant increases in hair density and thickness for postmenopausal women with female-pattern hair loss (FPHL) treated in real-world settings, according to a retrospective study.
From baseline to week 52, the primary endpoint of hair density increased by a mean of 23.37 hairs/cm2, from 149.48 to 172.84 hairs/cm2 (p<0.001), reported study author Dr Bianca Maria Piraccini, a dermatologist in private practice in Bologna, Italy, and colleagues. [Int J Dermatol 2026;doi:10.1111/ijd.70730]
Additionally, hair thickness increased by a mean of 10.62 μm (from 40.42 to 51.04 μm; p<0.001) in target areas in frontal and vertex regions, while terminal-to-vellus hair ratio improved by a mean of 0.52 (from 1.04 to 1.56; p<0.001), “suggesting favourable overall follicular response,” Piraccini and colleagues continued.
Treatment responses did not differ significantly by disease severity.
Patient-reported perceived effectiveness (mean 1.73), clinician-reported effectiveness (mean 1.62), and the trichoscopic effectiveness assessments (mean 1.77) indicated good-to-excellent improvement, which underscores “strong agreement between subjective and objective assessments,” according to Piraccini and colleagues.
There were no adverse events documented, and tolerability was rated highly by patients (mean 1.77). The mean compliance rating was 1.65, indicating good treatment compliance.
“By combining objective quantitative measurements with patient- and clinician-reported outcomes, this study provides useful real-world observational data regarding topical finasteride use in the treatment of FPHL,” Piraccini and colleagues said.
The findings are consistent with evidence from a prior randomized controlled trial of topical finasteride 0.25% in male-pattern hair loss (MPHL), with significant improvements in hair density demonstrated over 24 weeks. [J Eur Acad Dermatol Venereol 2022;36:286-294]
“Although the contribution of androgens to FPHL is less clearly defined than in MPHL, the present findings are consistent with the hypothesis that dihydrotestosterone-mediated mechanisms remain clinically relevant in at least a subset of affected women,” Piraccini and colleagues explained.
“This may be particularly pronounced in postmenopausal women, where the rapid decline in oestrogen levels combined with temporarily preserved androgen activity could increase the relative effect of androgens at the follicular level,” they added.
Larger prospective, randomized controlled trials are needed to establish the efficacy of topical finasteride 0.25% in women with FPHL, who have limited treatment options, according to the authors. “A topical formulation of finasteride may offer the advantage of localized 5α-reductase inhibition within the scalp while minimizing systemic exposure,” they said.
The study included 26 postmenopausal women with FPHL (mean age 64.4 years) who received treatment at the Dermatology Unit of the IRCCS AOU Policlinico Sant'Orsola Malpighi and at a private dermatology clinic located in Bologna, Italy.
Disease severity according to the Ludwig Scale was stage I in 15 women, stage II in five, and stage III in six. Hair loss was concentrated in frontal regions in 69.2 percent of women, in the vertex in 19.2 percent, and in both regions in 11.5 percent. The women administered an average of 2.65 sprays of topical finasteride each day for 52 weeks.