Oral Minoxidil
Oral minoxidil is an emerging treatment for hair loss that has garnered significant attention in recent years. While minoxidil is commonly known as a topical solution under the FDA-approved hair growth drug Rogaine, its oral form can be prescribed off-label in low doses to treat hair loss. This innovative approach has shown promising results for patients who struggle with traditional topical treatments.
In the above video, Dr. Alan Bauman discusses the benefits of Low Dose Oral Minoxidil for hair growth on Local10 WPLG Miami.
“What’s old is new” regarding oral minoxidil for hair growth. Can off-label low-dose minoxidil give your hair loss treatment regimen a much-needed boost? Find out how Bauman Medical has used oral low-dose minoxidil for hair regrowth in patients for years.
History of Minoxidil
In the 1970s, Minoxidil was first approved as an oral medication to treat hypertension (high blood pressure) in dosages typically ranging from 10mg to 40mg daily. At these dosages, patients often experience hypertrichosis (excessive hair growth on the face and body). This observation led to the development of a topical version under the brand name Rogaine, which became the first FDA-approved hair growth treatment. Topical minoxidil is now considered a first-line therapy for hair loss.
Minoxidil is available today in various formats, including:
- Name-brand Rogaine and generic topicals (2% and 5% solutions and foam versions available over-the-counter)
- Prescription versions such as off-label compounded pharmaceutical topicals (like Formula 82M and 82F Topical Finasteride)
- Generic oral tablets
- Off-label quality-compounded low-dose oral versions
Recent Interest in Low-Dose Minoxidil
Recently, interest has significantly increased regarding low-dose minoxidil due to news articles in the NY Times (“An Old Medicine Grows New Hair…”) and GQ (“What Guys With Thinning Hair Should Know About Off-Label Hair Growth Prescriptions”), as well as coverage on local and national broadcast TV news, such as WPLG Local 10 Miami above.
Many hair restoration physicians, including Dr. Bauman and other providers at Bauman Medical, have been prescribing minoxidil orally off-label in “micro” or low-dose formats for years. This method has proven effective for many patients who struggle with traditional topical treatments.
[Side Note: Unfortunately, most traditional dermatologists are unaware of these types of advances and alternative treatments, are inexperienced in prescribing them, and also very, very rarely have the equipment or the motivation to actually measure results for their hair loss patients.]
What does “off-label” mean?
Doctors may prescribe “off-label” treatments to help improve efficacy and reduce the side effects of previously FDA-approved drugs. For example, the most commonly prescribed off-label treatment at Bauman Medical, called Formula 82M, is a carefully compounded mixture of minoxidil, tretinoin, fluocinolone, and other ingredients in a non-greasy, scalp-friendly topical hair growth solution. Formula 82M has been used in tens of thousands of prescriptions over two decades and can be compounded and prescribed in both the US and Canada. Formula 82M improves the effectiveness of traditional over-the-counter topical minoxidil (rogaine or generic minoxidil) and reduces the side effects by making it less greasy and less irritating.
How Does Minoxidil Work?
Minoxidil is a potent vasodilator that increases blood circulation. At the hair follicle level, minoxidil enhances hair growth by reducing the time hair follicles spend in the Telogen (resting) phase and increasing the time they spend in the Anagen (growing) phase. This results in thicker, stronger, longer, and often more pigmented hair fibers.
What is Oral Minoxidil?
Originally available in a topical version (Rogaine), minoxidil has been prescribed orally off-label in a “micro” or low dose for hair growth. Doctors around the world, including those at Bauman Medical, have been prescribing and studying the effects of low-dose oral minoxidil on hair regrowth in men and women for many years. Recently, interest in low-dose minoxidil has significantly increased.
Effectiveness of Oral Minoxidil
Minoxidil is one of the two FDA-approved drugs for hair growth, and published studies have proven its effectiveness. Off-label low-dose oral minoxidil has been a part of Bauman Medical’s hair loss treatment plans for years and can be used as a stand-alone therapy or in conjunction with other pharmaceutical or non-pharmaceutical treatments, as well as an adjunct to hair transplantation.
Who is a Good Candidate for Oral Minoxidil Treatment?
Oral minoxidil has been used off-label successfully for the treatment of:
- Androgenetic Alopecia (male/female pattern hair loss)
- Chronic telogen effluvium (cyclical synchronized shedding of hair)
- Traction alopecia
- Post-chemotherapy-induced alopecia
It is an excellent treatment option for people who find it challenging to adhere to topical treatments or who have scalp health concerns.
If you feel you have reached a plateau on your hair growth regimen (you’re not improving) or you feel like hair loss is progressing, it’s time to schedule a hair loss consultation with Dr. Bauman or his team to review your hair loss status.
Obtaining Low-Dose Oral Minoxidil
Because low-dose minoxidil is an off-label prescription medication, you will need a prescription from a doctor. Bauman Medical has years of experience treating men and women with low-dose minoxidil and can help you track your progress. Start a hair loss consultation here.
Can oral minoxidil work for me if topical minoxidil does not?
Yes! Many patients find it easier to take oral medications consistently than to apply topical medications.
How long does it take to see results with low-dose oral minoxidil?
Minoxidil can start to work immediately. However, similar to any non-invasive hair growth treatment, it always takes longer than you think to see the results! Because hair grows at a rate of ¼ to ½ inch per month, it typically takes a minimum of three to six months to measure improvements with HairCheck and six to twelve months to judge the full results of the treatment.
Do I Need to Stay on Oral Minoxidil Indefinitely?
Yes, in order to maintain the hair growth results, you must continue the medication.
Can oral minoxidil be used in conjunction with topical minoxidil or other therapies?
Yes, in fact, Dr. Bauman always recommends a multi-therapy approach to treating hair loss, which includes reducing risk factors and improving lifestyle, as well as considering treatments such as laser therapy/photobiomodulation, regenerative therapies (PRP, PDO, exosomes, etc.), other oral medications as well as nutritional supplementation, proper scalp hygiene, and hair care, and transplantation for severe cases.
Should I stop topical minoxidil when starting oral minoxidil?
Patients will likely achieve the best results when adding the oral low-dose minoxidil to their regimen while also continuing to use the topical version.
Will oral minoxidil work even though topical (rogaine) minoxidil did not?
There is evidence that oral minoxidil may provide better hair regrowth in some patients than topical treatment. This depends on several factors, including genetics, the type of topical minoxidil used, the application method, and the frequency/consistency of use.
Who should not take oral minoxidil?
People with heart disease, low blood pressure, congestive heart failure (CHF), kidney or liver disease, pheochromocytomas, porphyria, and women who are pregnant or nursing should check with their physician before taking oral minoxidil.
How should I take oral minoxidil?
The best results with oral minoxidil are produced by taking a low dosage once or twice daily. Dr. Bauman recommends “Start Low, Go Slow” to minimize the possibility of side effects. To find out the correct starting dose for you, Dr. Bauman recommends a comprehensive private one-on-one consultation. This can be done virtually or in the office.
What kind of low-dose minoxidil should I take?
Dr. Bauman suggests using a quality compounded low-dose minoxidil mixture that contains other synergistic ingredients.
Is oral minoxidil dangerous?
Minoxidil is a potent vasodilator and antihypertensive agent that, at standard doses, can have serious adverse side effects. The warnings on the official label include pericardial effusion progressing to tamponade and exacerbation of angina pectoris. Minoxidil has been known to cause adverse myocardial lesions and cardiac effects in animals. Dr. Bauman strongly recommends a detailed consultation and medical examination before starting any off-label hair growth treatment, especially low-dose oral minoxidil.
What are the potential side effects of oral minoxidil?
About 10% of women experience increased hair growth on the face or body, and some may experience water retention. Spironolactone, a diuretic and anti-androgen medication, can be prescribed concurrently with minoxidil in women to reduce the risk of unwanted hair growth. If you do experience unwanted hair growth, it is generally easily managed in our office with laser hair removal or other methods of hair removal. Men should not take spironolactone orally.
More serious but rare side effects of oral minoxidil include dizziness, headaches, ankle swelling, increased heart rate, palpitations, or weight gain from fluid retention. If you experience any of these, discontinue oral minoxidil and notify our office immediately. It typically takes 24 to 48 hours for minoxidil side effects to resolve after stopping the medication. Since side effects are dose-dependent, a smaller dosage of minoxidil can be prescribed to reduce the side effects but maintain the hair growth effects.
Will oral minoxidil lower my blood pressure?
It is possible. However, the doses used for hair growth are significantly smaller than the doses to treat blood pressure. Most patients will not experience decreased blood pressure (resulting in headaches or dizziness, etc.), and in fact, some studies support the concept that minoxidil will not have any effect on patients who have normal blood pressure.
If you feel you have reached a plateau on your hair growth regimen (you’re not improving) or you feel like hair loss is progressing, it’s time to schedule a hair loss consultation and evaluation with Dr. Bauman or his team to review your hair loss status.
Will some initial hair shedding occur when I start oral minoxidil?
It is possible to see increased shedding when adding or increasing oral minoxidil to your regimen. This usually occurs within a month and lasts for a few weeks.
What is the correct dose of oral minoxidil for me?
Your individualized, safest, and most effective oral minoxidil dose should be discussed with Dr. Bauman. Dr. Bauman generally prescribes a very low dose to start and increases slowly while monitoring you for side effects and also for improvement in your HairCheck measurements. Dr. Bauman typically does NOT prescribe generic minoxidil and prefers a custom compounded version that may include synergistic and beneficial ingredients depending on age, gender, weight, health status, hair loss diagnosis, the extent of hair loss, and other treatments.
Take Action Today
The first step in any hair restoration treatment program should be a consultation with an experienced, credentialed, and ABHRS board-certified Hair Restoration Physician. An accurate diagnosis should be obtained. Hair loss status should be measured and tracked using both HairCheck and HairMetrix. First-line therapies should be tried. Low-dose minoxidil may be added depending on your hair loss status, adherence to treatment, and response to the therapies. If you feel you have reached a plateau on your hair growth regimen or you feel like hair loss is progressing, it’s time to schedule a hair loss evaluation with Dr. Bauman or his team to review your hair loss status.