Objective To explore the effect of Astragalus granule combined with minoxidil on symptom improvement and sex hormone levels in patients with androgenetic alopecia (AGA). Methods A total of 128 AGA patients admitted to Beijing Biliansheng Medical Beauty Clinic from February 2023 to February 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 64 patients in each group. The control group was treated with minoxidil alone, and the observation group was treated with Astragalus granule combined with minoxidil. The symptom improvement, sex hormone levels [estradiol (E2), testosterone (T)], clinical efffcacy and adverse reactions were compared between the two groups. Results After treatment, the scores of alopecia, greasiness, pruritus and desquamation in the observation group were lower than those in the control group (P<0.05). After treatment, the level of E2 in the observation group was higher than that in the control group, and the level of T was lower than that in the control group (P<0.05). The total effective rate of the observation group (95.31%) was higher than that of the control group (84.38%) (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The application of Astragalus granule combined withminoxidil in the treatment of AGA patients can effectively improve their sex hormone levels and symptoms, enhance the clinical effect, and does not increase the incidence of adverse reactions.