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Abstract

Background: Androgenetic alopecia (AGA) is a common androgen-dependent hair loss disorder in men, often managed with topical minoxidil or oral finasteride. Autologous platelet-rich plasma (PRP) has emerged as an adjunct therapy. This study evaluated the efficacy of PRP alone versus PRP combined with topical minoxidil in moderate AGA. Methods: We conducted a cross-sectional study in a tertiary care center (Abbotabad) from November 2024 to March 2025. A total of 180 males (age 20–50) with moderate AGA (Hamilton-Norwood grade III–V) were divided into three equal groups (n=60 each): Group A – PRP injections monthly; Group B – 5% minoxidil topical solution twice daily; Group C – combination of PRP + 5% minoxidil. Efficacy was assessed at 6 months by hair density (trichoscopy), hair diameter, hair pull test, patient satisfaction and adverse events. Results: All groups showed significant improvement from baseline. The combination group achieved the greatest increase in hair density (mean +24.8 hairs/cm; p<0.001). PRP-alone and minoxidil-alone groups had comparable hair density gains (+14.2 vs +11.6 hairs/cm; p=0.18). Hair shaft diameter improved similarly with PRP (+12.4 µm) and minoxidil (+10.7 µm), but more with combination therapy (+18.9 µm). The combination therapy yielded a higher rate of negative hair pull tests (93%) compared to PRP (88%) and minoxidil (72%). Patient satisfaction was highest in the combination group. No serious adverse effects occurred; transient injection-site pain was more frequent in PRP-treated patients. Conclusion: In men with moderate AGA, PRP monotherapy is as effective as topical minoxidil. The addition of topical minoxidil to PRP significantly improves hair regrowth outcomes, indicating synergistic effect. PRP therapy was well-tolerated, suggesting it as a viable adjunct to standard AGA treatment.