DTC AA treatment offers the potential to improve access to care for patients who would otherwise potentially forgo treatment. Abeck et al [2] found that 55.4% of patients had never consulted a physician due to AA and 76.1% of patients had not previously received treatment with oral finasteride before undergoing telemedicine care. Treatment barriers included low disease burden, prolonged outpatient appointment waiting times, and shame [2]. A further study confirmed convenience and discretion as key motivators involved in choosing DTC treatment [4]. According to Young et al [3], almost one in three new patients had not considered hair loss treatment until they became aware of telemedical platforms.

After 6 months, 81% of patients from a US platform reported hair regrowth or cessation of hair loss [3]. Similar results were reported among patients taking oral finasteride from a German platform: 79% reported positive changes in hair appearance and 59% reported an improvement in self-esteem after 6 weeks [5]. Slightly lower treatment success was reported by patients undergoing topical finasteride/minoxidil treatment [6]. In the study from Abeck et al [2] nearly all patients (97.7%) wished to continue therapy on the DTC platform, and most (81%) patients rated medical care via the platform as at least as good as, or better than, care provided in a previous outpatient appointment with a physician.

Adverse events (AEs) associated with DTC teledermatology treatment for AA were reported in 5%‐12% of patients, with most being mild [5,6]. DTC platforms can improve patient safety by implementing automated systems that prevent the simultaneous ordering of contraindicated medications. Additionally, DTC platforms can expand scientific knowledge through real-world digital data collection. Sexual AEs, such as decreased libido and erectile dysfunction, may be associated with finasteride usage [1]. The study by Abeck et al [6] using data from a German DTC platform found no difference in the incidence of sexual AEs between patients treated with topical finasteride and those treated with oral finasteride. In total, 2.3%‐2.5% of patients reported sexual AEs. This real-world data expands upon our knowledge of the incidence of potential AEs.

Full treatment adherence with DTC teledermatology treatment for AA varied from 74.4% (topical finasteride/minoxidil) to 87% (oral finasteride) in patients visiting a German platform [5,6]. Additionally, 91% of patients from a platform in the United States reported never or rarely missing their medication [3].

Buxo and Fakhoury [8] compared the prices of generic finasteride in 5 DTC platforms and 3 wholesale pharmacies in the United States. The study identified that finasteride was significantly more expensive when purchased from DTC pharmacies. Specifically, the lowest 3-month price from DTC pharmacies was about 1.5 times higher than that from the cheapest wholesale pharmacies. Similar price differences were described by Jean-Pierre and Williams [7], as DTC companies showed a 1.6-fold increase for oral finasteride compared to traditional pharmacies. However, indirect costs of doctor visits, such as transport costs and lost working time, must also be accounted for when assessing prices [8].