Androgenetic alopecia (AGA) is a common form of hair loss that can be influenced by psychological factors.To investigate the impact of mental stress on neurotrophic factors in patients with AGA and correlate the findings with the progression of AGA.A total of 120 patients with AGA were analyzed in this study, which were divided into a non-stress group (n = 30) and a stress group (n = 90) on the basis of the presence or absence of psychological stress confirmed by Depression Anxiety Stress Scale-21 scale. The baseline demographic characteristics, serum cortisol levels, hair growth parameters, neurotrophic factors, and AGA progression scores between the non-stress and stress groups were compared. Correlation analyses were conducted to assess the relationships among stress, neurotrophic factors, hair loss progression, and AGA progression.This study revealed significantly higher cortisol levels throughout the day in the stress group than in the non-stress group. The stress group exhibited lower levels of nerve growth factor, brain-derived neurotrophic factor, and glial cell line-derived neurotrophic factor and higher expression levels of neurotrophin (NT)-3 and NT-4 than the non-stress group. Hair parameters indicated lower hair diameter, decreased hair density, and more severe AGA grading in the stress group, whereas follicle count and terminal/vellus hair ratio showed no significant differences between the two groups. After 1 year of treatment with 5% minoxidil, efficacy was observed to be lower but AGA progression was notably more pronounced in the stress group than in the non-stress group. Disease progression was positively correlated with high stress and NT-4 levels.This study provides compelling evidence of the influence of mental stress on neurotrophic factors and its correlation with the progression of AGA. The findings underscore the need for a comprehensive approach to the management of AGA that considers the physiological and psychosocial aspects. Further research is warranted to validate the findings and explore targeted therapeutic interventions for individuals with stress-related AGA.©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.