Efficacy and safety of oral finasteride versus dutasteride in moderate-to-severe androgenetic alopecia in males based on trichoscopic and laboratory findings: a clinical comparison in Iran

Abstract

BACKGROUND: Androgenetic alopecia (AGA) is the most common type of hair loss in men. Finasteride and dutasteride are oral 5-alpha-reductase inhibitors. This study compared their efficacy and safety in Iranian men with moderate to severe AGA. METHODS: This randomized single-blind clinical trial included 46 men aged 20-50 years. Patients received finasteride 1 mg daily or dutasteride 0.5 mg daily for 24 weeks. Hair density and thickness were measured by trichoscopy and photographs. Satisfaction was recorded with a visual analog scale (VAS). Adverse effects were documented. RESULTS: Both groups improved in hair growth after 24 weeks with no significant difference. Serum PSA fell in the dutasteride group from 0.63 +/- 0.18 to 0.42 +/- 0.22 (p < 0.001). No significant change appeared in the finasteride group. Dutasteride produced greater PSA reduction than finasteride (B = 0.17, p < 0.01). Age had no effect on PSA (p = 0.58). VAS scores showed no difference. Safety profiles were similar. Sexual side effects were most common, with erectile dysfunction more frequent in the finasteride group. No serious events occurred. CONCLUSION: Finasteride and dutasteride improved hair density with similar safety. Dutasteride caused stronger PSA reduction, suggesting more potent 5-alpha-reductase inhibition.