5-Alpha-Reductase Inhibitors in the Treatment of Male Androgenetic Alopecia: Clinical Experience

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Androgenetic alopecia (AGA) is hair loss followed by the formation of bald patches. The cause of hair thinning and loss is the negative effect of androgens on the hair follicle, the blood vessels that supply it, and the skin itself. This condition usually develops in people with a genetic predisposition. The effectiveness of treatment largely depends on a timely visit to a doctor. 5-alpha-reductase inhibitors have demonstrated their effectiveness in male AGA, but the search for optimal treatment regimens is ongoing. The objective: to evaluate the effectiveness and safety of a differentiated method for treating male AGA depending on the severity, using low doses of systemic dutasteride. Materials and methods. We observed 35 men aged 20–50 years (the average age was 28.2±1.6 years) with a diagnosis of AGA. A burdened family history of AGA was noted in 28 patients. Dermatotrichoscopic examinations were performed using FotoFinder (GMBH) equipment and TrichoScale software. The severity of AGA was determined according to the Hamilton-Norwood classification and the Basic and Specific Classification (BASP). All patients received dutasteride at a dose of 0.5 mg for 12 months, with 3–5 capsules per week, depending on severity. Additionally, a topical 5% minoxidil solution was prescribed. Therapeutic response was evaluated by comparing clinical data before and after treatment, results from dermatotrichoscopic examinations, and subjective assessments of the therapy outcomes. Results. After 12 months of therapy, clinical assessment showed a significant and a moderate increase in hair growth in 24 (68.6%) of patients, and a slight increase in 6 (17.2%). Phototrichogram results indicated an increase in total hair count per cm2 (p<0.05) and a decrease in fine hair per cm2 (p<0.05), indicating a reversal of the miniaturization process. A positive effect of therapy was recorded in 26 (74.3%) patients. All 35 (100%) patients reported a reduction in hair shedding. Patient satisfaction scores on a scale from 0 to 5 showed that 30 (85.7%) had a positive outcome. Isolated side effects of dutasteride related to sexual dysfunction were observed, but they resolved spontaneously and did not require discontinuation of the drug. Conclusions. Low-dose dutasteride is an effective and safe treatment for male AGA when used differentially based on severity. Further studies are needed to expand knowledge of the effectiveness and safety of 5-alpha reductase inhibitors, determine optimal doses, and establish the appropriate duration of treatment.