Efficacy of non-surgical treatments for androgenetic alopecia: a systematic review and network meta-analysis

J Eur Acad Dermatol Venereol. 2018 Dec;32(12):2112-2125. doi: 10.1111/jdv.15081. Epub 2018 Jul 11.


Androgenetic alopecia, or male/female pattern baldness, is the most common type of progressive hair loss disorder. The aim of this study was to review recent advances in non-surgical treatments for androgenetic alopecia and identify the most effective treatments. A network meta-analysis (NMA) was conducted of the available literature of the six most common non-surgical treatment options for treating androgenetic alopecia in both men and women; dutasteride 0.5 mg, finasteride 1 mg, low-level laser therapy (LLLT), minoxidil 2%, minoxidil 5% and platelet-rich plasma (PRP). Seventy-eight studies met the inclusion criteria, and 22 studies had the data necessary for a network meta-analysis. Relative effects show LLLT as the superior treatment. Relative effects show PRP, finasteride 1 mg (male), finasteride 1 mg (female), minoxidil 5%, minoxidil 2% and dutasteride (male) are approximately equivalent in mean change hair count following treatment. Minoxidil 5% and minoxidil 2% reported the most drug-related adverse events (n = 45 and n = 23, respectively). The quality of evidence of minoxidil 2% vs. minoxidil 5% was high; minoxidil 5% vs. placebo was moderate; dutasteride (male) vs. placebo, finasteride (female) vs. placebo, minoxidil 2% vs. placebo and minoxidil 5% vs. LLLT was low; and finasteride (male) vs. placebo, LLLT vs. sham, PRP vs. placebo and finasteride vs. minoxidil 2% was very low. Results of this NMA indicate the emergence of novel, non-hormonal therapies as effective treatments for hair loss; however, the quality of evidence is generally low. High-quality randomized controlled trials and head-to-head trials are required to support these findings and aid in the development of more standardized protocols, particularly for PRP. Regardless, this analysis may aid physicians in clinical decision-making and highlight the variety of non-surgical hair restoration options for patients.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • 5-alpha Reductase Inhibitors / therapeutic use
  • Alopecia / drug therapy*
  • Alopecia / radiotherapy*
  • Dutasteride / therapeutic use*
  • Finasteride / therapeutic use*
  • Humans
  • Low-Level Light Therapy*
  • Minoxidil / therapeutic use*
  • Network Meta-Analysis
  • Platelet-Rich Plasma
  • Vasodilator Agents / therapeutic use


  • 5-alpha Reductase Inhibitors
  • Vasodilator Agents
  • Finasteride
  • Minoxidil
  • Dutasteride