Oral Minoxidil for Hair Loss

Hair loss conditions can be very distressing for the many patients who experience hair disorders throughout their lifetime. There are many reasons why hair loss or thinning may occur, ranging from female or male pattern hair loss (androgenetic alopecia), hair loss as a result of shock, severe stress, or trauma (telogen effluvium), auto-immune disorders, or other genetic conditions. According to published studies, androgenetic alopecia alone can affect up to 80% of men and 50% of women throughout their lives, which equates to approximately 50 million American men and 30 million American women each year. As every patient’s hair loss is different, understanding the underlying cause of your hair loss and addressing it is key to successful treatment. Dr. Green holds over two and a half decades of experience treating her NYC patients with the most innovative treatment options available, including oral minoxidil.

Oral minoxidil was historically a prescription medication used to treat high blood pressure and hypertension. Through its usage, researchers discovered that a side effect of oral minoxidil was hair growth. In lower doses, oral minoxidil has been found to effectively strengthen hair follicles for increased hair retention and growth, thereby treating hair loss conditions. While topical minoxidil is still an excellent treatment for hair loss, many patients turn to oral minoxidil to avoid the greasy, oily residue from the topical solution. Oral minoxidil can be taken in conjunction with other treatments, such as finasteride or spironolactone, and it is typically less expensive than the topical formulation. As such, oral minoxidil has become a popular option for hair loss treatment that is both safe and effective long-term. If you are struggling with hair loss or thinning, Dr. Green can see if oral minoxidil is the right treatment for you.

Dr. Michele Green is an experienced, board-certified dermatologist who has been expertly treating a wide range of patients in her New York City Upper East Side office for more than 25 years. Dr. Green offers a wide variety of treatments in her office, including treatment for medical conditions such as androgenetic alopecia and cosmetic treatments, including Botox, dermal fillers, and much more. Well known for patient satisfaction and expertise, Dr. Green has been voted one of New York City’s best healthcare providers by Castle Connolly, New York Magazine Super Doctors, and The New York Times. When you consult with Dr. Green in her private NYC dermatology office, she will assess your hair and medical history to tailor a customized treatment plan to leave you with thicker, denser, healthier hair.

What is oral minoxidil?

Oral minoxidil is a medication that was created as an antihypertensive drug to treat high blood pressure. With its usage, researchers found it to have positive effects on hair growth. Oral minoxidil has been found to be a safe and effective treatment option for various types of hair loss, including androgenetic alopecia, telogen effluvium, alopecia areata, and traction alopecia. Minoxidil was first introduced into the dermatology world in its topical form, often referred to as over-the-counter Rogaine. While topical minoxidil is incredibly effective in reducing shedding and promoting hair growth, many patients turn to oral minoxidil tablets due to the ease of taking a pill compared to using a messy topical solution. Oral minoxidil also works well for patients who experience rashes or allergic contact dermatitis as a result of the topical Minoxidil. Additionally, there are very few downsides associated with low-dose oral minoxidil usage. With oral minoxidil, patients can look forward to thicker, stronger hair without the need for adverse side effects or greasiness.

How does oral minoxidil work?

Though oral minoxidil treatment has been available for some time now, the scientific community does not completely understand the exact mechanism used for hair restoration and strengthening. Several new studies in the Journal of the American Academy of Dermatology have suggested ways that oral minoxidil may affect the hair system. A review by Randolph and Tosti in 2022 (doi: 10.1016/j.jaad.2020.06.1009) discussed how minoxidil’s effects on blood pressure can lower blood pressure. As minoxidil is a vasodilator, it opens blood vessels, allowing for an increased flow of nutrients and oxygen to hair follicles. Minoxidil also is believed to shorten the telogen, or shedding, phase and elongate the anagen, or growth phase, of the hair growth cycle. Some research also suggests that minoxidil can suppress T-lymphocytes, or T-cells, to regulate the immune system in autoimmune-related hair loss conditions.

When Minoxidol is taken for hypertension, it is typically prescribed at a dose of 5 to 40mg a day. When investigating the effects of oral minoxidil on hair growth, an Australian dermatologist, Dr. Sinclair, found that doses as low as 0.625 to 1.25mg a day can decrease observable shedding. Research has since expanded, including doses of oral minoxidil anywhere between 0.25 and 5mg a day.

What is low-dose oral minoxidil used to treat?

Several hair disorders can be addressed with the use of low-dose oral minoxidil. Most commonly, researchers have studied oral minoxidil when it comes to its use to combat androgenetic alopecia. However, the drug has also been reportedly used to address other hair disorders, including telogen effluvium, alopecia areata, and traction alopecia.

Androgenetic Alopecia – is a condition that causes baldness in both men and women as a result of high levels of androgen hormones. Androgen hormones can lead to the growth of weak and short strands of hair as well as a shortened anagen, or hair growth phase. As a result, the hair begins to thin and fall out. Male androgenetic alopecia, or male pattern baldness, typically manifests in the thinning of hair first near the temples, creating an “M” shape along the hairline. Hair can also begin to thin at the crown of the head. Female androgenetic alopecia, or female pattern hair loss, often manifests in a thinning of the hair along the part as though the part is expanding. Oral minoxidil’s effectiveness on androgenetic alopecia has been well-studied in journals, with one study suggesting that 61% to 100% of patients using oral minoxidil see some improvement in their hair.

Telogen Effluvium – is a hair condition in which hair shedding occurs as a result of stress or trauma experienced by the patient. When a significant, stressful event occurs, the body responds by pushing hairs from the anagen or growing phase into the telogen or resting phase of hair growth. Typically, hair spends 2-6 years in the growing phase before proceeding to the resting phase, after which the hair falls out. The growing and resting phase for hair is typically staggered; however, when a stressful event causes hair to enter the telogen phase prematurely, approximately two months later, all of that hair will enter the shedding phase. After a “shock,” up to 70% of the hair follicles can enter the shedding phase at once, which can cause the patient significant distress. While it is typical for hair regrowth to occur on its own 2 to 6 months following hair shedding, oral minoxidil can help promote and speed up new hair growth as well as improve hair volume and thickness.

Alopecia Areata – is caused by autoimmune dysfunction, which leads to hair loss. The condition occurs when the white blood cells in the body attack the hair follicles, causing the production of hair to decrease and the follicles to weaken. Often, the hair shedding occurs in small patches and will grow back within a year. The condition differs from telogen effluvium in that alopecia areata is genetic rather than being caused by stress. As the condition often comes on quickly and without warning, it isn’t easy to prevent; however, oral Minoxidil is a treatment option that has been shown to be effective at improving the condition. According to a full-text review done by Sharma et al., 18-82.4% of alopecia areata patients studied showed signs of improvement with the consistent prescribing of oral Minoxidil.

Traction Alopecia – Traction alopecia occurs when there is chronic friction or tension on the hair. Over time, the hair follicles become damaged and stop producing new growth. Tension on the hair can also weaken hair follicles, leading to thinning hair and bald patches. Traction alopecia can be prevented by avoiding pulling the hair into tight hairstyles, using hair clips, or wearing tight head scarves. Once these factors have been eliminated, oral minoxidil can help to reverse hair loss as long as permanent damage has not been done to the hair follicles. One study in women experiencing traction alopecia found a 61% to 86% improvement with the use of oral minoxidil.

Do you need a prescription for oral minoxidil?

Yes, oral minoxidil can only be obtained through a prescription by a board-certified dermatologist like Dr. Green. First, you will need to have an initial consultation to discuss your medical history and the severity of hair loss. Bloodwork may be taken to determine the underlying cause of the hair loss. Afterward, Dr. Green will tailor a treatment plan customized to retain and grow your hair. As oral minoxidil was historically used as a blood pressure medication, Dr. Green requires patients to obtain clearance from their primary care physician, internist, or cardiologist before prescribing the medication. A provider who knows your health history and has listened to your heart must clear the medication to ensure that no adverse side effects occur.

Who should not use oral minoxidil?

While oral minoxidil is a safe treatment option for various types of hair loss, it should not be used by everyone. Oral minoxidil is contraindicated in patients with pheochromocytoma or precious hypersensitivity reaction. Oral minoxidil is also contraindicated during pregnancy due to the risk of neonatal hypertrichosis, a condition characterized by excess hair growth across the body. Oral minoxidil should not be prescribed to patients with an increased risk or history of heart failure, severe hypertension, or myocardial infarction. If you are still determining whether oral minoxidil is right for you, it is essential to contact a board-certified dermatologist like Dr. Green. Dr. Green will review your medical history and seek clearance from your healthcare provider to ensure that oral minoxidil will be safe for you.

How long does it take to see hair growth with oral minoxidil?

It takes several months of taking oral minoxidil as prescribed before the full effects of the treatment become visible. In fact, it can take anywhere between 6 and 12 months for the treatment to become fully effective, as it takes a minimum of four months for new hair to grow. It is important to follow your provider’s prescribing directions when taking the medication, as consistency in taking the medication is key to getting the best results. Throughout the first couple of months of treatment, your dermatologist will monitor your progress on the drug and determine whether or not the dosage requires adjustment.

How long should you take oral minoxidil for male pattern hair loss?

Oral minoxidil is a long-lasting solution for hair loss conditions, such as male pattern hair loss, female pattern hair loss, telogen effluvium, and alopecia areata, as long as you continue to take the medication. At the low dosage, oral minoxidil can be taken long-term in order to maintain hair-strengthening results. As such, patients should expect to be prescribed oral minoxidil for as long as they want to see the effects of the treatment. For patients who are gradually experiencing hair loss, such as patients with androgenetic alopecia, oral minoxidil will not completely prevent hair loss from occurring. Still, it can dramatically slow down the thinning process by strengthening the hair follicles and increasing hair density for thicker, more rapidly growing hair.

Is oral minoxidil safe compared to its side effects?

Researchers have more recently started extensively studying the effects of oral minoxidil when it is used to treat hair loss conditions and are demonstrating that oral minoxidil is a safe and effective treatment long-term. When starting oral minoxidil for hair disorders, it is important to begin at a low dose. A low dose of the medication can help to strengthen and thicken the hair without the increased potential of adverse effects that can be associated with a higher dosage. The first step for addressing hair loss is to consult with a dermatologist who can help determine the treatment plan that will be best for you. There are many treatment options, including topical minoxidil, finasteride, and other oral medications that can be used to treat hair loss. When you have your initial consultation with board-certified dermatologist Dr. Michele Green, she will examine the treatment area and determine the treatment, or combination of treatments, that will best fit your needs.

What are the downsides of oral minoxidil?

Several potential side effects can develop as a result of taking oral minoxidil. One of the most common side effects is hypertrichosis, which is defined as excessive hair growth in the body. Researchers found that hypertrichosis can occur in 10-25% of patients who take oral Minoxidil at low doses and up to 50% of patients who take the medication at a higher dosage. Hypertrichosis typically did not stop patients from taking the medication since most were easily able to engage in easy hair removal treatments, such as shaving or electrolysis. As Minoxidil is typically prescribed to treat high blood pressure, patients taking Minoxidil in any dosage may experience low blood pressure and, as a result, lightheadedness. Another very common side effect of oral Minoxidil is temporary hair shedding, which can occur when patients first begin taking the medication. This side effect will usually subside after four weeks, and in order to get the best results, patients must continue to take the medication as directed.

At higher doses, there is a higher risk of adverse effects such as postural hypotension (a sudden drop in blood pressure occurs when you sit or stand up quickly), pedal edema (fluid retention in the feet causing the feet and ankles to swell), tachycardia (elevated heart rate outside of strenuous activity), and, in more serious cases, angina, (low blood flow to the heart leading to chest pain and potential heart failure). When taking oral minoxidil, it is essential to check in with your dermatologist if you experience any side effects so that dosage or treatment can be adjusted as needed.

Can you use oral and topical minoxidil (Rogaine) together for hair loss treatment?

Topical minoxidil and oral minoxidil should not be used together. Typically, a dermatologist may begin by prescribing topical minoxidil and then may switch the prescription to oral minoxidil if the topical formulation is not proving to be effective or is irritating the scalp. Patients who need more treatment due to the severity of hair loss can turn to other oral medications, such as finasteride, dutasteride, or spironolactone, or in-office treatments like platelet-rich plasma injections. Consulting with a board-certified dermatologist like Dr. Green is essential for creating a hair loss treatment plan specific to your medical history and hair loss concerns.

Is oral minoxidil better than topical?

Both oral minoxidil and topical Minoxidil are safe and effective treatments for a variety of hair loss conditions. One treatment is not necessarily inherently “better” than the other – rather, it is about finding the treatment plan that will work best for you. Studies by Ramos and others in 2020 found that 1mg of minoxidil was just as effective in reducing hair loss as the usage of a 5% solution of minoxidil once a day, making oral minoxidil a great alternative to topical minoxidil.

There are some reasons why patients might prefer oral to topical minoxidil. When minoxidil is applied topically, the enzymes in the hair follicle root will perform sulfotransferase, which changes minoxidil into its active form of minoxidil sulfate. Sometimes, however, these enzymes are not present on the scalp but can be found in the liver. As such, these patients will not respond well to the topical minoxidil solution but may respond to oral treatment. Another reason that patients may prefer oral minoxidil to topical minoxidil is that topical minoxidil can affect the hair, making it greasy and irritating the scalp. This can lead patients to refrain from complying with the prescription of the medication. Oral minoxidil does not affect the scalp in that way, making it an easier and more appealing option for many patients. It is also often easier to swallow a pill than to apply a solution to the scalp.

However, patients with contraindications towards oral minoxidil may prefer topical minoxidil, as the topical solution is administered locally and does not affect the rest of the body. When you have your initial consultation with Dr. Green, you can discuss your condition and the treatment area to determine which treatment or series of treatments will work best for you. Be sure to disclose to Dr. Green if you have any drug allergies or a history of heart issues and angina, which might be a contraindication for oral minoxidil.

Is there a better option than oral minoxidil?

While one option is not inherently better than the other, several other hair loss treatments can be used instead of or in conjunction with oral minoxidil for hair loss. Often, patients find that a combination of topical or oral medications and in-office treatments are necessary for hair rejuvenation. After an initial consultation with Dr. Green, she will assess medical history, severity of hair loss, and type of hair loss to determine the treatment options best suited to retain and regrow your hair.

Platelet-Rich Plasma (PRP) Injections

Platelet-rich plasma (PRP) injections are one of the newer, more innovative hair loss treatments available at Dr. Green’s private NYC dermatology office. PRP treatment begins with taking a sample of the patient’s blood that is spun down to remove the plasma from other blood components. The plasma is rich in epidermal growth factors and proteins necessary for tissue regeneration and healing. The plasma is then injected into the affected areas of the scalp to halt shedding, boost the health of new hair follicles, and promote new hair growth. Typically, an initial series of four treatment sessions spaced one month apart is required to observe the best results. Afterward, patients engage in regular maintenance sessions to enhance the effects of PRP. PRP is often performed in conjunction with oral and topical medications to maximize results.

Finasteride

Patients looking to supplement their treatment plan with another oral medication can turn to finasteride. More commonly known as Propecia, finasteride is a 5-alpha reductase inhibitor that reduces the conversion of testosterone to dihydrotestosterone (DHT). DHT is an androgen hormone that leads to hair follicle miniaturization and hair thinning. By regulating DHT levels, finasteride can work to stop and reverse hair loss. Finasteride is FDA-approved for treating androgenetic alopecia in men; however, it can be used off-label in women who are not currently trying to become pregnant.

Dutasteride

Dutasteride is another oral medication that can be prescribed to treat androgenetic alopecia in men. Similarly to finasteride, it is a 5-alpha reductase inhibitor that decreases DHT levels in the body. Once used as a prostate medication, dutasteride is commonly prescribed off-label to prevent and reverse hair loss.

Spironolactone

Women experiencing hair loss can turn to an oral medication called Spironolactone. Spironolactone is an FDA-approved anti-androgen drug that slows the production of male androgen hormones. It is particularly helpful in treating female patients with polycystic ovary syndrome (PCOS)- related hair loss.

Oral contraceptives

Oral contraceptives can also be beneficial for women experiencing hair loss, especially after menopause. Oral contraceptives can regulate hormones in the body, which contribute to hair thinning and loss. As some oral contraceptives can cause hair loss in some women, they must have a low androgen index to be an effective hair loss treatment. A certified OBGYN can speak with you regarding an effective oral contraceptive for reducing hair thinning and loss.

How common is shedding with oral minoxidil?

Patients will sometimes ask, “Can oral minoxidil cause hair loss?” The answer is sometimes, but only temporarily. One of the common side effects of oral minoxidil is an initial shedding of the hair during the first six weeks of treatment. This hair shedding is only temporary, lasting generally for four weeks, and will resolve itself after that short period. Patients must continue to take the medication during this time in order to gain the full helpful effects of the treatment. It can take up to a year for the full effects of the treatment to become visible, but after that time, the medication can help provide patients with thicker, fuller, stronger hair as long as they continue to take it.

Does oral minoxidil cause weight gain?

When used at higher doses for hypertension, oral minoxidil can cause weight gain due to fluid retention. However, this side effect is not commonly seen when oral minoxidil is prescribed for hair loss, as it is prescribed at such a low dosage.

What to avoid when taking oral minoxidil

It is helpful to cut back on alcohol during oral minoxidil usage, as alcohol can further lower blood pressure. When taking oral minoxidil, it is important to disclose to your dermatologist any medical conditions you have and the oral medications you are taking. As oral minoxidil is a medication used for high blood pressure, it is important to review if any of your current medical conditions or medications can be affected by oral minoxidil. During your initial consultation, Dr. Green will conduct a thorough review of your medical history to ensure it is safe for you to take oral minoxidil.

How fast does hair grow on oral minoxidil?

Even on oral minoxidil, hair grows very slowly, and it can take four to six months to see any regrowth. Oral minoxidil allows for better circulation of nutrients and oxygen to hair follicles, strengthening the follicles and promoting hair growth.

Is minoxidil damaging my hair?

No, minoxidil does not damage hair. Oral minoxidil works systemically to increase blood circulation to hair follicles, lengthen the anagen phase, and strengthen follicles. Even though topical minoxidil is administered locally, it does not cause any damage to hair strands or hair follicles. However, topical minoxidil can cause scalp irritation, redness, and flaking due to other ingredients compounded in the formulation. Topical minoxidil can also feel heavy and greasy on the hair.

Will oral minoxidil thicken hair?

Yes! One of the benefits of using oral minoxidil is its ability to promote hair density. In addition to increased circulation of nutrients and oxygen, oral minoxidil has also been shown to increase the size and thickness of hair follicles.

Why is oral minoxidil not approved?

Oral minoxidil for hair loss is still considered an off-label use of the medication, meaning it has yet to be FDA-approved. While some studies and retrospectives have been done on the effectiveness of the drug in low doses for preventing hair loss, oral minoxidil is still undergoing clinical trials for hair conditions. Though oral minoxidil is not yet FDA-approved to treat hair disorders, it has been shown to be safe and effective as a long-term treatment of female-pattern hair loss, male-pattern baldness, traction alopecia, and alopecia areata. Topical minoxidil, however, was FDA-approved in 1988 to treat hair conditions for men and in 1991 to treat hair conditions for women.

Is oral minoxidil worth the risk?

Absolutely! There is minimal risk associated with oral minoxidil, especially when a board-certified dermatologist like Dr. Green manages treatment. While oral minoxidil is not yet FDA-approved for hair loss treatment, patients have been using oral minoxidil for many years with little to no side effects. One of the most common side effects, excessive hair growth on the body, can be mitigated with increased shaving, waxing, or electrolysis. As oral minoxidil is prescribed at such a low dose for hair loss, patients typically do not experience any severe side effects. An expert like Dr. Green will also thoroughly review your medical history and medications to ensure that you are a good candidate for treatment with oral minoxidil.

Is oral minoxidil effective for hair loss?

Yes! Oral minoxidil is considered one of the most effective treatment options for hair loss. Oral minoxidil works to keep hairs in the anagen or growth phase, shortening the duration of the resting or shedding phase. Oral minoxidil is also a vasodilator, working to increase blood flow and the delivery of nutrients and oxygen to hair follicles. Research into oral minoxidil’s effectiveness on hair loss has been incredibly promising, with studies showing significant improvement in hair density, growth, and retention. Studies have also displayed that low-dose oral minoxidil is just as, if not more effective than topical minoxidil. For maximum effectiveness, oral minoxidil is often paired with PRP injections as well as other oral medications, such as finasteride, dutasteride, or spironolactone.

How do I get started with oral minoxidil today?

For many people, hair is a defining feature, which is why hair loss disorders can be so distressing. Hair conditions can come in many forms, from the genetic androgenetic alopecia condition that affects both men and women, the auto-immune disorder alopecia areata, and the stress or trauma-based telogen effluvium. If you are dealing with any of those conditions, oral minoxidil may be the best solution for you. While once a cardiac drug, oral minoxidil is a safe and effective medication used off-label and at a low dose to prevent, slow, and reverse hair loss. Using oral minoxidil can result in thicker, healthier hair follicles, increased volume, and less hair loss without the need for an invasive hair transplant. If you are experiencing hair loss and are ready to retain and grow thicker, healthier hair, Dr. Green is here to help.

Dr. Michele Green is a world-renowned board-certified dermatologist with over 25 years of experience in treating various hair loss conditions, including female and male pattern baldness. She is consistently rated as one of New York City’s top dermatologists by Castle Connolly, Super Doctors, New York Magazine, and The New York Times due to her expertise and dedication to her patients. Dr. Green is sought after by men and women alike due to her ability to expertly craft a treatment plan specific to each patient’s hair loss type and severity. Please contact us online or call 212-535-3088 to learn more about how oral minoxidil can treat your hair disorder.

Please note: Due to NY state laws, Patient Consultations can only be done in person.