Management of androgenetic alopecia: a review


  • Deepa Dev Chhetri Department of Dermatology, Shanghai Tongji Hospital Affiliated to Tongji University, Shanghai, China
  • Xin Huang Department of Dermatology, Shanghai Tongji Hospital Affiliated to Tongji University, Shanghai, China



Androgenetic alopecia, Hair loss, Finasteride, Minoxidil, Alternative therapies


Androgenetic alopecia is a patterned hair loss disorder affecting approximately 73% of men and 57% of women in their lifetime, this affection can cause psychological effects like low self-stem and depression diminishing the quality of life. Currently, finasteride and minoxidil are the only two drugs approved by the food and drug administration (FDA), and devices of low-level laser therapy are FDA cleared. Alternative therapies for androgenetic alopecia treatment include a drug like dutasteride, botulinum toxin A, cell-based therapies like adipose-derived stem cell-conditioned medium and platelet-rich plasma protocols. A combination of two or more therapies can be found in the literature, the general consent indicates that any combination has higher efficiency than a single therapy. Finasteride is in less use due to the related sexual side effects, some adjuvant techniques have emerged to improve the delivery and effectiveness of minoxidil, i.e. micro needling. The surgical approach is mainly focused on hair transplant surgery, which offers relatively less invasive procedures and is a more suitable option for long time results, however, it is expensive. Recently, drug-assisted delivery techniques have emerged to improve the efficiency of conventional drugs; transdermal drug delivery through ultrasound pressure waves means creating diffusion channels, increasing skin permeability and stimulating cell differentiation and growth factor utilization along with minoxidil absorption. Another approach for drug-assisted delivery is the embodiment of finasteride in polymer-based microspheres aiming for a sustained and controlled delivery, which can be beneficial to reduce the regular doses decreasing adverse effects.

Author Biography

Deepa Dev Chhetri, Department of Dermatology, Shanghai Tongji Hospital Affiliated to Tongji University, Shanghai, China

Resident Dermatologist at Tongji University, Shanghai, China.


Light AE. Patterned Loss of Hair in Man; Pathogenesis and Prognosis. Ann N Y Acad Sci. 1951;53(3):729–34.

Adil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(1):136-141.

Goren A, Naccarato T. Minoxidil in the treatment of androgenetic alopecia. Dermatol Ther. 2018;31(5):1–2.

Savin RC. Psychological effects of androgenetic alopecia on women: Comparisons with balding men and with female control subjects. J Am Acad Dermatol. 1993;29(4):568–75.

Cash TF. The psychological effects of androgenetic alopecia in men. J Am Acad Dermatol. 1992;26(6):926–31.

Hu R, Xu F, Sheng Y, Qi S, Han Y, Miao Y, et al. Combined treatment with oral finasteride and topical minoxidil in male androgenetic alopecia: A randomized and comparative study in Chinese patients. Dermatol Ther. 2015;28(5):303–8.

Andy G, John M, Mirna S, Rachita D, Michael K, Maja K, et al. Controversies in the treatment of androgenetic alopecia: The history of finasteride. Dermatol Ther. 2019;32(2):8–10.

Oliveira-Soares R, E Silva J, Correia M, André M. Finasteride 5 mg/day treatment of patterned hair loss in normo-androgenetic postmenopausal women. Int J Trichology. 2013;5(1):22–5.

Eun HC, Kwon OS, Yeon JH, Shin HS, Kim BY, Ro BI, et al. 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. J Am Acad Dermatol. 2010;63(2):252–8.

Gubelin Harcha W, Barboza Martínez J, Tsai TF, Katsuoka K, Kawashima M, Tsuboi R, et al. 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. J Am Acad Dermatol. 2014;70(3):489-98.

Chen L, Zhang J, Wang L, Wang H, Chen B, Chen B. The Efficacy and Safety of Finasteride Combined with Topical Minoxidil for Androgenetic Alopecia: A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2020;(270).

Kanti V, Messenger A, Dobos G, Reygagne P, Finner A, Blumeyer A, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men – short version. J Eur Acad Dermatol Venereol. 2018;32(1):11–22.

Lueangarun S, Panchaprateep R, Tempark T, Noppakun N. Efficacy and safety of oral minoxidil 5 mg daily during 24-week treatment in male androgenetic alopecia. J Am Acad Dermatol. 2015;72(5):AB113.

Jimenez-Cauhe J, Saceda-Corralo D, Rodrigues-Barata R, Hermosa-Gelbard A, Moreno-Arrones OM, Fernandez-Nieto D, et al. Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. J Am Acad Dermatol. 2019;81(2):648–9.

Tanaka Y, Aso T, Ono J, Hosoi R, Kaneko T. Androgenetic alopecia treatment in Asian men. J Clin Aesthet Dermatol. 2018;11(7):32–5.

Hamblin MR. Photobiomodulation or low-level laser therapy. J Biophotonics. 2016;9(11–12):1122–4.

Darwin E, Heyes A, Hirt PA, Wikramanayake TC, Jimenez JJ. Low-level laser therapy for the treatment of androgenic alopecia: a review. Lasers Med Sci. 2018;33(2):425–34.

Ghanaat M. Types of hair loss and treatment options, including the novel low-level light therapy and its proposed mechanism. South Med J. 2010;103(9):917–21.

Gentile P, Garcovich S. Advances in Regenerative Stem Cell Therapy in. Cells. 2019;8(466):1–21.

Fukuoka H, Suga H. Hair Regeneration Treatment Using Adipose-Derived Stem Cell Conditioned Medium: Follow-up With Trichograms. Eplasty. 2015;15:e10.

Park BS, Kim WS, Choi JS, Kim HK, Won JH, Ohkubo F, et al. Hair growth stimulated by conditioned medium of adipose-derived stem cells is enhanced by hypoxia: Evidence of increased growth factor secretion. Biomed Res. 2010;31(1):27–34.

Fukuoka H, Narita K, Suga H. Hair Regeneration Therapy: Application of Adipose-Derived Stem Cells. Curr Stem Cell Res Ther. 2017;12(7):531–4.

Dhurat R, Sukesh M, Avhad G, Dandale A, Pal A, Pund P. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: A pilot study. Int J Trichology. 2013;5(1):6–11.

Kumar M, Inamadar A, Palit A. A randomized controlled, single-observer blinded study to determine the efficacy of topical minoxidil plus microneedling versus topical minoxidil alone in the treatment of androgenetic alopecia. J Cutan Aesthet Surg. 2018;11(4):211–6.

Shah KB, Shah AN, Solanki RB, Raval RC. A comparative study of microneedling with platelet-rich plasma plus topical minoxidil (5%) and topical minoxidil (5%) alone in androgenetic alopecia. Int J Trichology. 2017;9(1):14–8.

Herakal CK, Vallabhbhai PP, Siddalingappa K. Microneedling with platelet-rich plasma versus microneedling with topical 5% minoxidil in patients with androgenetic alopecia- a comparative study. J Evol Med Dent Sci. 2017;6(26):2182–6.

Singh S, Neema S, Vasudevan B. A pilot study to evaluate effectiveness of botulinum toxin in treatment of androgenetic alopecia in males. J Cutan Aesthet Surg. 2017;10(3):163.

Tao L, Zhi-wu L, Jie-sheng D, Xiu-qin D. Local Injections of Botulinum Toxin A in Treatment of Androgenetic Alopecia. J Sun Yat⁃Sen Univ Sci. 2018;39(3):467–71.

2Zhang L, Yu Q, Wang Y, Ma Y, Shi Y, Li X. A small dose of botulinum toxin A is effective for treating androgenetic alopecia in Chinese patients. Dermatol Ther. 2019;32(4).

Sharma R, Ranjan A. Follicular Unit Extraction (FUE) Hair Transplant: Curves Ahead. J Maxillofac Oral Surg. 2019;18(4):509–17.

3Rose PT. Hair restoration surgery: Challenges and solutions. Clin Cosmet Investig Dermatol. 2015;8:361–70.

Oberli MA, Schoellhammer CM, Langer R, Blankschtein D. Ultrasound-enhanced transdermal delivery: Recent advances and future challenges. Ther Deliv. 2014;5(7):843–57.

Liao A, Lin K, Chuang H, Tsai C, Lin Y. ultrasound-mediated microbubble cavitation for transdermal minoxidil delivery and hair growth enhancement. 2020;1–12.

Kim JH, Na J, Bak DH, Lee BC, Lee E, Choi MJ, et al. Development of finasteride polymer microspheres for systemic application in androgenic alopecia. Int J Mol Med. 2019;43(6):2409–19.






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