Oral Minoxidil to Treat Hair Loss

I have discussed Minoxidil many times on this blog in the past since it is one of only two drugs officially approved by the US FDA to treat hair loss. Most men use 5% topical Minoxidil foam and apply it to their scalps twice per day. For those who get adverse reactions, dosage is sometimes reduced to once per day.

Unbeknownst to many, Minoxidil was originally approved in 1979 as an oral medication (brand name “Loniten”) to treat hypertension (high blood pressure). It was only approved for treating hair loss in men in 1988 as a topical medication. A women’s version was approved in 1991. To this day, it is not entirely clear as to how Minoxidil works in promoting hair growth, with a number of theories out there, implying the likely involvement of multiple mechanisms.

Oral Minoxidil for Hair Loss

For many years, I have heard that the oral version of Minoxidil results in even more hair growth compared to the topical version, but I always assumed that the side effects would be much worse. Besides blood pressure fluctuations and potential water retention, I was most concerned about the side effect of excess body hair growth from oral Minoxidil turning me into a werewolf. Note: Make sure to read my post on topical Minoxidil and beard growth.

Acceptable in Thailand

Several years ago I read and bookmarked a very lengthy and thoughtful comment by respected Thai hair transplant surgeon Dr. Damkerng Pathomvanich about why he prescribes oral Minoxidil to a select few of his patients. According to him as well as other physicians that had given him feedback, 5 mg per day was an ideal dosage that did not even change patient blood pressure readings significantly. However, some western publications and websites recommend a lower dosage (see links in some of the comments to this post). Image below shows generic 5 mg Minoxidil tablets from Thailand.

Generic 5mg Minoxidil

Side effects are still possible at low doses. Dr. Pathomvanich does not prescribe oral Minoxidil to patients who have blood pressure, heart, liver or kidney problems. Note that according to the official brochure for Loniten, maximum recommended dosage is listed as high as 100 mg per day, which seems crazy. Most patients taking the drug for hypertension do not cross 40 mg per day.

Dr. Rodney Sinclair in Australia Agrees

I had forgotten about the above till today, when commentator “Billa” posted an interesting link to a new audio interview with Australian Dr. Rodney Sinclair. I have covered this well known hair expert a number of times on this blog in the past. In this latest interview, one of the things that Dr. Sinclair states is that oral Minoxidil is much more effective than topical Minoxidil when it comes to hair growth based on some clinical trials that his clinic is currently undertaking.

While the article describing the above interview states that side effects from oral Minoxidil were not significant according to Dr. Sinclair, I did not hear that in the audio interview. I am guessing that this must be true or else they would stop conducting the trials.

Note that oral Minoxidil is not currently FDA approved for treating hair loss, and I do not intend to take the drug.

Mesotherapy with Dutasteride to Treat Hair Loss

The single best currently available medication to treat hair loss is enlarged prostate drug Dutasteride (which is basically Finasteride/ Propecia on steroids). I have covered Dutasteride or its brand name Avodart numerous times on this blog in the past. For many lucky people, this drug represents an already available cure for hair loss.

While Dutasteride is not yet approved for treating hair loss in the US or Europe, it is approved for that purpose in Japan and South Korea. Nevertheless, many US doctors are willing to prescribe it for hair growth purposes. To get an idea of how effective this medication can be, you can read the hundreds of mostly positive comments in this blog’s Dutasteride testimonials page.

Side Effect Fears from Ingesting Oral Dutasteride

I tried Dutasteride pills many years ago shortly after they first came out, but got paranoid about the potential side effects and stopped after several months of experimentation. However, based on the above mentioned numerous positive testimonials on this blog, I restarted the drug last year, albeit taking the recommended 0.5 mg per day dosage every second day rather than daily. As far as my hair loss goes, Dutasteride has been a miracle and instead of shedding 100 plus hairs after my daily shower, I shed 10-20 now. As far as regrowth goes, I have definitely seen some in my crown, but not elsewhere as far as I can tell.

However, despite this very successful outcome, I still have second thoughts about taking this drug because its long term side effects are certainly going to be worse than those from Finasteride for the unlucky who get them. Besides inhibiting a significantly higher portion of dihydrotestosterone (DHT) in comparison to Finasteride, Dutasteride inhibits all three isoforms of 5α-reductase (i.e., types I, II, and III). Finasteride only inhibits types II and III. Hopefully my fears are overblown, and most studies from around the world seem to suggest so. Dutasteride is largely well tolerated per most research findings and very few people get major long-term side effects upon cessation of the drug. However, since the drug was only approved to treat enlarged prostates in 2001, there are very few studies out there that follow people who have taken the drug for 10 plus years.

Topical Dreams

For many years, I have been hoping that a topical gel or cream or liquid version of Dutasteride would come out so that I could take daily and higher doses with fewer chances of side effects, but so far no luck. In general, topical versions of drugs seem to result in fewer side effects than oral versions, although this is not set in stone. In some cases topical products still get into the bloodstream and show up in various tissues and organs in similar concentrations to their oral counterparts. Nevertheless, topical is always preferable to oral if both are equally effective in my opinion. Note: topical Finasteride is now available from various sources, and hopefully P-3074 will be released in the near future.

Local compounding pharmacies can often also make topical Finasteride or Dutasteride for you, but prices are very high. Moreover, I would be more comfortable with a well known corporation making the product so that I know that the topical compound and delivery method are reliable.

Mesotherapy with Dutasteride in the Treatment of Androgenetic Alopecia

Last week, I got a great surprise when I was browsing through PubMed for the keyword “Dutasteride”.

It seems like a new way of applying Dutasteride through mesotherapy scalp injections seems to give great results with no side effects. This potentially groundbreaking study comes from Spain. Moreover, the best part of the story is that:

“Laboratory tests showed no differences between serum hormone levels before and after treatment”.

This means that unlike oral Dutasteride, this treatment method does not alter your hormones beyond localized scalp DHT reduction. The scientists involved treated six patients (five male, one female) and all got good results. They posted one before and after photo:

Mesotherapy and Dutasteride for Hair Loss

The second best part of this story is that the treatment was only done once every three months. The authors mention that in the past, three other groups had tried similar mesotherapy treatments, but all involved far more frequent treatments. It would be very expensive and annoying to get injected every couple of weeks, but every three months as in the latest work is not so bad.

Dr. David Saceda-Corralo

I contacted one of the study’s lead authors Dr. David Saceda-Corralo to see if he had photos of any of the other five patients and to ask whether this treatment is available in the US. Unfortunately, while he has other photos, those patients have not given him permission to share them. He did say that he may share other relevant photos on his Instagram account.

According to Dr. Saceda-Corralo, this treatment is not easy to get in USA (he has worked in Miami). However, it is getting increasingly popular in Spain and the rest of Europe.

A Hair Loss Blog