Management of Androgenic Alopecia: A Systematic Review of the Literature

May 2024 in “ Journal of cosmetic and laser therapy ”

Amanda Rosenthal, Geena Conde, Joseph F. Greco, Nima M. Gharavi

androgenic alopecia minoxidil finasteride low-level laser therapy platelet-rich plasma AGA Rogaine Propecia LLLT PRP

TLDR Minoxidil and finasteride are the most effective treatments for hair loss.

The systematic review on the management of androgenic alopecia (AGA) evaluates various treatment options, including pharmacological and non-pharmacological interventions. The review highlights that minoxidil and finasteride remain the most effective FDA-approved treatments for AGA, with significant hair regrowth observed in numerous studies. Additionally, low-level laser therapy (LLLT) and platelet-rich plasma (PRP) show promise as alternative treatments, though more extensive clinical trials are needed to confirm their efficacy. The review underscores the importance of early intervention and personalized treatment plans to optimize outcomes for patients suffering from AGA.

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10 citations , April 2015 in “PubMed”

Rosemary oil and minoxidil 2% both effectively increase hair count in people with androgenetic alopecia, but rosemary oil causes less scalp itching.

research Oxidative Stress-Associated Senescence in Dermal Papilla Cells of Men with Androgenetic Alopecia

93 citations , February 2015 in “Journal of Investigative Dermatology”

Oxidative stress affects hair loss in men with androgenetic alopecia.

Safety and Efficacy of Rice Bran Supercritical CO2 Extract for Hair Growth in Androgenic Alopecia: A 16-Week Double-Blind Randomized Controlled Trial

research Safety and Efficacy of Rice Bran Supercritical CO2 Extract for Hair Growth in Androgenic Alopecia: A 16-Week Double-Blind Randomized Controlled Trial

7 citations , January 2015 in “Biological & Pharmaceutical Bulletin”

Rice Bran Supercritical CO2 Extract significantly increased hair density and diameter in male alopecia patients without any side effects.

research Epidermal Stem Cells and Skin Tissue Engineering in Hair Follicle Regeneration

83 citations , January 2015 in “World Journal of Stem Cells”

Hair follicle regeneration needs special conditions and young cells.

A Single-Center, Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Investigate the Efficacy and Safety of Minoxidil Topical Foam in Frontotemporal and Vertex Androgenetic Alopecia in Men

research A Single-Center, Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Investigate the Efficacy and Safety of Minoxidil Topical Foam in Frontotemporal and Vertex Androgenetic Alopecia in Men

19 citations , January 2015 in “Skin Pharmacology and Physiology”

Minoxidil foam effectively promotes hair growth and reduces hair loss in men.

research Hair Follicle Dermal Stem Cells Regenerate the Dermal Sheath, Repopulate the Dermal Papilla, and Modulate Hair Type

184 citations , November 2014 in “Developmental Cell”

Hair follicle dermal stem cells are key for regenerating parts of the hair follicle and determining hair type.

research The Growth of Human Scalp Hair in Females Using Visible Red Light Laser and LED Sources

81 citations , August 2014 in “Lasers in Surgery and Medicine”

Red light therapy is safe and effectively increases hair growth in women with hair loss.

research Platelet-Rich Plasma for Androgenetic Alopecia

107 citations , August 2014 in “Dermatologic Surgery”

PRP injections improve hair thickness for baldness.

research Bio-Enhanced Hair Restoration

8 citations , July 2014 in “Hair transplant forum international”

Bio-enhanced hair restoration, using methods like growth factors, stem cells, and ATP, results in better hair growth and density than traditional hair transplants.

research Cold X5 Hairlaser Used to Treat Male Androgenic Alopecia and Hair Growth: An Uncontrolled Pilot Study

15 citations , February 2014 in “BMC Research Notes”

The X5 Hairlaser might help treat male hair loss, but more research is needed.

Topical Valproic Acid Increases Hair Count in Male Patients with Androgenetic Alopecia: A Randomized, Comparative, Clinical Feasibility Study Using Phototrichogram Analysis

research Topical Valproic Acid Increases Hair Count in Male Patients with Androgenetic Alopecia: A Randomized, Comparative, Clinical Feasibility Study Using Phototrichogram Analysis

37 citations , February 2014 in “Journal of Dermatology”

Valproic acid increases hair count in men with hair loss.

Efficacy and Safety of a Low-Level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-Controlled, Double-Blind Study

research Efficacy and Safety of a Low-Level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-Controlled, Double-Blind Study

147 citations , January 2014 in “American Journal of Clinical Dermatology”

Laser device increases hair density, safe for treating hair loss in men and women.

A Randomized, Active- and Placebo-Controlled Study of the Efficacy and Safety of Different Doses of Dutasteride Versus Placebo and Finasteride in the Treatment of Male Subjects with Androgenetic Alopecia

research A Randomized, Active- and Placebo-Controlled Study of the Efficacy and Safety of Different Doses of Dutasteride Versus Placebo and Finasteride in the Treatment of Male Subjects with Androgenetic Alopecia

97 citations , January 2014 in “Journal of The American Academy of Dermatology”

Dutasteride 0.5 mg works better than finasteride and placebo for increasing hair in men with hair loss.

Preparation and Evaluation of a Multimodal Minoxidil Microemulsion Versus Minoxidil Alone in the Treatment of Androgenic Alopecia of Mixed Etiology: A Pilot Study

research Preparation and Evaluation of a Multimodal Minoxidil Microemulsion Versus Minoxidil Alone in the Treatment of Androgenic Alopecia of Mixed Etiology: A Pilot Study

24 citations , May 2013 in “Drug Design Development and Therapy”

Multimodal minoxidil microemulsion is more effective in treating hair loss than minoxidil alone.

research Comparison of the Efficacy of Topical Minoxidil 5% and Adenosine 0.75% Solutions on Male Androgenetic Alopecia and Measuring Patient Satisfaction Rate

1 citations , January 2013 in “PubMed”

Adenosine led to higher patient satisfaction than minoxidil for hair loss treatment.

research Hair Restoration Surgery: The State of the Art

32 citations , November 2012 in “Aesthetic Surgery Journal”

Hair restoration surgery has advanced, focusing on natural results and may improve further with new techniques and therapies.

research Comparative Effectiveness of Finasteride vs Serenoa Repens in Male Androgenetic Alopecia: A Two-Year Study

51 citations , October 2012 in “International Journal of Immunopathology and Pharmacology”

Finasteride works better than Serenoa repens for male hair loss.

research Prostaglandin D2 Inhibits Hair Growth and Is Elevated in Bald Scalp of Men with Androgenetic Alopecia

205 citations , March 2012 in “Science Translational Medicine”

PGD2 stops hair growth and is higher in bald men with AGA.

research Hydrogen Peroxide and Monoethanolamine Are the Key Causative Ingredients for Hair Dye-Induced Dermatitis and Hair Loss

34 citations , January 2012 in “Journal of Dermatological Science”

Hydrogen peroxide and monoethanolamine in hair dye can cause dermatitis and hair loss.

research Hair Regrowth Following a Wnt- and Follistatin-Containing Treatment: Safety and Efficacy in a First-in-Man Phase 1 Clinical Trial

16 citations , November 2011 in “PubMed”

The treatment improved hair growth in people with male pattern baldness.

research Evaluation of Efficacy and Safety of Finasteride 1 mg in 3177 Japanese Men with Androgenetic Alopecia

41 citations , October 2011 in “Journal of Dermatology”

Finasteride 1 mg effectively and safely increases hair growth in Japanese men with hair loss.

research Enhanced Effect of Platelet-Rich Plasma Containing a New Carrier on Hair Growth

166 citations , August 2011 in “Dermatologic Surgery”

Platelet-rich plasma with a new carrier significantly increases hair thickness without serious side effects.

A Randomized Double-Blind Placebo-Controlled Pilot Study to Assess the Efficacy of a 24-Week Topical Treatment by Latanoprost 0.1% on Hair Growth and Pigmentation in Healthy Volunteers with Androgenetic Alopecia

research A Randomized Double-Blind Placebo-Controlled Pilot Study to Assess the Efficacy of a 24-Week Topical Treatment by Latanoprost 0.1% on Hair Growth and Pigmentation in Healthy Volunteers with Androgenetic Alopecia

81 citations , August 2011 in “Journal of The American Academy of Dermatology”

Latanoprost 0.1% may effectively treat hair loss.

Curcuma Aeruginosa, A Novel Botanically Derived 5α-Reductase Inhibitor In The Treatment Of Male-Pattern Baldness: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study

research Curcuma Aeruginosa, A Novel Botanically Derived 5α-Reductase Inhibitor In The Treatment Of Male-Pattern Baldness: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study

34 citations , July 2011 in “Journal of Dermatological Treatment”

Curcuma aeruginosa extract combined with minoxidil effectively treats male-pattern baldness.

A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

research A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

100 citations , June 2011 in “Journal of The American Academy of Dermatology”

5% minoxidil foam once daily works as well as 2% minoxidil solution twice daily for female hair growth and is more convenient.

Efficacy, Safety, and Tolerability of Dutasteride 0.5 mg Once Daily in Male Patients with Male Pattern Hair Loss: A Randomized, Double-Blind, Placebo-Controlled, Phase III Study

research Efficacy, Safety, and Tolerability of Dutasteride 0.5 mg Once Daily in Male Patients with Male Pattern Hair Loss: A Randomized, Double-Blind, Placebo-Controlled, Phase III Study

92 citations , June 2010 in “Journal of The American Academy of Dermatology”

Dutasteride 0.5 mg daily improves hair growth safely in men with hair loss.

research Contemporary Hair Transplantation

54 citations , August 2009 in “Dermatologic Surgery”

Modern hair transplants use small grafts for a natural look and drugs to prevent further loss, with high patient satisfaction.

research Randomized Clinical Trial Comparing 5% and 1% Topical Minoxidil for the Treatment of Androgenetic Alopecia in Japanese Men

29 citations , July 2009 in “Journal of Dermatology”

5% minoxidil works better for hair growth than 1% minoxidil.

research Oxidative Stress in Aging of Hair

126 citations , January 2009 in “International Journal of Trichology”

Oxidative stress contributes to hair graying and loss as we age.

research HairMax LaserComb Laser Phototherapy Device in the Treatment of Male Androgenetic Alopecia

160 citations , January 2009 in “Clinical Drug Investigation”

HairMax LaserComb® effectively promotes hair growth and stops hair loss in males with androgenetic alopecia, with no serious side effects.

Adenosine Increases Anagen Hair Growth And Thick Hairs In Japanese Women With Female Pattern Hair Loss: A Pilot, Double-Blind, Randomized, Placebo-Controlled Trial

research Adenosine Increases Anagen Hair Growth And Thick Hairs In Japanese Women With Female Pattern Hair Loss: A Pilot, Double-Blind, Randomized, Placebo-Controlled Trial

33 citations , December 2008 in “Journal of Dermatology”

Adenosine lotion improves hair growth and thickness in women with hair loss.

Topical Fulvestrant Solution Has No Effect on Male and Postmenopausal Female Androgenetic Alopecia: Results from Two Randomized, Proof-of-Concept Studies

research Topical Fulvestrant Solution Has No Effect on Male and Postmenopausal Female Androgenetic Alopecia: Results from Two Randomized, Proof-of-Concept Studies

6 citations , November 2007 in “British Journal of Dermatology”

Fulvestrant solution doesn't help hair loss in men and postmenopausal women.

The Influence of 3% Hydrogen Peroxide on the Survival Rate of Hair Grafts When Used as an Antiseptic Solution for Surgical Wound Care: Experience with Five Patients

research The Influence of 3% Hydrogen Peroxide on the Survival Rate of Hair Grafts When Used as an Antiseptic Solution for Surgical Wound Care: Experience with Five Patients

September 2007 in “Dermatologic Surgery”

3% hydrogen peroxide does not reduce hair graft survival compared to saline.

research A Randomized, Placebo-Controlled Trial of 1% Topical Minoxidil Solution in the Treatment of Androgenetic Alopecia in Japanese Women

10 citations , May 2007 in “PubMed”

1% topical minoxidil solution significantly improved hair growth in Japanese women with androgenetic alopecia, with no major side effects.

Comparison of the Efficacy and Safety of Topical Minoxidil and Topical Alfatradiol in the Treatment of Androgenetic Alopecia in Women

research Comparison of the Efficacy and Safety of Topical Minoxidil and Topical Alfatradiol in the Treatment of Androgenetic Alopecia in Women

56 citations , April 2007 in “Journal der Deutschen Dermatologischen Gesellschaft”

Minoxidil works better for female hair loss than alfatradiol, both safe.

research Efficacy of 5% Minoxidil Versus Combined 5% Minoxidil and 0.01% Tretinoin for Male Pattern Hair Loss

43 citations , January 2007 in “American Journal of Clinical Dermatology”

Combined minoxidil and tretinoin solution works as well as regular minoxidil for male hair loss.

The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

research The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

215 citations , November 2006 in “Journal of The American Academy of Dermatology”

Dutasteride more effective for hair growth, but has more side effects than finasteride.

research Reversal of Androgenetic Alopecia by Topical Ketoconazole: Relevance of Anti-Androgenic Activity

38 citations , September 2006 in “Journal of Dermatological Science”

Ketoconazole lotion can improve hair regrowth for some people with androgenetic alopecia.

research Changes in Hair Weight in Men with Androgenetic Alopecia After Treatment with Finasteride (1 mg Daily): Three- and Four-Year Results

66 citations , June 2006 in “Journal of The American Academy of Dermatology”

Finasteride increases hair weight and count in men with hair loss, with best results after four years.

research Effects of Finasteride (1 mg) on Hair Transplant

23 citations , October 2005 in “Dermatologic Surgery”

Finasteride improves surrounding scalp hair and increases hair density after hair transplant.

research Genetic Variation in the Human Androgen Receptor Gene Is the Major Determinant of Common Early-Onset Androgenetic Alopecia

195 citations , June 2005 in “American Journal of Human Genetics”

Genetic variation in the androgen receptor gene mainly causes early-onset hair loss, with maternal inheritance playing a key role.

research Treatment of Female Pattern Hair Loss With Oral Antiandrogens

179 citations , March 2005 in “British Journal of Dermatology”

Oral antiandrogens effectively treat female hair loss, with better results in higher hair loss grades.

research A Randomized, Placebo-Controlled Trial of 5% and 2% Topical Minoxidil Solutions in the Treatment of Female Pattern Hair Loss

219 citations , March 2004 in “Journal of The American Academy of Dermatology”

5% and 2% minoxidil solutions effectively promote hair growth and reduce hair loss, with 5% being slightly more effective but having more side effects.

research The Effects of Minoxidil, 1% Pyrithione Zinc, and a Combination of Both on Hair Density: A Randomized Controlled Trial

57 citations , August 2003 in “British Journal of Dermatology”

Minoxidil and pyrithione zinc combo most effectively increases hair density.

research Efficacy and Tolerability of Finasteride 1 mg in Men Aged 41 to 60 Years with Male Pattern Hair Loss

22 citations , July 2003 in “PubMed”

Finasteride 1 mg significantly improves hair growth in men aged 41 to 60 with male pattern hair loss.

research Association Between Smoking and Hair Loss: Another Opportunity for Health Education Against Smoking?

102 citations , January 2003 in “Dermatology”

Smoking may contribute to hair loss in men.

research Is Androgenetic Alopecia a Photoaggravated Dermatosis?

62 citations , January 2003 in “Dermatology”

Sunlight worsens hair loss; protect scalp.

research Pilot Study of a Novel Treatment for Androgenetic Alopecia Using Enriched Cell Culture Medium: Clinical Trials

12 citations , January 2003 in “Dermatology Online Journal”

A new treatment for hair loss was tested and most participants saw their hair loss stop within 2-8 weeks, with up to 50% more hair after 4 months, and no side effects.

A Randomized Clinical Trial of 5% Topical Minoxidil Versus 2% Topical Minoxidil and Placebo in the Treatment of Androgenetic Alopecia in Men

research A Randomized Clinical Trial of 5% Topical Minoxidil Versus 2% Topical Minoxidil and Placebo in the Treatment of Androgenetic Alopecia in Men

269 citations , August 2002 in “Journal of The American Academy of Dermatology”

5% minoxidil works better for hair growth and density, with minor irritation.

research Comparative Efficacy of Various Treatment Regimens for Androgenetic Alopecia in Men

80 citations , August 2002 in “Journal of Dermatology”

Best hair growth results from combining finasteride and minoxidil.

research Journal Review: Long-Term (5-Year) Multinational Experience with Finasteride 1mg in the Treatment of Men with Androgenetic Alopecia

7 citations , May 2002 in “Hair transplant forum international”

Finasteride 1mg is effective and safe for long-term use in treating male hair loss.

research Changes in Hair Weight and Hair Count in Men with Androgenetic Alopecia After Treatment with Finasteride, 1 mg, Daily

66 citations , April 2002 in “Journal of The American Academy of Dermatology”

Finasteride increases hair weight and count in men with hair loss.

Changes in Hair Weight and Hair Count in Men with Androgenetic Alopecia After Application of 5% and 2% Topical Minoxidil, Placebo, or No Treatment

research Changes in Hair Weight and Hair Count in Men with Androgenetic Alopecia After Application of 5% and 2% Topical Minoxidil, Placebo, or No Treatment

115 citations , November 1999 in “Journal of The American Academy of Dermatology”

Minoxidil increases hair weight and count temporarily in men with hair loss.

research Finasteride in the Treatment of Men with Androgenetic Alopecia

581 citations , October 1998 in “Journal of The American Academy of Dermatology”

Finasteride safely and effectively treats male pattern hair loss, but may cause reversible sexual issues and harm male fetuses.

research Lipid Peroxides Induce Early Onset of Catagen Phase in Murine Hair Cycles

49 citations , January 1998 in “International Journal of Molecular Medicine”

Lipid peroxides can cause early hair loss by damaging hair follicles.

research Ketoconazole Shampoo: Effect of Long-Term Use in Androgenic Alopecia

92 citations , January 1998 in “Dermatology”

Ketoconazole shampoo improves hair growth and reduces oil similarly to minoxidil in male pattern hair loss.

research Topical Minoxidil Therapy for Androgenic Alopecia in the Middle East

5 citations , October 1993 in “International Journal of Dermatology”

Topical minoxidil is effective and safe for hair regrowth in Middle Eastern men with early baldness, with better results in younger patients and certain types of baldness.