Androgenetic alopecia - a literature review

Abstract

Introduction and Purpose: Androgenetic alopecia (AGA) is the most common form of hair loss, affecting both men and women. It involves progressive miniaturization of hair follicles due to dihydrotestosterone (DHT) and genetic factors. AGA has cosmetic and psychological impacts and is linked to systemic conditions such as cardiovascular and metabolic disorders. Although treatments like finasteride and minoxidil are FDA-approved, alternative therapies are being explored to improve outcomes and reduce side effects. This review provides an updated overview of AGA pathogenesis and emerging treatment options.

Material and Methods: A comprehensive literature review was conducted, analyzing recent studies on AGA pathophysiology, genetics, and treatments. Findings on FDA-approved drugs, alternative pharmacologic therapies, mesotherapy, and low-level light therapy (LLLT) were evaluated for efficacy and safety.

State of Knowledge: AGA pathogenesis includes hormonal, genetic, and environmental components. DHT binds to androgen receptors in vulnerable hair follicles, leading to miniaturization. Genetic susceptibility involves loci like AR/EDA2R. While finasteride and minoxidil remain mainstays, newer treatments—such as dutasteride, androgen receptor antagonists (e.g., spironolactone, clascoterone, pyrilutamide), mesotherapy, and low-dose oral minoxidil—show promise. LLLT, particularly red LED light (630–660 nm), stimulates hair growth and reduces inflammation. Clinical studies suggest combination therapies are more effective than monotherapy.

Conclusions: AGA is complex and requires long-term management. Finasteride and minoxidil are effective, but alternative treatments like dutasteride, mesotherapy, androgen blockers, and red LED therapy offer promising results. Combination therapy appears most effective, though more research is needed to standardize protocols and confirm long-term safety.