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.