Emerging pharmacotherapies for androgenetic alopecia

INTRODUCTION: Androgenetic alopecia (AGA) is the most common form of hair loss, characterized by androgen-dependent follicular miniaturization. To date, topical and oral minoxidil, 5-α-reductase inhibitors and oral antiandrogens remain the mainstay of treatment, but research is progressing fast in the search of new mechanism-targeted pharmacotherapies. AREAS COVERED: This article summarizes emerging therapies for AGA and highlights their underlying mechanisms. A targeted review was conducted of PubMed, ClinicalTrials.gov, Food and Drug Administration available resources, company-press releases and published abstracts from database inception through December 2025. EXPERT OPINION: Recent advances in hair biology and drug development have led to a paradigm shift toward new strategies to prevent androgen effects on the follicle, improve minoxidil delivery, activate follicle stem cells and prevent follicular apoptosis. These include topical androgen-receptor antagonists and degraders (clascoterone, GT20029), biologics targeting prolactin receptor inhibition (HMI-115, ABS-201), anagen-inducing injectables (AMP-303), metabolic and follicular activators (PP405, ET-02), thyroid hormone receptor-β agonists (KB-141), optimized potassium channel opener delivery systems (extended-release and sublingual minoxidil) and modulation of longevity pathways using rapamycin and metformin. Collectively, these newer pharmacotherapeutics aim to improve efficacy, safety, and patient adherence. Ongoing and future clinical trials will determine their definitive role in reshaping the therapeutic landscape of androgenetic alopecia.