Research Progress on the Synergistic Role of Gut Microbiota and Exosomal miRNAs in the Treatment of Androgenetic Alopecia

Introduction: Androgenetic alopecia (AGA), a widespread condition marked by the gradual shrinkage of hair follicles, involves complex pathogenic mechanisms. Recently, a growing body of research has begun to uncover the influence of gut microbial communities and exosomederived microRNAs (miRNAs) in hair follicle regulation. Although current findings remain preliminary, they point toward a potential interplay between intestinal microbiota and exosomal signaling pathways, which may offer novel therapeutic avenues. This review seeks to dissect the biological contributions of gut microbiota and exosomal miRNAs to the onset and progression of AGA, aiming to inform future clinical approaches through an integrative perspective. Methods: We performed a comprehensive literature search (2018-2025) in PubMed, Web of Science, and CNKI. Studies were selected based on predefined criteria focusing on gut microbiota, exosomal miRNAs, and their roles in AGA pathogenesis. Results: Gut microbiota contribute to hair follicle health by modulating host immune responses, metabolic pathways, and the skin microbiome, thereby enhancing follicular stem cell activity. Exosomes, as key mediators of intercellular communication, transport miRNAs that play essential roles in regulating the hair growth cycle. These miRNAs can counteract follicular miniaturization by targeting specific suppressor molecules. Discussion: The gut microbiota may influence the composition and functional properties of exosomes, thereby exerting indirect regulatory effects on hair follicle dynamics. These findings provide new insights into potential therapeutic strategies for AGA. Conclusion: Gut microbiota and exosomal miRNAs may synergistically influence the progression of AGA through interconnected metabolic, immune, and microbial skin axes. Targeted modulation of the "microbiota-miRNA axis" could represent a novel, multidimensional approach for AGA treatment. Nevertheless, the precise molecular crosstalk and signaling cascades underlying these phenomena remain largely unresolved, warranting more targeted experimental investigations.