Beyond Minoxidil: Off-Label Therapies for Male Androgenetic Alopecia-A Systematic Review with Network Meta-Analyses.

Background

There is limited evidence on comparative effectiveness of off-label therapies approved by the United States Food and Drug Administration (FDA) for androgenetic alopecia (AGA) and the unregulated ones.

Objective

To evaluate and compare the molecular mechanisms, clinical efficacy, and safety of off-label therapies for male AGA through a network meta-analysis (NMA).

Methods

A systematic literature search in PubMed, Scopus, Web of Science, and ClinicalTrials.gov was conducted on 23 January 2026. We examined studies that assessed mean 6-month change in total hair density of off-label monotherapies, including topical minoxidil (2%, 5%) for male AGA. Sensitivity analyses were conducted.

Results

Our search identified 23 studies (15 off-label and 8 topical minoxidil). We found topical minoxidil 5% to be ranked most effective. Other effective therapies included melatonin (topical), diaminopyrimidine oxide 1% (topical), procyanidin 1% (topical), saw palmetto (topical), exosome-based formulation containing plant-derived extracts (subcutaneous), cetirizine 1% (topical) and finasteride (topical).

Conclusions

Our results substantiate topical minoxidil 5% being the most effective option; our findings also suggest that other off-label therapies demonstrate potential clinical benefit, warranting further high-quality comparative trials.