Comparative Efficacy of Oral and Topical 5-Alpha Reductase Inhibitors in Reducing Dihydrotestosterone Levels in Men with Androgenetic Alopecia: A Network Meta-Analysis

January 2026 in “ Open Science Framework ”

Gupta, Aditya, Bamimore, Mary, Wang, Tong, Williams, Greg, Mesbah Talukder

5-alpha reductase inhibitors dihydrotestosterone androgenetic alopecia oral 5-alpha reductase inhibitors topical 5-alpha reductase inhibitors hair density serum DHT levels 5-ARIs DHT AGA

TLDR Oral and topical 5-alpha reductase inhibitors affect DHT levels and hair density differently in treating hair loss.

The study conducted a network meta-analysis to compare the efficacy of oral and topical 5-alpha reductase inhibitors (5-ARIs) in reducing dihydrotestosterone (DHT) levels in men with androgenetic alopecia (AGA). The analysis included various doses, types, and routes of administration of 5-ARIs, focusing on changes in DHT levels and total hair density over 6 months. The study found that different 5-ARIs have varying impacts on serum DHT levels and hair density, with the extent of DHT suppression significantly predicting improvements in hair density. The study used data from multiple randomized clinical trials and employed post-hoc ecological regression to explore correlations between biochemical changes and clinical outcomes. The findings suggest that the choice of 5-ARI treatment can influence the effectiveness in managing AGA by altering DHT levels and hair density.

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