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Androgenetic Alopecia: An Evidence-Based Treatment Update

American Journal of Clinical Dermatology volume 15, pages 217–230 (2014)Cite this article

Abstract

Background

Androgenetic alopecia (AGA) is one of the most common chronic problems seen by dermatologists worldwide. It is characterized by progressive hair loss, especially of scalp hair, and has distinctive patterns of loss in women versus men, but in both genders the central scalp is most severely affected. It often begins around puberty and is known to effect self-esteem and the individual’s quality of life. In contrast to the high prevalence of AGA, approved therapeutic options are limited. In addition to the scarce pharmacologic treatments, there are numerous nonprescription products claimed to be effective in restoring hair in androgenetic alopecia.

Objectives

The purpose of this paper is to review published medical and non-medical treatments for male and female AGA using the American College of Physicians evidence assessment methods. MEDLINE, EMBASE and Cochrane Library were searched for systematic reviews, randomized controlled trials, open studies, case reports and relevant studies of the treatment of male and female AGA. The relevant articles were classified according to grade and level of evidence.

Results

The medical treatments with the best level of evidence classification for efficacy and safety for male AGA are oral finasteride and topical minoxidil solution. For female AGA, topical minoxidil solution appears to be the most effective and safe treatment. The medical treatments corresponding to the next level of evidence quality are some commonly used therapeutic non-FDA-approved options including oral and topical anti-hormonal treatments. Surgical treatment of follicular unit hair transplantation is an option in cases that have failed medical treatment although there is high variation in outcomes.

Limitations

Some articles, especially those concerning traditional herbs claimed to promote hair regrowth, were published in non-English, local journals.

Conclusions

An assessment of the evidence quality of current publications indicates that oral finasteride (for men only) and topical minoxidil (for men and women) are the best treatments of AGA.

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Acknowledgements

No sources of funding were used to prepare this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Supenya Varothai

  2. Department of Dermatology, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH, 44195, USA

    Supenya Varothai & Wilma F. Bergfeld

  3. Department of Dermatology and Pathology, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH, 44195, USA

    Wilma F. Bergfeld

Authors
  1. Supenya Varothai
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  2. Wilma F. Bergfeld
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Correspondence to Wilma F. Bergfeld.

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Varothai, S., Bergfeld, W.F. Androgenetic Alopecia: An Evidence-Based Treatment Update. Am J Clin Dermatol 15, 217–230 (2014). https://doi.org/10.1007/s40257-014-0077-5

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  • DOI: https://doi.org/10.1007/s40257-014-0077-5

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