What’s the science behind Botox injections for androgenetic alopecia?

Although botox may seem unlikely that a toxin used in aesthetic medicine could help restore hair, there are studies that explore this possibility with a certain degree of rigor. In this review, we analyze what science really says about this proposal, relying exclusively on real clinical studies, with direct links and without using unreliable sources.

First, it is important to understand how Botox works.

Its active ingredient is botulinum toxin type A, which blocks the release of acetylcholine, a substance necessary for muscle contraction. This causes muscles to relax. On the face, this prevents wrinkles; on the scalp, the hypothesis is that this relaxation reduces pressure from the muscles on the scalp’s blood vessels, improving local circulation. In turn, better blood flow could help hair follicles receive more oxygen and nutrients, creating a healthier environment for hair growth.

Androgenetic alopecia is a progressive condition characterized by the miniaturization of hair follicles, usually caused by the action of dihydrotestosterone (DHT), a hormone derived from testosterone. By compressing blood vessels, tense scalp muscles could contribute to weakening the follicles more quickly. That is why reducing this tension through Botox might be beneficial. One of the first documented and real studies was published in 2017 in the Journal of Cutaneous and Aesthetic Surgery. **It was a pilot study conducted in India, involving ten men with androgenetic alopecia between grades II and IV on the Norwood-Hamilton scale. Botox injections were applied to their scalp, and they were followed for 24 weeks. **

Evaluation was done through clinical photographs and self-assessment by the patients. Eight of the ten participants reported a good or excellent improvement in hair density, while seven said they were satisfied with the results.

However, the study did not include a control group, and the sample size was very small, which limits its conclusions. Another relevant study was published in 2020 by Zhou and colleagues and is indexed in PubMed. In this case, it was a randomized clinical trial involving 63 patients with androgenetic alopecia. The researchers compared three groups: one received Botox alone, another received Botox combined with finasteride (an oral anti-androgenic medication), and the third received no treatment. Over the 12-month follow-up, the group that received only Botox increased its hair density from around 180 to 218 hairs per cm², while the group combined with finasteride achieved a density of 234 hairs per cm². Few side effects were reported, such as mild headaches or local discomfort. Still, this study did not include a placebo group, which limits its scientific robustness.

A more recent study, published in 2024 in the journal Dermatology and Therapy, compared intramuscular and intradermal Botox injections.

It was a randomized, double-blind trial with 90 participants, in which hair thickness and density were evaluated over 12 weeks. Both methods resulted in an increase in hair diameter, but intramuscular injections were more effective in increasing density. **An interesting adverse effect was the appearance of alopecia areata in one patient, which raises the need to consider possible immune responses to the toxin. ** In 2025, a meta-analysis was published in the journal Dermatologic Surgery that compiled data from eight clinical studies evaluating the use of Botox for androgenetic alopecia in a total of 165 men. The duration of the studies ranged from 24 to 60 weeks. A significant average increase in hair density was observed.

When excluding studies with a high risk of bias, the positive effect was even greater. Still, the authors of the analysis acknowledged that the methodological quality of many of the studies was low, with small sample sizes and a lack of objective measurements such as blood flow.

Another aspect explored has been the physiological mechanism behind Botox’s effect on hair. In a 2022 review published in Skin Appendage Disorders, the authors explained that relaxing scalp muscles not only improves circulation but could also reduce local levels of TGF-β1, a pro-inflammatory protein linked to the inhibition of hair growth. In addition, animal studies have shown an increase in growth factors such as VEGF, which promote the transition to the anagen or active growth phase of the hair cycle. Meanwhile, a review article published in 2025 in the journal Toxins (MDPI) suggests that Botox’s effects on inflammation, blood flow, and the local hormonal environment could explain why some patients respond positively. **However, it also highlights that the lack of trials with direct measurements limits the interpretation of these findings. **

Regarding treatment safety, the studies agree that side effects are generally mild. The most common are injection site pain, nausea, and headaches. The appearance of alopecia areata in a single patient calls for careful evaluation before applying the treatment. So far, no serious or systemic adverse effects have been documented.

User Experiences with Botox for Hair Loss

Botox, long known for its cosmetic uses in reducing wrinkles, has emerged as a novel, off-label option for treating androgenetic alopecia (AGA). While not a mainstream therapy, a growing number of users in the Tressless community have shared their experiences and opinions about this unconventional approach.

Scientific studies provide the groundwork for these user experiments. A 2010 pilot study showed that botulinum toxin type A (Botox) injections in the scalp led to an 18% increase in hair count in men with AGA, with a 75% treatment response rate and no adverse effects reported. Another 2020 study confirmed that Botox may improve hair growth by reducing secretion of TGF-β1, a factor linked to follicle miniaturization. This mechanistic hypothesis suggests Botox may work by improving scalp blood flow or reducing scalp tension and inflammation, counteracting fibrosis and hypoxia. The community has responded with cautious optimism. In a thread titled "Botox is as effective as Finasteride in treating hair loss", users debated a study claiming Botox rivaled finasteride’s effectiveness. Some users suggested combining Botox with minoxidil and microneedling for synergy, while others remained skeptical, citing the lack of large-scale clinical validation.

Another user shared their results in the post "Botox for Hair Loss", reporting reduced scalp itch and shedding after scalp Botox injections. However, they noted that it was too early to assess regrowth. Similarly, in the post "anybody actually got botox on their scalp and had success?", members discussed the theoretical benefits of reducing scalp muscle tension. One commenter explained that tension in the galea aponeurotica—the connective tissue layer under the scalp—may restrict blood flow and contribute to hair miniaturization, and Botox might relieve this pressure. Other posts questioned the practicality and availability of the treatment. In "Has anyone found any US Doctors willing to do Botox injections for hair loss?", a user searched for providers in the U.S. and expressed a preference for Botox over finasteride due to concerns about hormonal side effects.

The post "The Effect of Intradermal Botox on Androgenetic Alopecia and Its Possible Mechanism" gained traction for its explanation of the mechanism—blocking DHT-induced TGF-β1 secretion from dermal papilla cells. While several users were intrigued, many emphasized the experimental nature of the treatment and called for more clinical trials. The Tressless community reflects a mix of curiosity, anecdotal success, and caution regarding Botox for hair loss. While small studies provide promising evidence, the treatment remains largely off-label and experimental. Users are encouraged to view it as a supplementary option rather than a primary treatment like finasteride or minoxidil.

It is important to underline that the use of Botox for androgenetic alopecia is considered an experimental treatment.

Despite promising results from some studies, Botox is not FDA-approved for this purpose. Currently approved therapies include the use of minoxidil and finasteride, with well-studied mechanisms and robust evidence. In summary, science shows that Botox could have a potential role as a complementary treatment for androgenetic alopecia, particularly by improving the physiological environment of the scalp. However, more studies with placebo groups, objective measurements, and longer follow-ups are needed before considering its widespread use.

References

Pilot study in India (2017): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782443/

Randomized clinical trial (2020): https://pubmed.ncbi.nlm.nih.gov/32802833/

Double-blind trial (2024): https://link.springer.com/article/10.1007/s13555-024-01189-x

Meta-analysis (2025): https://pubmed.ncbi.nlm.nih.gov/39840856/

Physiological review (2022): https://pubmed.ncbi.nlm.nih.gov/35415183/

Toxins review (2025): https://www.mdpi.com/2072-6651/17/4/163

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