Pathogenic Mechanisms And Mechanism-Directed Therapies For Androgenetic Alopecia: Current Understanding And Future Directions

This review discusses the pathogenic mechanisms of androgenetic alopecia (AGA), highlighting the roles of the dihydrotestosterone–prostaglandin D2 (DHT–PGD2) loop, oxidative stress and inflammation, and lipid metabolism dysregulation in suppressing Wnt/β‐catenin signaling, crucial for hair growth. DHT and PGD2 promote follicular miniaturization through CXXC5 and GSK‐3β activation, while oxidative stress and inflammation, worsened by an imbalanced scalp microbiome, damage the follicular environment. Disrupted PPARγ signaling affects adipocyte‐follicle interactions, reducing growth factor support. The review identifies potential therapeutic targets, such as DP2 antagonists, CXXC5/GSK‐3β inhibitors, antioxidants, microbiome modulators, and PPARγ agonists, proposing a multitarget approach to improve AGA treatments.