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

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.

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).

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.

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.