Systemic Treatment Options for Androgenic Alopecia

March 2026 in “ Lithuanian University of Health Sciences ”

Arijana Bagdanavičiūtė, Katrina Gaidulevič, Kamilė Kalendraitė

androgenic alopecia dihydrotestosterone DHT hair follicle miniaturization 5-alpha reductase inhibitors finasteride dutasteride oral minoxidil antiandrogen therapy spironolactone Propecia Rogaine

TLDR Finasteride, dutasteride, and oral minoxidil are effective for treating hair loss, with spironolactone as an option for women.

This review examines systemic treatment options for androgenic alopecia, highlighting the importance of dihydrotestosterone (DHT) in hair follicle miniaturization and hair thinning. The study identifies 5-alpha reductase inhibitors, such as finasteride and dutasteride, and oral minoxidil as the most effective systemic treatments for slowing disease progression and promoting hair regrowth. For women, additional antiandrogen therapy like spironolactone may be used. Systemic treatment is essential, especially when topical treatments are insufficient, as it targets the fundamental mechanisms of the disease and provides broader therapeutic effects.

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The conversation discusses whether finasteride's reduction of DHT and increase in scalp testosterone contribute to hair follicle miniaturization. Some participants argue testosterone does not cause miniaturization, while others suggest that even with reduced DHT, other androgens like testosterone may still contribute to hair loss.

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Finasteride can impact neurosteroids, potentially causing depression and other side effects in some users. Despite these concerns, many continue using it for hair loss, with some switching to topical applications to mitigate side effects.

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Scalp biopsies are crucial for diagnosing hair loss conditions like Diffuse Unpatterned Alopecia (DUPA) and retrograde hair loss, as treatments like finasteride and dutasteride may not be effective if other conditions are present. Combining PPAR-GAMMA agonists with retinoids could improve treatments for conditions like Lichen Planopilaris.

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community 5% Minoxidil after 4 months - started with twice a day but went down to once because I kept forgetting in the morning. Really happy with how it is going!

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