Following some messages on Reddit, a reader of the Hyperhidrosis Observatory asked for my opinion on the oxybutynin-based gel marketed by the American brand Twofold — here it is!
💬 The comment section is there for you! Feel free to share your experiences, as they can be valuable to others.
♻️ Last update: September 6, 2025. Written by Nelly Darbois, physical therapist and scientific writer (see here)
Summary
What does Twofold’s Oxybutynin RxGel contain?
This product comes in a gel tube, with oxybutynin as the active substance — the same compound sometimes found in medications for hyperhidrosis.
Each tube contains 8% oxybutynin.
The gel is aluminum-free and designed to be applied on most areas of the body (feet, hands, buttocks, chest, back, armpits, etc.) as well as the face, except for the scalp.
How can you get this gel?
Twofold works like a virtual clinic specialized in sweating disorders.
Subscription model:
First, you complete an asynchronous teleconsultation by filling out a questionnaire about your symptoms and medical history. If a professional finds the gel suitable for you, it will be shipped directly to your home in discreet packaging.
The cost is $150 for three months of treatment, including delivery (within the U.S.). You receive one 50 mL tube for this 3-month period.
There is no reimbursement through health insurance or mutual funds.
Personal note: I went through the process myself to test it for you. You must provide your email, full name, and phone number first. Most importantly, you need to enter a U.S. postal address: shipping to France or other countries doesn’t seem possible.
What do users say about it?
So far, I haven’t found any fully independent and verifiable reviews online, either in French or English.
This is not surprising for a brand that has just entered such a complex market as hyperhidrosis.
What other oxybutynin-based antiperspirants exist?
To my knowledge, there have long been antiperspirants based on glycopyrrolate, mostly in patch form. But until now, no oxybutynin-based gel had been available on the market, although clinical trials have tested such formulations.
Other oxybutynin-based antiperspirants include:
- APOHIDE Lotion 20% (restricted to healthcare professionals)
What do studies say about topical oxybutynin?
In December 2024, U.S. researchers compiled the results of all studies evaluating the effectiveness of oxybutynin-based topical antiperspirants.
They analyzed 8 studies involving 593 patients, using gels, lotions, creams, or patches, over periods ranging from 4 weeks to 1 year.
Key findings:
- Sweating was significantly reduced in most patients: 7 out of 10 improved by at least 1 point on the HDSS scale, compared with 4 out of 10 on placebo.
- 7 out of 10 patients reported being satisfied with the treatment.
- In a one-year study, 7 out of 10 maintained a lasting reduction in sweating.
Side effects:
- Most common: local skin reactions (irritation, dryness, redness), dry mouth, or thirst.
- Systemic effects like headaches, blurred vision, or constipation were rare (<1%) and less frequent than with oral oxybutynin.
Should you choose oxybutynin, glycopyrronium, or aluminum-based antiperspirants?
So far, no clinical studies directly compare the effectiveness of these different types of antiperspirants.
Since aluminum-based antiperspirants are the most established, it’s standard practice to try aluminum chloride antiperspirants (like Etiaxil) first.
If those aren’t effective or satisfactory, other topical options can be considered:
- Antihydral
- Sofpironium bromide gel
- Glycopyrrolate (glycopyrronium) antiperspirants
- And now, Oxybutynin RxGel (Twofold).
And of course, don’t forget the other available treatments, reviewed in detail on this blog.
***
Do you have any comments or questions? Your comments are welcome 🙂 !
You may also like:
📚 SOURCES
Okawa K, Terahara T. [Pharmacologic properties and results of a clinical study of oxybutynin hydrochloride lotion (APOHIDE® Lotion 20%) as a novel treatment for primary palmar hyperhidrosis]. Nihon Yakurigaku Zasshi. 2024;159(6):413-422. Japanese. doi: 10.1254/fpj.24037. PMID: 39496419.
Written by Nelly Darbois
I founded this website in 2012. Since then, I’ve been providing information and positive support to people suffering from excessive sweating. I’m also a physical therapist and science writer, living in French Alps 🌞❄️.