Challenge Case! How do minoxidil and finasteride treatments rank for female AGA?

A Challenge for You! How would you rank treatments for female AGA?

We had a great response across our various social media channels this week to a question regarding the effectiveness of various treatments for female pattern hair loss. Participants were asked to arrange these five treatments for female pattern hair loss from MOST EFFECTIVE to LEAST EFFECTIVE! (at least in terms of hair density at 24 weeks). How would you do? Give it a try!

To answer this question, we turn to a very nice study recently published in the Journal of Cosmetic Dermatology by Dr Gupta and colleagues.

Researchers performed a network meta-analysis (NMA) to estimate the relative efficacy of solo treatments (monotherapy) with minoxidil or finasteride for adult women with AGA when used for 24 weeks.
 
Authors found 13 trials whose data were used for the analysis. Estimates regarding a given treatment protocol’s  comparative effectiveness were based on their surface under the cumulative ranking curve (SUCRA) values. Data showed that oral finasteride 5 mg was the most effective at 24 weeks.

We’ll get to the full ranking in a moment, but based on the paper by Gupta and colleagues, the answer to the challenge question introduced in the opening is as follows:

The full ranking in the SUCRA analyses are shown here

One can read the entire commentary here:

Comments

Once must not miss out on a few key points. This is not a study ranking ALL the treatments for female pattern hair loss. Rather, this is a study ranking minoxidil and finasteride – and only select minoxidil and finasteride concentrations & doses and only at 24 weeks. Dutasteride data is not here (because studies meeting the inclusion criteria were not found). Spironolactone & bicalutamide are not here (because these are not pure 5 alpha reductase inhibitors). That data is important to use as oral spironolactone is among the more common treatments for FPHL. One should note that “topical finasteride” is not here in this study nor is all the wonderful topical finasteride-minoxidil combinations. Minoxidil foam twice daily is not here either - so we have no idea if minoxidil 5 % foam twice daily might beat out finasteride or beat out minoxidil solution twice daily. In addition, oral minoxidil at doses 1.25 mg and 2.5 mg are not here – doses which are used in many many many patients. Other treatments like PRP and laser are not on this list as this was a study of minoxidil and 5 alpha reductase inhibitors.
 
Finally, the study compares data at 24 weeks and not longer. This is also not a  study about safety and so side effects are not part of this study. This is a study of effectiveness.

REFERENCE

Gupta AK et al. The relative effect of monotherapy with 5-alpha reductase inhibitors and minoxidil for female pattern hair loss: A network meta-analysis study. J Cosmet Dermatol. 2023 Jun 29