Finasteride or Minoxidil, what is better for hair regrowth in female pattern hair loss?

"Our findings can improve clinical guidelines and help dermatologists manage female pattern hair loss more optimally with the available options," Mesbah Talukder, School of Pharmacy, BRAC University, Dhaka, Bangladesh, and colleagues wrote in their study.

Female pattern hair loss is a distressing condition affecting millions of women worldwide. While it shares similarities with male pattern hair loss (MPHL), its underlying mechanisms and treatment responses differ. Among the various therapeutic options, monotherapy with 5-alpha reductase inhibitors (5-ARIs) and minoxidil is widely used, however, evidence on the relative effectiveness of these drugs is far less for women than for men.

To fill this knowledge gap, the researchers performed an age-adjusted NMA to determine the comparative efficacy of monotherapy with the three agents—in any dosage and administrative route—on PHL in adult women.

For this purpose, the researchers systematically reviewed the peer-reviewed literature to obtain data for the NMA. The outcome measure for the NMA was a "change in total hair density." The regimen was referred to as an “agent and its dosage;” Bayesian NMA estimated regimens' surface under the cumulative ranking curve (SUCRA) values and pairwise relative effects.

The NMA used data from 13 trials—across which the following ten regimens were identified (in decreasing order of SUCRA): 5 mg/day finasteride for 24 weeks (SUCRA = 95.7%), 5% topical minoxidil solution twice daily for 24 weeks (SUCRA = 89.5%), 1 mg/day minoxidil for 24 weeks (SUCRA = 78.1%), 5% topical minoxidil foam 1 half capful/day for 24 weeks (SUCRA = 66.5%), 3% topical minoxidil solution 1 mL twice daily for 24 weeks (SUCRA = 45.1%), 2% topical minoxidil solution 1 mL twice daily for 24 weeks (SUCRA = 44.6%), 5% topical minoxidil solution 1 mL/day for 24 weeks (SUCRA = 41.7%), 0.25 mg/day minoxidil for 24 weeks (SUCRA = 35.5%), 1.25 mg/day finasteride for 24 weeks (SUCRA = 24.8%) and 1 mg/day finasteride for 24 weeks (SUCRA = 4.3%).

"To our knowledge, this is the first report of an NMA in female androgenetic alopecia (AGA) comparing the relative efficacies of oral minoxidil (1, 0.25 mg/day), oral finasteride (5, 1.25, 1 mg/day), and topical minoxidil (5% and 2% each applied twice daily) in total hair regrowth. The efficacy demonstrated a possible dose-dependent effect for oral finasteride and topical and oral minoxidil," the researchers concluded.

Reference:

Gupta, A. K., Wang, T., Bamimore, M. A., & Talukder, M. (2023). The relative effect of monotherapy with 5-alpha reductase inhibitors and minoxidil for female pattern hair loss: A network meta-analysis study. Journal of Cosmetic Dermatology, 23(1), 154-160. https://doi.org/10.1111/jocd.15910