Is there a rationale for the use of botulinum toxin in the treatment of Androgenetic Alopecia?

Androgenetic alopecia (AGA) is a common form of hair loss that affects both men and women. Currently, the only FDA-approved treatments for AGA are topical minoxidil and oral finasteride. However, recent studies have suggested that injectable botulinum toxin (BT) may be a potential adjuvant treatment for AGA. BT could promote relaxation of the scalp muscles, reduce muscle pressure on perforating vessels, and potentially increase blood and oxygen flow to bald areas. This could reduce tissue dihydrotestosterone (DHT) and prevent follicular miniaturization, which is considered the main pathophysiological basis of AGA. Additionally, BT injection could inhibit the secretion of transforming growth factor-B1 (TGF-B1) from hair follicles, contributing to the antifibrotic effect. While more clinical trials are needed to validate the use of BT in AGA, it has a theoretical rationale that supports its use as a complementary treatment.