Relative efficacy of conventional monotherapies and select nonconventional, over-the-counter products for male androgenetic alopecia: A network meta-analysis study

Abstract

Society values a full head of hair. Therefore, androgenetic hair loss (AGA), though medically benign, can cause significant emotional distress. There is strong demand for alternative (nonconventional, over-the-counter) AGA treatments. It is important to have evidence on the efficacy of these treatments for AGA—especially in comparison with treatments that are approved by the United States Food and Drug Administration (FDA), such as oral finasteride and topical minoxidil. Following a systematic review, we conducted a network meta-analysis (NMA) to determine the relative efficacy of conventional monotherapies and selected alternative (nonconventional, over-the-counter) products for male AGA. We conducted a Bayesian NMA under a fixed effect model with uniform priors; the NMA estimated relative effects—as per mean difference (MD), along with the 95% credible interval (CI)—and surface under the cumulative ranking curve (SUCRA) values. We also assessed study-level evidence quality. Eligible studies were identified through systematic searches (without date restrictions) in PubMed and Scopus on April 30, 2025. The main outcome measure was change in total hair density at 24 weeks from baseline (in hairs/cm2). We found 24 eligible trials—where the relative efficacy of eight conventional monotherapies and seven alternative (nonconventional, over-the-counter) products was determined. The current NMA study confirms the efficacy of conventional monotherapies such as oral dutasteride, topical/oral minoxidil, and oral/topical finasteride for male AGA. We have provided guidance regarding the relative efficacy of some alternative (nonconventional, over-the-counter) agents (e.g., melatonin (topical) and rosemary oil (topical)) compared to conventional treatments.