Oral Minoxidil for Treatment of Hair Loss

Oral minoxidil has been proven as an effective medication for men and women with patterned hair loss. In general, a hair transplant procedure is viewed as the most effective method of restoring hair that has been lost on the scalp of a patient. However, there are some patients that are not ready, or willing, to commit to undergoing a surgical procedure to address their thinning hair. These patients often turn to hair loss medications such as minoxidil, which is also known as Rogaine, to stimulate the growth of hair in areas where it has been lost on the scalp. Oral minoxidil is a new hair loss treatment that addresses the issue of both male and female patterned baldness. One of the reasons that oral minoxidil has grown in popularity is that it is currently viewed as possibly being an effective hair loss medicine option for patients that cannot use finasteride or for patients that suffer adverse effects from the application of topical minoxidil.

Discovery and Use of Oral Minoxidil

Topical minoxidil or Rogaine is a popular hair loss treatment for both male and female patients that are experiencing active hair loss. The use of minoxidil as a hair loss medicine was actually a discovery made when examining the side effects of a blood pressure medicine, oral minoxidil; that is rarely used anymore for the purpose of treating high blood pressure.

It was discovered that patients that took oral minoxidil to treat and regulate their blood pressure had the side effect of growing more hair on their scalp as well as other areas of the body. Even though topical minoxidil is one of the most established treatment options for hair loss, a recent study shows that low doses of oral minoxidil might be a helpful adjunct treatment for female pattern hair loss (1). In addition, oral minoxidil has also been investigated by the medical community as a potential agent for male pattern hair loss.

Oral Minoxidil Study Results

In a relatively recent study published in the Journal of the American Academy of Dermatology, oral minoxidil was evaluated by scientists as a treatment for the issue of male pattern hair loss (2). In the study, a group of 41 patients were given a low dose (2.5mg or 5mg/day) of oral minoxidil for ≥6 months as either a monotherapy or as an add-on therapy for the issue of hair loss. After assessing the results shown on clinical “before and after” photos, a team of dermatologists judged the changes in hair loss on a 4-point scale that measured the members of the study group based on worsening of the hair loss, stabilization of hair loss, mild improvement of hair loss and marked improvement of hair loss.

The results showed:

• 90% of the patients experienced clinical improvement
• Over 1/4th (26.8%) of patients showed marked improvement in their hair loss

In addition, almost 1/3rd (29.3%) of patients experienced minor adverse events such as:

• Hypertrichosis (i.e. development of hair in other areas of the body in addition to the scalp in 24.3% of the study group)
• Lower limb edema (4.8%)
• Shedding (2.4%)

It should be noted, as a caveat to this study, that the study was retrospective by design which is quite different than a clinical trial that is performed to prospectively test a new treatment against a control group. In addition, the study discussed above had a very small sample size of study participants and it also lacked a control group. Nonetheless, the main takeaway from this study is that oral minoxidil might be a useful adjunct or monotherapy for treating the issue of male pattern hair loss. The ability to use oral minoxidil as a male pattern hair loss treatment would be quite relevant for patients who are not able to tolerate finasteride (Propecia) and/or those who get less than ideal results from the use of topical minoxidil (Rogaine).

Side Effects of Oral Minoxidil

Oral minoxidil may have the following side effects:

• Swelling in extremities due to salt and water retention. This temporary edema developed in 7% of patients.
• Skin changes including excess facial or body hair that could be a problem in women. This usually is seen 3 to 6 weeks after starting the treatment. Allergic rashes have also been reported.

Other rare side effects of oral minoxidil include

• Pericarditis
• Pericardial Effusion
• Hematologic changes in a lower number of white blood cells
• Nausea and vomiting
• Breast tenderness (in less than 1% laboratory changes such as ECG changes and these changes usually disappear with continuation of treatment)

Hair Loss Treatment Options at Parsa Mohebi Hair Restoration

A good number of patients who visit my Los Angeles medical clinic or San Francisco hair transplant office have already tried some or all of the well-established medical treatments (topical and oral) for hair loss. Even though they have tried these hair loss treatments, they are still looking for a permanent solution. Hair transplantation is the only permanent solution to hair loss and can serve as a great adjunct to patients who are currently on medical treatments for hair loss but, for whatever reasons, they still have not achieved their desired hair coverage goals.

At Parsa Mohebi Hair Restoration, we strive to create a master plan for every patient based on their specific history of hair loss, their family pattern of hair loss and their medical history. The hair loss treatment master plan for any patient should include a complete medical treatment plan, surgical interventions (when needed), cosmetic changes and any applicable hair loss products. Oral minoxidil is finding its place as a treatment option for certain types of hair loss that other treatments are ineffective in treating for patients of all ages.

References:

1) Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone.

Sinclair RD. Int J Dermatol. 2018 Jan;57(1):104-109. doi: 10.1111/ijd.13838. Epub 2017 Dec 12.

2) Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia.

Jimenez-Cauhe J1, Saceda-Corralo D2, Rodrigues-Barata R2, Hermosa-Gelbard A3, Moreno-Arrones OM2, Fernandez-Nieto D3, Vaño-Galvan S2.J Am Acad Dermatol. 2019 May 2. pii: S0190-9622(19)30685-1. doi: 10.1016/j.jaad.2019.04.054. [Epub ahead of print]