Comparative efficacy of oral dutasteride and low-, medium-, and high-dose oral minoxidil: a six-month prospective trichoscopic and clinical study

Introduction: Androgenetic alopecia is a common progressive hair loss disorder that affects quality of life and often prompts long-term medical management. Oral minoxidil and oral dutasteride are widely used treatments, yet comparative data on their early clinical and microscopic effects remain limited. This study examined six-month changes in clinical severity and regional hair characteristics in men receiving different doses of oral minoxidil or oral dutasteride. Methods: Men with clinically confirmed androgenetic alopecia received oral dutasteride 0.5 milligrams daily or oral minoxidil at doses of 1, 2.5, or 5 milligrams daily, with treatment selection guided by clinical judgment and patient preference. Standardized clinical staging and trichoscopic imaging of the fronto-parietal, temporal, and occipital scalp regions were performed at baseline, 3 months, and 6 months. Outcomes included changes in clinical severity and region-specific measures of hair density, hair shaft diameter, and follicular unit composition. Results: Sixty-seven participants were enrolled, and forty-six completed the six-month assessment. Across the oral minoxidil groups, improvements in clinical severity scores were observed, whereas no statistically significant change was detected in the oral dutasteride group over the same period. Trichoscopic changes were generally modest across all treatment regimens, with no group demonstrating significant increases in total hair density. Selective, region- and dose-specific structural changes were noted, including a higher proportion of thicker hairs in the fronto-parietal region with oral dutasteride and increased hair shaft diameter in the occipital region with low-dose oral minoxidil. However, these findings were limited in scope and did not correspond to broad improvements across trichoscopic parameters. Discussion: In this exploratory, non-randomized clinical trial, oral minoxidil was associated with short-term improvements in clinical severity, while oral dutasteride did not demonstrate measurable early clinical change within the six-month follow-up. Trichoscopic findings were limited and did not consistently parallel clinical outcomes, suggesting that early therapeutic effects in routine practice may be more readily captured by clinical staging than by regional microscopic assessment. These observations should be interpreted cautiously given the study design and sample size, and they warrant confirmation in larger, randomized studies with longer follow-up.