Implications for clinical practice

Currently, minoxidil 2% solution is the only effective way to treat AGA in women. There are no systemic side-effects.

Systemic oestrogens and/or antiandrogens for women with AGA Efficacy

Because oestrogens have many antiandrogenic actions, it is thought that they might have a positive influence on hair growth. Antiandrogens such as cyproterone acetate and chlormadinone acetate directly block the androgen receptor. However, most women with AGA have normal oestrogen and androgen levels.29 Therefore, positive effects of oestrogens and/or antiandrogens on hair growth are questionable. There are no systematic reviews. Recently, one RCT compared the efficacies of the antiandrogen cyproterone acetate, 52 mg daily on days 1-20 of the cycle with twice-daily 2% minoxidil application in 66 women with AGA Ludwig I (67%), II (31%) and III (2%). The study duration was 1 year and each treatment group consisted of 33 women. The main outcome was number of strong hair (>40 micrometer in diameter) in a test area as detected by the phototrichogram. After 1 year, hair counts in the 0-32 cm2 test area were -2-4 ± 6-2 in the cyproterone acetate group and +6-5 ± 9-0 hairs in the minoxidil group.30 Thus, 2% minoxidil was significantly more effective than cyproterone acetate.

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