A systematic review of clinical evidence on the efficacy and safety of conditioned media, platelet-rich fibrin, stromal vascular fraction, extracellular vesicles, and stem cells in androgenetic alopecia.

[AIMS AND OBJECTIVES] Androgenetic alopecia (AGA) is a common progressive hair loss disorder caused by follicular miniaturization and shortened anagen phases. Conventional treatments mainly target androgen pathways but often yield unsatisfactory results. Regenerative medicine has emerged as a novel therapeutic approach aiming to restore follicular function through biologically active cell-based or cell-free therapies. This systematic review aimed to evaluate the efficacy and safety of five major regenerative modalities in AGA-conditioned media (CM), platelet-rich fibrin (PRF), stromal vascular fraction (SVF), extracellular vesicles (EV), and stem cells (SCs)-while comparing their outcomes and identifying the most frequently investigated methods, highest response rates, and areas requiring further research.

[METHODS] This systematic review followed PRISMA guidelines. PubMed, Scopus, and Web of Science were searched for studies published up to September 1, 2025. Eligible studies included patients diagnosed with AGA who received regenerative medicine interventions and reported measurable clinical outcomes. Data were extracted on participant characteristics, intervention type, efficacy outcomes, and adverse events. Risk of bias was assessed using ROB-2 for RCTs and ROB-I for non-randomized studies.

[RESULTS] A total of 20 clinical studies involving 724 patients were included, encompassing randomized controlled trials, prospective cohorts, case series, pilot studies, and retrospective analyses. Among the included studies, CM was the most extensively investigated therapy (6 studies, 229 patients), showing consistent improvements in hair density (7-16%) and thickness (11-32%), with up to 85% increase in hair count when combined with minoxidil. PRF demonstrated the fastest and most consistent responses, with 62-97% improvements in hair density within 3-6 months and additional benefits when used with hair transplantation. SVF showed comparable or superior outcomes to platelet-rich plasma (PRP), with density increases of 41-48% after a single injection and synergistic effects when combined with PRP or fat grafting. EV therapy, though less studied (3 studies, 89 patients), showed hair count increases of 28% and density gains up to 45% in certain subgroups, with higher responses in early-stage AGA. Stem cell and micrograft therapies (3 studies, 146 patients) demonstrated the strongest regenerative potential, with hair density improvements of 30% within two months, histological evidence of follicle regeneration, and significant quality of life benefits. Across all approaches, only mild, transient adverse events were reported.

[CONCLUSION] Regenerative medicine offers effective and safe therapeutic options for AGA, with each modality providing distinct advantages. Despite encouraging results, heterogeneity in study protocols and limited long-term data highlight the need for larger randomized controlled trials, standardized methodologies, and extended follow-up to determine the optimal regenerative strategy for AGA.