Effectiveness and Safety of Combined Therapy with Oral Minoxidil, Oral Dutasteride, and Mesotherapy with Dutasteride in Real Clinical Practice

Background: Androgenetic alopecia (AGA) is the most prevalent form of hair loss in humans. Oral minoxidil and dutasteride are widely used treatments, while intradermal dutasteride mesotherapy has recently gained interest as a complementary approach. However, comparative studies in real-world settings are lacking. Objective: The aim was to compare the effectiveness and safety of four AGA therapies: oral minoxidil alone (OM), OM plus oral dutasteride (OM + OD), OM plus mesotherapy (OM + MD), and a combination of all three (CT). Methods: A retrospective study was conducted, including 280 adult patients (mean age 35 ± 9.4 years) with AGA, excluding those with recent treatment (last 3 months) or other hair loss disorders. The therapeutic response was assessed by comparing treatment outcomes from standardized clinical images at 6 and 12 months using a four-point improvement scale. Patient satisfaction was also assessed using a four-point subjective scale. Results: Participants were divided into four treatment groups. In total, 74 patients (26.4%) were treated with OM, 65 patients (23.2%) with OM + OD, 61 patients (21.8%) with OM + MD, and 80 patients (28.6%) with CT. At 12 months, group 4 treated with CT showed significantly better results in both frontal and vertex areas (p < 0.001), while group 3 (OM + MD) performed best at 6 months in the vertex. Side effects were mild and infrequent, with hypertrichosis being the most common. Erectile dysfunction was reported with a lower incidence than reported in the literature: two patients (3.1%) in group 2 (OM + OD) and three (3.8%) patients in CT. Overall, no serious adverse events were detected. Conclusions: Combining oral minoxidil, oral dutasteride, and mesotherapy with dutasteride yields the most effective results for AGA with a favorable safety profile.