Anagen formulation · 4 activesBDesigned for the systemic-side-effect-averse

Mr. Middleground

Anagen's safety-leaning combo: same minoxidil and supporting actives as Budget Growth Maxi, but with finasteride reduced to 0.005% — a 20× lower dose chosen to retain meaningful scalp DHT effect while minimizing systemic exposure.

What's in it

Every active in Mr. Middleground

Each active in this formulation, scored against its own standalone evidence for AGA. Click any active for the full claim-by-claim breakdown.

Active	Grade	Why it's in this formula
Finasteride0.005%→Sub-systemic DHT suppression	B	Ultra-low-dose topical finasteride — 20× lower than the 0.1% used in Growth Maxi. The Caserini pharmacokinetic work on topical finasteride 0.25% shows dose-dependent systemic absorption; at 0.005%, circulating finasteride should be substantially lower while preserving local scalp activity. Trades some efficacy ceiling for a far tighter side-effect envelope.
Minoxidil5%→Follicular activator	A	Full-dose topical 5% minoxidil — same as the other Anagen combos. Carries the primary efficacy load in this formulation given the reduced finasteride dose.
Liothyronine (T3)6.5 ng/mL→Anagen induction	C	Same microdose T3 used across Anagen's topicals.
Levocetirizine0.5%→Anti-inflammatory / anti-PGD2	C	PGD2 inhibition adjunct with the Zaky 2021 supporting evidence.

The case for this stack

Why we paired these actives

Why the 0.005% finasteride dose

Mr. Middleground exists for users who want a combination protocol but are wary of the systemic side-effect profile that comes with full-dose finasteride. The ultra-low 0.005% topical dose is the formulation's central choice — and the reasoning is anchored in the pharmacokinetic literature on topical finasteride. Caserini and colleagues characterized the pharmacokinetics of topical finasteride 0.25%, demonstrating dose-dependent systemic absorption with measurably lower serum levels than oral dosing. At 0.005% — a 50× lower concentration than the studied 0.25% solution — circulating finasteride should approach negligible. The local scalp activity may also be reduced, but local follicular DHT suppression appears to be preserved at very low topical doses based on the formulation's design rationale. The rest of the stack (full-dose minoxidil + T3 + levocetirizine) carries the bulk of the efficacy work. This is the formulation we'd recommend to users with a history of finasteride sensitivity, those concerned about post-finasteride syndrome reports, or those who want to preserve future fertility options while still using a five-alpha-reductase inhibitor in some form.

Cited literature

Caserini M, Radicioni M, Leuratti C, et al. (2014). A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Int J Clin Pharmacol Ther PMID 25074865
Caserini M, Radicioni M, Leuratti C, et al. (2016). Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Int J Clin Pharmacol Ther PMID 26636418
Li Y, Huang Q, Zhou Z, Zhang Y (2025). Comparing minoxidil-finasteride mixed solution with minoxidil solution alone for male androgenetic alopecia: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Medicine PMID 41127390

What's been studied

The studies behind the combination

The 0.005% topical finasteride concentration has not been directly studied in an RCT — Anagen's case rests on extrapolation from the Caserini pharmacokinetic work at 0.25% and the established efficacy ceiling of full-strength fin + min combinations. Here are the most directly relevant studies.

Caserini 2014 — Topical finasteride 0.25% pharmacokinetics

Int J Clin Pharmacol Ther · PMID 25074865

STUDY

Design

Pharmacokinetic study in healthy male volunteers

—

Duration

Multi-dose

Topical finasteride 0.25% showed measurably lower plasma finasteride levels than oral 1 mg (Cmax 0.46 ± 0.28 ng/mL, AUC 6.64 ± 7.50 ng/mL·h after multiple doses). Establishes the basic principle that topical fin reduces systemic exposure relative to oral.

Caserini 2016 — Topical finasteride dose-response on serum DHT

Int J Clin Pharmacol Ther · PMID 26636418

STUDY

Design

Pharmacokinetic/pharmacodynamic study

—

Duration

—

Serum DHT reduction was -24% to -26% with 100–200 µL of 0.25% topical fin and -44% to -48% with 300–400 µL — demonstrating dose-dependent systemic effect. At 0.005% (50× lower concentration), serum DHT impact should be substantially smaller.

Li 2025 — Topical fin + min meta-analysis (foundation pairing)

Frontiers in Medicine · PMID 41127390

What the science doesn't yet answer

No RCT has tested topical finasteride at 0.005% specifically. The dose is chosen for safety-leaning pharmacokinetics, but the efficacy floor at this dilution is inferred, not directly measured.
Whether 0.005% topical finasteride produces a clinically meaningful efficacy gain over minoxidil alone — or whether the dose is so low it functions as an effective placebo on the DHT axis — has not been directly studied.
Long-term real-world outcomes (>1 year) of this safety-leaning protocol vs the full-dose Growth Maxi haven't been characterized.
Mr. Middleground is the right choice if you want a fin-containing protocol with the side-effect risk minimized; it may not be the right choice if maximum regrowth is your only priority.

Bottom line

Our verdict on Mr. Middleground

Safety-leaning, evidence-extrapolated

Mr. Middleground is a deliberate trade-off: keep the fin+min combination foundation, but reduce finasteride to a dose where systemic exposure becomes minimal. The pharmacokinetic case is solid — at 0.005% topical, circulating finasteride should approach negligible based on the Caserini dose-response data. The efficacy case is inferred from the standard fin+min combination evidence (Grade A) plus the assumption that local scalp activity is preserved at this dilution. That assumption isn't directly tested — and that's why Mr. Middleground is the right formulation for safety-prioritizing users, not for users who want maximum regrowth. If you'd rather take less finasteride than more, this is the calibration point. If you'd rather take more finasteride for more efficacy, see Growth Maxi or The Basics.

The safety-leaning calibration of the fin + min foundation. Pharmacokinetic case for the low fin dose is solid; the efficacy case at this dilution is inferred rather than directly tested.

Go deeper

Long-form analysis and primary-source breakdowns that go beyond the summary above.

Compare

How does Mr. Middleground compare to its closest Anagen siblings?

The BasicsA

The cleanest evidence in the catalog

Read the evidence →

Growth MaxiB

Strong pairwise evidence, novel combination

Read the evidence →

Guys & GirlsB

Strong base regimen without androgen modulation

Read the evidence →

← Back to all treatments & brands

Every active in Mr. Middleground

Each active in this formulation, scored against its own standalone evidence for AGA. Click any active for the full claim-by-claim breakdown.

Active	Grade	Why it's in this formula
Finasteride0.005%→Sub-systemic DHT suppression	B	Ultra-low-dose topical finasteride — 20× lower than the 0.1% used in Growth Maxi. The Caserini pharmacokinetic work on topical finasteride 0.25% shows dose-dependent systemic absorption; at 0.005%, circulating finasteride should be substantially lower while preserving local scalp activity. Trades some efficacy ceiling for a far tighter side-effect envelope.
Minoxidil5%→Follicular activator	A	Full-dose topical 5% minoxidil — same as the other Anagen combos. Carries the primary efficacy load in this formulation given the reduced finasteride dose.
Liothyronine (T3)6.5 ng/mL→Anagen induction	C	Same microdose T3 used across Anagen's topicals.
Levocetirizine0.5%→Anti-inflammatory / anti-PGD2	C	PGD2 inhibition adjunct with the Zaky 2021 supporting evidence.

Why we paired these actives

Why the 0.005% finasteride dose

Cited literature

Caserini M, Radicioni M, Leuratti C, et al. (2014). A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Int J Clin Pharmacol Ther PMID 25074865
Caserini M, Radicioni M, Leuratti C, et al. (2016). Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Int J Clin Pharmacol Ther PMID 26636418
Li Y, Huang Q, Zhou Z, Zhang Y (2025). Comparing minoxidil-finasteride mixed solution with minoxidil solution alone for male androgenetic alopecia: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Medicine PMID 41127390

The studies behind the combination

Caserini 2014 — Topical finasteride 0.25% pharmacokinetics

Int J Clin Pharmacol Ther · PMID 25074865

STUDY

Design

Pharmacokinetic study in healthy male volunteers

—

Duration

Multi-dose

Caserini 2016 — Topical finasteride dose-response on serum DHT

Int J Clin Pharmacol Ther · PMID 26636418

STUDY

Design

Pharmacokinetic/pharmacodynamic study

—

Duration

—

Li 2025 — Topical fin + min meta-analysis (foundation pairing)

Frontiers in Medicine · PMID 41127390

Mr. Middleground

Every active in Mr. Middleground

Why we paired these actives

Why the 0.005% finasteride dose

The studies behind the combination

What the science doesn't yet answer

Our verdict on Mr. Middleground

From the Anagen blog

Related Anagen formulations

Mr. Middleground

Every active in Mr. Middleground

Why we paired these actives

Why the 0.005% finasteride dose

The studies behind the combination

What the science doesn't yet answer

Our verdict on Mr. Middleground

From the Anagen blog

Related Anagen formulations

Mr. Middleground