Journal of Cosmetic Dermatology

<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Society values a full head of hair. Therefore, androgenetic hair loss (AGA), though medically benign, can cause significant emotional distress. There is strong demand for alternative (nonconventional, over‐the‐counter) AGA treatments. It is important to have evidence on the efficacy of these treatments for AGA—especially in comparison with treatments that are approved by the United States Food and Drug Administration (FDA), such as oral finasteride and topical minoxidil.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>Following a systematic review, we conducted a network meta‐analysis (NMA) to determine the relative efficacy of conventional monotherapies and selected alternative (nonconventional, over‐the‐counter) products for male AGA.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a Bayesian NMA under a fixed effect model with uniform priors; the NMA estimated relative effects—as per mean difference (MD), along with the 95% credible interval (CI)—and surface under the cumulative ranking curve (SUCRA) values. We also assessed study‐level evidence quality. Eligible studies were identified through systematic searches (without date restrictions) in PubMed and Scopus on April 30, 2025. The main outcome measure was change in total hair density at 24 weeks from baseline (in hairs/cm<jats:sup>2</jats:sup>).</jats:p></jats:sec><jats:sec><jats:title>Results and Conclusion</jats:title><jats:p>We found 24 eligible trials—where the relative efficacy of eight conventional monotherapies and seven alternative (nonconventional, over‐the‐counter) products was determined. The current NMA study confirms the efficacy of conventional monotherapies such as oral dutasteride, topical/oral minoxidil, and oral/topical finasteride for male AGA. We have provided guidance regarding the relative efficacy of some alternative (nonconventional, over‐the‐counter) agents (e.g., melatonin (topical) and rosemary oil (topical)) compared to conventional treatments.</jats:p></jats:sec>

publication_history

received

accepted

published

Multi‐Therapies in Androgenetic Alopecia: Review and Clinical Experiences

Dermatologic Therapy

Evidence for a Polygenic Contribution to Androgenetic Alopecia

British Journal of Dermatology

Female Pattern Hair Loss

Journal of the American Academy of Dermatology

Clinical Study to Evaluate the Efficacy and Safety of a Hair Serum Product in Healthy Adult Male and Female Volunteers With Hair Fall

Clinical, Cosmetic and Investigational Dermatology

The Psychosocial Consequences of Androgenetic Alopecia: A Review of the Research Literature

Psychosocial Impact of Androgenetic Alopecia on Men: A Systematic Review and Meta‐Analysis

Psychology, Health & Medicine

Experimental and Early Investigational Drugs for Androgenetic Alopecia

Expert Opinion on Investigational Drugs

Nutraceuticals for Androgenetic Alopecia

Journal of Clinical and Aesthetic Dermatology

Medical Treatments for Male and Female Pattern Hair Loss

Controversies in the Treatment of Androgenetic Alopecia: The History of Finasteride

The Booming Business of Hair Loss

Trends in Biotechnology

An Overview of Commonly Used Natural Alternatives for the Treatment of Androgenetic Alopecia, With Special Emphasis on Rosemary Oil

The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta‐Analyses of Health Care Interventions: Checklist and Explanations

Annals of Internal Medicine

Automation of Duplicate Record Detection for Systematic Reviews: Deduplicator

Systematic Reviews

Risk‐Of‐Bias VISualization (Robvis): An R Package and Shiny Web App for Visualizing Risk‐Of‐Bias Assessments

Research Synthesis Methods

Automated Generation of Node‐Splitting Models for Assessment of Inconsistency in Network Meta‐Analysis

The Kilim Plot: A Tool for Visualizing Network Meta‐Analysis Results for Multiple Outcomes

Comparative Efficacy of Topical Finasteride (0.25%) in Combination With Minoxidil (5%) Against 5% Minoxidil or 0.25% Finasteride Alone in Male Androgenetic Alopecia: A Pilot, Randomized Open‐Label Study

International Journal of Trichology

Efficacy of the Association of Topical Minoxidil and Topical Finasteride Compared to Their Use in Monotherapy in Men With Androgenetic Alopecia: A Prospective, Randomized, Controlled, Assessor Blinded, 3‐Arm, Pilot Trial

Effects of Watercress Extract Fraction on R‐Spondin 1‐Mediated Growth of Human Hair

International Journal of Cosmetic Science

Efficacy and Safety of Topical Finasteride Spray Solution for Male Androgenetic Alopecia: A Phase III, Randomised, Controlled Clinical Trial

Journal of the European Academy of Dermatology and Venereology

Efficacy and Safety of Oral Minoxidil 5 Mg Once Daily in the Treatment of Male Patients With Androgenetic Alopecia: An Open‐Label and Global Photographic Assessment

Dermatology and Therapy (Heidelberg)

Comparison of Efficacy of Platelet‐Rich Plasma Therapy With or Without Topical 5% Minoxidil in Male‐Type Baldness: A Randomized, Double‐Blind Placebo Control Trial

Indian Journal of Dermatology, Venereology and Leprology

Superiority of Dutasteride Over Finasteride in Hair Regrowth and Reversal of Miniaturization in Men With Androgenetic Alopecia: A Randomized Controlled Open‐Label, Evaluator‐Blinded Study

A 6‐Month, Randomized, Double‐Blind, Placebo‐Controlled Study Evaluating the Ability of a Marine Complex Supplement to Promote Hair Growth in Men With Thinning Hair

Rosemary Oil vs Minoxidil 2% for the Treatment of Androgenetic Alopecia: A Randomized Comparative Trial

Skinmed

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

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

Comparing the Therapeutic Effects of Finasteride Gel and Tablet in Treatment of the Androgenetic Alopecia

Investigation of the Topical Application of Procyanidin Oligomers From Apples to Identify Their Potential Use as a Hair‐Growing Agent

Clinical Dose Ranging Studies With Finasteride, a Type 2 5α‐Reductase Inhibitor, in Men With Male Pattern Hair Loss

Finasteride in the Treatment of Men With Androgenetic Alopecia. Finasteride Male Pattern Hair Loss Study Group

Ketoconazole Shampoo: Effect of Long‐Term Use in Androgenic Alopecia

Dermatology

Androgenetic Alopecia in Men: The Scale of the Problem and Prospects for Treatment

International Journal of Clinical Practice

Topical Minoxidil in Androgenetic Alopecia Scandinavian and Middle East Experience

International Journal of Dermatology

Treatment of Male Pattern Alopecia Using Topical Minoxidil in The Netherlands

The German Double‐Blind Placebo‐Controlled Evaluation of Topical Minoxidil Solution in the Treatment of Early Male Pattern Baldness

2% Topical Minoxidil Solution in Male‐Pattern Baldness: Preliminary European Results

Dermatologica

Dose‐Response Study of Topical Minoxidil in Male Pattern Baldness

Treatment of Male Androgenetic Alopecia With Topical Products Containing S Erenoa Repens Extract

Australasian Journal of Dermatology

Topical Melatonin for Treatment of Androgenetic Alopecia

Network Meta‐Analysis: A Technique to Gather Evidence From Direct and Indirect Comparisons

Pharmacy Practice (Granada)

Efficacy and Safety of Microneedling Radiofrequency in Patterned Hair Loss

Journal of Cutaneous and Aesthetic Surgery

Standardized Scalp Massage Results in Increased Hair Thickness by Inducing Stretching Forces to Dermal Papilla Cells in the Subcutaneous Tissue

Eplasty

A Systematic Review and Meta‐Analysis of Randomized Controlled Trials of United States Food and Drug Administration‐Approved, Home‐Use, Low‐Level Light/Laser Therapy Devices for Pattern Hair Loss: Device Design and Technology

Natural Products for Male Androgenetic Alopecia

Investigation of Topical Application of Procyanidin B‐2 From Apple to Identify Its Potential Use as a Hair Growing Agent

Phytomedicine

SULT1A1 (Minoxidil Sulfotransferase) Enzyme Booster Significantly Improves Response to Topical Minoxidil for Hair Regrowth

Minoxidil Sulfotransferase Enzyme (SULT1A1) Genetic Variants Predicts Response to Oral Minoxidil Treatment for Female Pattern Hair Loss

Sulfotransferase SULT1A1 Activity in Hair Follicle, a Prognostic Marker of Response to the Minoxidil Treatment in Patients With Androgenetic Alopecia: A Review

Postepy Dermatologii I Alergologii

Relative Efficacy of Minoxidil and the 5‐Alpha Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients: A Network Meta‐Analysis

JAMA Dermatology

The Comparative Effects of Monotherapy With Topical Minoxidil, Oral Finasteride, and Topical Finasteride in Postmenopausal Women With Pattern Hair Loss: A Retrospective Cohort Study

Skin Appendage Disorders

Pumpkin Seed Oil vs. Minoxidil 5% Topical Foam for the Treatment of Female Pattern Hair Loss: A Randomized Comparative Trial

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

Biological & Pharmaceutical Bulletin

Society values a full head of hair. Therefore, androgenetic hair loss (AGA), though medically benign, can cause significant emotional distress. There is strong demand for alternative (nonconventional, over-the-counter) AGA treatments. It is important to have evidence on the efficacy of these treatments for AGA-especially in comparison with treatments that are approved by the United States Food and Drug Administration (FDA), such as oral finasteride and topical minoxidil.
Following a systematic review, we conducted a network meta-analysis (NMA) to determine the relative efficacy of conventional monotherapies and selected alternative (nonconventional, over-the-counter) products for male AGA.
We conducted a Bayesian NMA under a fixed effect model with uniform priors; the NMA estimated relative effects-as per mean difference (MD), along with the 95% credible interval (CI)-and surface under the cumulative ranking curve (SUCRA) values. We also assessed study-level evidence quality. Eligible studies were identified through systematic searches (without date restrictions) in PubMed and Scopus on April 30, 2025. The main outcome measure was change in total hair density at 24 weeks from baseline (in hairs/cm
We found 24 eligible trials-where the relative efficacy of eight conventional monotherapies and seven alternative (nonconventional, over-the-counter) products was determined. The current NMA study confirms the efficacy of conventional monotherapies such as oral dutasteride, topical/oral minoxidil, and oral/topical finasteride for male AGA. We have provided guidance regarding the relative efficacy of some alternative (nonconventional, over-the-counter) agents (e.g., melatonin (topical) and rosemary oil (topical)) compared to conventional treatments.

Relative Efficacy of Conventional Monotherapies and Select Nonconventional, Over-the-Counter Products for Male Androgenetic Alopecia: A Network Meta-Analysis Study.

Relative Efficacy of Conventional Monotherapies and Select Nonconventional, Over‐the‐Counter Products for Male Androgenetic Alopecia: A Network Meta‐Analysis Study

Relative Efficacy of Conventional Monotherapies and Select Nonconventional, Over‐the‐Counter Products for Male Androgenetic Alopecia: A Network Meta‐Analysis Study

Clinical Summary

What was studied

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