Androgenetic alopecia is the most common hair loss type in women, but topical minoxidil is the only Food and Drug Administration-approved treatment option. The pathophysiology involves shortened anagen phases, lengthened telogen phases, and hair follicle miniaturization. Androgens, particularly dihydrotestosterone, play a crucial role in male androgenetic alopecia pathogenesis, but their exact role in female pattern hair loss is unclear. Oral antiandrogens demonstrate some efficacy in women, albeit with considerations for side effects and contraindications. Topical antiandrogens may be used in combination with topical minoxidil or as alternatives to oral medications, likely with fewer systemic adverse effects. Patient-specific factors, including age, signs of hyperandrogenism, or need for contraception may help determine which antiandrogen therapy is most appropriate. This review focuses on current antiandrogen treatments for female pattern hair loss available in the United States and their limitations, as well as emerging treatments that are investigational, studied in other hair loss types, or available in other countries.