Table 1.
Approved and Investigational drug therapies for androgenetic alopecia
| Drug (Trade name) | Structure | M, F, Both, animal | Class/route | Mechanism | Ref. |
|---|---|---|---|---|---|
| Minoxidil (Rogaine) |  |
Both; approved | Vasodilator, ATP-sensitive potassium channel opener; topical | Increases blood flow to HF, stimulates VEGF and PGE2 | [131] |
| PInacidil (Pindac) |  |
Both; clinical trial | Vasodilator, ATP-sensitive potassium channel opener; topical | Increases blood flow to HF, stimulates VEGF and PGE2 | [132] |
| Tretinoin (Retin-A) |  |
Both; clinical trial | Retinoid; topical | Promotes proliferation and differentiation, may promote vascular proliferation. | [133] |
| Finasteride (Propecia) |  |
Both, approved M | 5-α-reductase (5-α-R) inhibitor; oral, topical, mesotherapy | Inhibits 5-α-R2 | [134,135] |
| Dutasteride (Avodart) |  |
Both, approved M | 5-α-R inhibitor oral, topical, mesotherapy | Inhibits 5-α-R1 and 5-α-R2 | [136,137] |
| Bicalutamide (Casodex) |  |
F; clinical trial | Nonsteroidal antiandrogen; oral | Androgen receptor antagonist | [138] |
| Flutamide (Eulexin, Flutamin, Cytomid) |  |
F; clinical trial | Nonsteroidal antiandrogen; Oral | Androgen receptor antagonist | [139] |
| Fluridil (Eucapil) |  |
M; clinical trial | Nonsteroidal antiandrogen; topical | Androgen receptor antagonist | [140] |
| Cyproterone acetate (Androcur, Cyprostat) |  |
W; clinical trial | Steroidal antiandrogen | Androgen receptor antagonist; progesterone receptor agonist | [141] |
| Spironolactone (Aldactone) |  |
F; clinical trial | Steroidal potassium-sparing diuretic | Reduces adrenal androgen production and competitively blocks androgen receptors | [142] |
| Melatonin; N-acetyl-5-methoxytryptamine |  |
F; clinical trial | Hormone produced to regulate photo-periods, topical | Responsible for seasonal hair growth in animals | [143] |
| Bimatoprost (Lumigan, Latisse) |  |
Both; approved for eyebrows | Prostaglandin analog prodrug; topical | Activates prostamide α F2 receptors | [144] |
| RU-58841 myristate; |  |
Hamsters, macaques | Pro-drug for nonsteroidal antiandrogen; topical | Androgen receptor antagonist | [138] |
| SGF57 growth factors: bFGF, VEGF, IGF, SCF, KCF, SOD1, noggin | F; clinical trial | Growth factor cocktail; topical + microneedling | Stimulates HF | [145] | |
| Liposomal IGF-1 | Hamster | Growth factor, Topical | Stimulates HF | [146] | |
| Thymosin β 4 | Rats, mice | 43-amino acid protein; topical | Stimulates HF stem cells | [147] | |
| KF19418 |  |
Mice | Condensed naphthyridine derivative; topical | Anti-inflammatory, bronchodilator | [148] |
| Epigallocatechin-3-gallate (EGCG) |  |
Mice | Polyphenolic antioxidant; topical | Downregulated androgen receptor, reduced apoptosis | [149] |
| Polygonum multiflorum extract |  |
Mice | Botanical extract in water containing 2,3,5,4-tetrahydroxystilbene-2-O-β-dglucoside; topical with added lactobacilli | Increases anagen-phase HF; traditional folk-medicine for baldness | [150] |
| Eclipta alba extract | Mice | Botanical extract in methanol containing coumestans, triterpenes, saponins, flavonoids; topical | Increases melanogenesis, anagen-phase HF; traditional folk-medicine for baldness | [151] | |
| Thuja orientalis extract | Mice | Botanical extract in water containing flavonoids and diterpene; topical | Contains natural 5– reductase inhibitors; Traditional folk-medicine for baldness | [152] | |
| Steroid sulfatase inhibitors | Investigational | Topical | Reduce additional source of DHT | [153] | |
| Antisense oligonucleotides against AR | Investigational | Topical | Reduce expression of AR | [154] |
bFGF: Basic fibroblast growth factor: DHT: Dihydrotestosterone; HF: Hair follicle.