Is It Safe to Buy Finasteride Online?

IT CAN BE hard to know what to do when you’re dealing with hair loss. While dermatologists are specially trained to treat this kind of thing, there are plenty of companies that will ship compounded medications to you after a few clicks online. Which seems … much easier?

Except that the U.S. Food and Drug Administration (FDA) is now warning against going with option No.2, especially when it comes to using topical finasteride for hair loss. The agency points out in a health alert released Tuesday that there is no FDA-approved topical formulation of finasteride.

But popular telehealth sites like Hims, Keeps, and Ro, are selling compounded versions of these medications online anyway, and often without you needing to have a face-to-face consultation with a doctor.

According to the FDA, there are “potential serious risks” linked to using these products—and men aren’t being properly warned about them. Here’s the deal with finasteride, plus why doctors say you should think twice about getting it from a telehealth site.

What is finasteride?

Oral finasteride is an FDA-approved medication designed to help prevent hair loss. It specifically blocks type‑II 5‑α‑reductase, which is an enzyme that converts testosterone to dihydrotestosterone (DHT), explains Gary Goldenberg, MD, assistant clinical professor of dermatology at Icahn School of Medicine at Mount Sinai Hospital.

“Patients who are sensitive to elevated DHT levels often develop pattern hair loss,” Goldenberg says. “These patients’ follicles, especially on the crown of the scalp, are more sensitive to DHT than other hair follicles.” Lowering DHT can slow or reverse pattern hair loss, says Ken L. Williams Jr., DO, a hair-restoration specialist, surgeon, and author of Hair Transplant 360: Follicular Unit Extraction.

Here’s where things get a little confusing. There are two oral forms of finasteride approved for use in the U.S. by the FDA: Proscar, which was approved in 1992 to treat enlarged prostates, and Propecia, which was approved for male pattern hair loss in 1997.

However, some doctors recommend that patients use topical finasteride instead of the FDA-approved oral medications due to potential side effects (more on those in a moment).

“I have been using topical finasteride and combination with minoxidil [which stimulates hair growth] in my practice for over almost a decade,” Goldenberg says. “Topical finasteride is thought to be safer, since the absorption through the scalp would be much, much lower than oral finasteride.”

But again, the FDA warns against using topical finasteride from a compounded pharmacy—keep that in mind for later.

OK, so what’s the danger in getting this medication from an online source?

Oral finasteride has well documented side effects that can be severe. Propecia specifically warns about experiencing things like decreased libido, erectile dysfunction, and ejaculation disorder. Proscar warns of a higher risk of developing prostate cancer, impotence, decreased libido, decreased volume of ejaculate, breast enlargement, and rash. Research has also linked finasteride to serious mental health issues, including depression, anxiety, and thoughts of suicide.

Yes, serious stuff.

But because topical finasteride isn’t FDA-approved, there is no warning label on these products. As a result, patients can end up taking these medications without realizing that they’re also at risk of serious consequences.

The FDA’s health alert calls out 32 cases of serious side effects linked to compounded topical finasteride between 2019 and 2024. The medication is absorbed through the skin and into the bloodstream, and has been linked to side effects like erectile dysfunction, anxiety, suicidal ideation, brain fog, depression, fatigue, insomnia, decreased libido, and testicular pain, per the health alert.

For most of the reports the FDA received, the side effects continued even after people stopped using topical finasteride.

“In some cases, consumers expressed they were not aware of the potential adverse events associated with the use of topical finasteride, and other patients reported that they were told by the prescribers that there was no risk of any adverse event because the product was topical,” the alert reads. “Consumers said they wished they had been informed about the possible side effects. Some consumers expressed they became very depressed, suffering with pain and their lives were ruined because of these symptoms.”

Here’s the difference in getting topical finasteride from a website vs. a doctor: A doctor will monitor you for side effects after you’re prescribed the medication and should warn you of potential risks of taking the drug in advance, Williams says.

“There are intense social media and marketing campaigns by these companies,” Williams says. “But most patients just order it online and never meet with a physician.” (Keep in mind that many of these online services do have physicians on staff and on call if needed—it’s just unlikely that you’ll meet with one before getting your medication. Instead, customers will usually fill out an intake form, although some states do require a video visit with a provider.)

What to do if you’re dealing with hair loss

If you’re experiencing hair loss and it bothers you, see a board-certified dermatologist. Yes, it’s much less convenient to make the appointment and wait in a doctor’s office, but it’s the best way to know that you’ll receive proper medical care.

“There is a need for a face-to-face consultation with a board-certified physician who has been trained in hair loss,” Williams says. “You need an official diagnosis to learn the cause of your hair loss before you can figure out the proper treatment.”

A doctor can also help walk you through the risks and benefits of a range of potential treatments to allow you to make the best-informed decision for yourself, Goldenberg says. “I discuss all of these options with my patients, assess the risks and benefits of each treatment, and formulate a personalized plan of each patient,” he says.

If you’re interested in using topical finasteride, the FDA recommends working with a healthcare provide to go over potential risks first. Goldenberg stresses that the FDA’s warning about topical finasteride doesn’t apply to getting the medication through your doctor.

“The FDA warnings for oral finasteride are based on large populations of patients that have taken this medication over the past two decades,” he says. “The warnings for topical finasteride have been based on isolated case reports. While topical finasteride is not FDA-approved, I consider it much lower risk and much safer medication a than oral finasteride.”

Williams underlines the importance of seeing a doctor for hair loss, whether you’re interested in using finasteride or something else. “We’re seeing the illicit practice of medicine without a physician associated with it,” he says. “That’s not the proper way to practice medicine. These medications do have side effects and they need to have a physician with them.”