Topical Finasteride 0.25% Solution for Female Pattern Hair Loss (FPHL) in Postmenopausal Women: A 52‐Week Retrospective Observational Study

BACKGROUND: Female pattern hair loss (FPHL), characterized by progressive follicular miniaturization, is the most common cause of hair thinning in women and increases in prevalence after menopause. While topical minoxidil is approved for FPHL, clinical response is variable. Oral finasteride is used off label in postmenopausal women but raises concerns regarding systemic adverse effects. Topical finasteride may represent an alternative with reduced systemic exposure. METHODS: A retrospective observational study was conducted in 26 postmenopausal women with FPHL who were treated with topical finasteride 0.25% monotherapy for 52 weeks. Clinical and trichoscopic images obtained at baseline and Week 52 were used to assess changes in hair density, hair thickness, and the terminal-to-vellus hair ratio in predefined target areas in frontal or vertex regions. Patient-reported tolerability and compliance, as well as patient- and clinician-reported effectiveness, were assessed using 3-point ordinal scales. RESULTS: (p < 0.001). Hair thickness increased from 40.42 ± 7.15 μm to 51.04 ± 9.28 μm (p < 0.001), and terminal-to-vellus hair ratio increased from 1.04 ± 0.61 to 1.56 ± 0.64 (p < 0.001). Subjective patient and clinician assessments indicated good-to-excellent effectiveness. No adverse events were recorded; tolerability and compliance were rated highly by patients. CONCLUSIONS: Topical finasteride 0.25% monotherapy was associated with significant improvements in hair density and thickness, alongside favorable reported tolerability and compliance. These findings provide preliminary real-world observational data regarding topical finasteride use in the underserved population of postmenopausal women with FPHL.