Hydrogels are being investigated as delivery platforms for stem cells and extracellular vesicles (EVs) in regenerative medicine, but their relative advantages remain unclear. The objective of this critical narrative literature review is to compare stem‐cell‐loaded and EV‐loaded hydrogels in terms of biological activity, cell viability where applicable, retention and controlled release, stability, storage, safety, and clinical development. Published scientific studies were critically examined, considering experimental conditions, reported outcomes, methodological limitations, and levels of evidence. Stem‐cell‐loaded hydrogels can support living cells and their dynamic interactions with surrounding tissues but require maintenance of cell viability and control of cellular behavior. EV‐loaded hydrogels offer a cell‐free approach that avoids the administration of living therapeutic cells, although vesicle characterization, stability, dosing, and effective delivery remain challenges. Preclinical studies suggest improved local retention and sustained EV release, along with regenerative and immunomodulatory effects in specific experimental models. However, differences in hydrogel formulations, experimental conditions, and evaluation methods limit direct comparisons, while clinical effectiveness remains insufficiently established. Stimuli‐responsive hydrogels may provide additional control over EV delivery and regulate the microenvironment surrounding encapsulated stem cells, although their therapeutic superiority over conventional systems has not been demonstrated. Overall, neither strategy can currently be considered universally superior. Further research involving standardized characterization, direct comparative studies, long‐term safety evaluations, and clinical validation is necessary to determine their relative therapeutic potential.