Effectiveness and Safety of Topical Finasteride for Male Androgenetic Alopecia: Real World Data

Background: Androgenetic alopecia (AGA) is the most common cause of hair loss in men. Although oral finasteride is effective, concerns about systemic adverse effects have increased interest in topical formulations. Long-term real-world data on topical finasteride monotherapy with objective trichoscopic evaluation are still limited. Methods: We conducted a retrospective observational study evaluating the 52-week effectiveness and safety of topical finasteride 0.25% monotherapy in adult men with AGA. Patients receiving other AGA treatments, hair transplantation, or with a history of sexual, mood-related, or gynecomastia-related disorders were excluded. Clinical and trichoscopic assessments at baseline and Week 52 (T52w) included target area hair count (TAHC), target area hair width (TAHW), and terminal-to-vellus hair ratio in vertex and frontotemporal regions. Patient-reported outcomes were assessed using the Male Hair Growth Questionnaire (MHGQ), and physician evaluation through the Physician Global Assessment (PGA). Results: A total of 146 men (mean age 31.1 ± 9.8 years) were included. TAHC significantly increased at both the vertex (+ 22.7 hairs/cm2) and frontotemporal regions (+ 32.3 hairs/cm2) (p < 0.001). TAHW and the ratio of terminal hair to vellus hair also improved significantly in both areas. Mean MHGQ score was 14.7 ± 2.9 and mean PGA was + 1.9 ± 0.8 at T52w. Mild, transient local irritation occurred in 6.2% of patients, with no systemic adverse effects. Conclusions: Topical finasteride 0.25% demonstrated sustained 52-week effectiveness, particularly in the frontotemporal regions, with an excellent safety profile. These findings support topical finasteride as an effective long-term treatment option for male AGA. (Figure presented.).