Updates in Treatment for Androgenetic Alopecia

Abstract

Androgenetic alopecia (AGA) is a common nonscarring hair loss condition that affects both men and women, often resulting in psychological distress and reduced quality of life. AGA patho- genesis involves genetic predisposition and androgen influence, primarily dihydrotestosterone (DHT), which leads to hair follicle miniaturization and progressive hair thinning. AGA remains challenging to manage due to its chronic progression and the combined influence of genetic and environmental factors. Topical minoxidil and oral finasteride are the most widely used treat- ments for AGA, addressing follicular miniaturization. However, their reliance on long-term use and potential for side effects or inconvenience has prompted increasing interest in alternative therapies. The mainstream of current AGA treatment can be categorized into androgen-targeting and non-androgen-targeting approaches. Finasteride and dutasteride, both 5-α-reductase inhib- itors that reduce DHT levels in hair follicles, are key androgen-targeting treatments, with newer formulations like topical and injectable options emerging alongside traditional oral forms. Topical minoxidil remains central to non-androgen-targeted AGA treatments, though grow- ing evidence supports the efficacy and safety of its low-dose oral form. Additionally, therapies like low-level light therapy, platelet-rich plasma, and exosome treatments are being explored. Recently, therapies targeting the androgen receptor, including small interfering RNA-based approaches, have been developed and are currently in clinical trial stages, offering innovative potential for AGA treatment. This review explores current and emerging treatments for AGA, addressing both androgen-targeted and non-androgen-targeted approaches with an emphasis on their mechanisms, efficacy, and safety. It ultimately aims to provide a comprehensive update on the latest advancements in AGA management.