Disconnect between Patient and Dermatologist Perceptions in Androgenetic Alopecia Therapy: Social Analysis across More than 100,000 Digital Conversations.

INTRODUCTION: Individuals with alopecia encounter numerous treatment options and obtain guidance from both medical and nonmedical sources. Despite stronger clinical evidence for prescription therapies, many patients favor over-the-counter (OTC) products. We used large-scale social listening to characterize public sentiment toward androgenetic alopecia (AGA) treatments and compare perceptions of OTC and prescription modalities. METHODS: Over 700,000 publicly available posts (March 2024-April 2025) from major online forums were captured using hair-loss-related keywords, filtered to approximately 143,000 human-authored conversations. These were analyzed for treatment associations, concerns, thematic content, and sentiment. OTC and prescription discussions were compared using chi-square testing (Bonferroni-corrected, two-sided α = 0.006). RESULTS: Of included posts, 27,425 discussed prescription and 39,138 OTC therapies. Sentiment was dominated by frustration and anxiety, with low satisfaction. Prescription discussions more frequently referenced perceived lack of efficacy and side-effect concerns, whereas OTC discussions more often expressed positive themes, satisfaction, simplicity, and integration into personal routines. Prescription therapies were more commonly associated with skepticism, despair, and last-resort framing. DISCUSSION: Public sentiment toward AGA treatments is largely negative and favors OTC therapies despite stronger evidence for prescription modalities. These perception gaps may contribute to delayed dermatologic care, underscoring the need for targeted education, expectation setting, and earlier engagement with evidence-based treatment.