Optimizing Concentrated Growth Factor Therapy: Sodium Citrate Reduces Pain in Hair Loss Treatment

BACKGROUND: Androgenetic alopecia (AGA) is a prevalent condition causing significant psychosocial distress. While concentrated growth factor (CGF) therapy has emerged as a promising regenerative treatment, the choice of anticoagulant remains a critical but underexplored variable that may affect the growth factor release, and patient experience. OBJECTIVE: To compare the efficacy, procedural pain, and patient satisfaction of CGF prepared with sodium citrate, heparin sodium, or no anticoagulant in patients with AGA. METHODS: This phase 2, multicenter, single-blind, randomized controlled trial enrolled 267 patients aged 18 to 50 years across three tertiary hospitals in China. Participants were randomized 1:1:1 to receive CGF prepared without anticoagulant (Group A), with 3.2% sodium citrate (Group B), or with heparin sodium (Group C). All patients underwent five intradermal injection sessions over 12 months. Primary endpoints included injection-related pain (VAS) and changes in hair density at 3, 6, and 12 months. RESULTS: Injection pain was significantly lower in Group B (P < 0.001). At 6 and 12 months, Group B demonstrated significantly greater hair density increases and higher rates of ≥50% subjective clinical improvement (P < 0.001). In vitro analysis confirmed that sodium citrate best preserved growth factor levels and platelet function. Overall satisfaction and willingness for re-treatment were highest in Group B (87.6%). CONCLUSIONS: Sodium citrate provided the most favorable balance of procedural tolerability, delivery reliability, and clinical efficacy. These findings support sodium citrate as the preferred anticoagulant for CGF preparation in AGA, while confirmation in broader populations and phase 3 trials is warranted.