Topical 5% spironolactone lotion versus 5% minoxidil lotion in the management of androgenetic alopecia: A pilot study

Objectives: To compare the efficacy and safety of 5% topical spironolactone versus 5% topical minoxidil in adult males with androgenetic alopecia (AGA). Material and Methods: This 12-week, pilot comparative study enrolled 40 male patients (aged 18–50 years) with Hamilton–Norwood grades II–IV AGA at a tertiary center in Northern India. Participants were equally allocated ( n = 20/group) to receive either 5% topical spironolactone lotion or 5% topical minoxidil, applied twice daily. The primary outcome was the change in hair density measured by dermoscopy (×10 magnification) at baseline, 4, 8, and 12 weeks. Secondary outcomes included the physician global assessment (PGA), patient satisfaction score (PSS), and safety profile. Data were analyzed using statistical package for the social sciences version 25. Results: Forty patients completed the study (mean age 32.93 ± 6.67 years). Baseline characteristics and mean dermoscopic hair density (43.10 ± 9.84 vs. 43.35 ± 7.21; p = 0.927) were comparable between the spironolactone and minoxidil groups. At week 12, both groups showed significant improvement in hair density; mean scores increased to 51.40 ± 8.69 for spironolactone and 55.45 ± 6.31 for minoxidil ( p = 0.099). No statistically significant differences were observed in PGA (2.15 ± 0.81 vs. 2.40 ± 0.60; p = 0.275) or PSS (1.80 ± 1.01 vs. 2.05 ± 0.83; p = 0.395). Adverse events occurred in 15% of patients, primarily localized irritation and cosmetic residue, with no systemic side effects or significant differences in safety between groups. Conclusion: Both 5% topical spironolactone and 5% minoxidil are effective and well-tolerated for mild-to-moderate AGA. While minoxidil showed a trend toward higher density, spironolactone provided comparable clinical outcomes. Topical spironolactone represents a safe, effective non-systemic alternative or adjunct therapy for male patients with AGA.