Effectiveness of 1% Topical Spironolactone in the Management of Androgenetic Alopecia

Androgenetic alopecia (AGA) is a common progressive, nonscarring form of hair loss associated with follicular miniaturization and considerable psychosocial burden. Topical spironolactone is an investigational antiandrogenic approach, but clinical evidence for the 1% formulation remains limited. This study aimed to describe changes in trichoscopic hair-count measures and reported tolerability after 16 weeks of once-daily application of 1% topical spironolactone in patients with AGA. This single-centre descriptive case series included 60 adults aged 18–55 years with clinically diagnosed AGA who attended the Dermatology outpatient department at Lahore Medical and Dental College, Ghurki Trust Teaching Hospital, Lahore, between March and July 2026. All participants applied 1% topical spironolactone once daily to the affected scalp areas for 16 weeks. Trichoscopic findings were recorded at baseline and at week 16. The mean age was 32.12 ± 8.30 years, and 33 participants (55.0%) were male. Mean thin terminal-hair counts increased from 12.73 ± 3.24 to 15.63 ± 5.49, thick terminal-hair counts increased from 17.55 ± 6.88 to 22.78 ± 13.47, total terminal-hair counts increased from 30.28 ± 8.79 to 39.15 ± 17.58, and total hair counts increased from 41.95 ± 11.40 to 48.33 ± 17.42. Mean vellus-hair counts decreased from 11.68 ± 4.14 to 9.18 ± 3.50. The manuscript reports p < 0.001 for these comparisons, although the paired statistical test outputs were unavailable for independent verification. Overall, 42 participants (70.0%) were classified as having an effective treatment response, although the original response criterion requires further clarification. No adverse effects were reported by 50 participants (83.3%), while pruritus was reported by six participants (10.0%) and scalp dryness or peeling by four participants (6.7%). These findings indicate that 16 weeks of treatment with 1% topical spironolactone was associated with favorable within-participant changes in trichoscopic hair-count measures and generally acceptable local tolerability. However, given the absence of a control group and unresolved discrepancies among certain tabulated measurements, the findings should be considered preliminary and cannot establish comparative treatment efficacy or systemic safety.