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Topical androgen receptor antagonists may not be necessary if 5-AR inhibitors like finasteride or dutasteride effectively reduce DHT levels. Combining a 5-AR inhibitor with a topical androgen antagonist could potentially enhance treatment, but oral use of androgen antagonists is too risky due to severe side effects.

Pyrilutamide is a selective AR antagonist with a high binding affinity, making it effective in competing with DHT for androgen receptors. The 1% concentration is more effective than the 0.5%, but the latter may suffice for mild hair loss; the drug is considered a good option for those avoiding 5AR blockers due to side effects.

Clascoterone in Winlevi, a topical AR antagonist, is being re-examined due to concerns about HPA axis suppression in adolescents, but it's unlikely to be banned for adult use in androgenetic alopecia (AGA). The European Medicines Agency recommended refusing Winlevi for acne vulgaris, but this may not affect Breezula's approval for AGA.

Clascoterone cream can be used on the scalp, but it may not be effective due to its dosage. AR antagonists like clascoterone are generally less effective than 5AR inhibitors for hair loss.

Pyrilutamide is discussed as a potential hair loss treatment, acting as an androgen receptor antagonist. The conversation questions if it can maintain hair long-term without using finasteride.