Therapeutic Efficacy of Botulinum Toxin (BOTOX®) and Minoxidil in the Treatment of Androgenetic Alopecia in Males

Background: Androgenetic alopecia is hair loss in men. Minoxidil is an established treatment, whereas botulinum toxin is an uncertain therapeutic option. Objective: To compare the therapeutic efficacy of minoxidil and BOTOX®. Methods: Our randomized, comparative interventional clinical study included male patients with androgenetic alopecia who were randomly allocated to two treatment groups. Group I received topical 5% minoxidil twice daily, while Group II received botulinum toxin type A. Treatment response was assessed next month using vertex hair density and patient-reported hair-growth improvement. Results: The clinical and demographic characteristics were comparable in our two groups at baseline. Vertex hair density is comparable at baseline (84.5 vs. 78.5 hairs/cm², p=0.1), at 3 months (84.5 vs. 81 hairs/cm², p=0.3), and at 6 months (90 vs. 86 hairs/cm², p=0.2) in the minoxidil and BOTOX® groups, respectively. Within-group analysis demonstrated a statistically significant increase in hair density over time in the minoxidil group (p=0.007), with no significant change observed in the BOTOX® group (p=0.6). However, the change in hair density and improvement were not very different in our two study groups (p=0.7 and p=0.5, respectively). At month 6, hair growth was significantly favored by minoxidil (p=0.001), with 86.7% reporting some degree of improvement compared with 73.4% in the BOTOX® group. Conclusions: Topical 5% minoxidil produced a significant improvement in vertex hair density and was associated with greater patient-reported improvement over six months. Botulinum toxin showed less effect.