I originally wrote this post on oral Minoxidil for hair loss in 2017. However, since an August 2022 NY Times article on this subject went viral, the media keeps covering this topic regularly. I will republish this post every time there are a few new important updates to discuss on top.
When I first wrote the article, doctors from Thailand had already been using oral Minoxidil to treat hair loss patients for a decade. And an Australian doctor was also using it regularly. Thereafter, Spanish doctors also got into the game. It is only in 2022 that this option really took off in the US and parts of Western Europe.
Always consult your physician before taking oral or sublingual Minoxidil. One of the studies I discuss in this post warns on the dangers of compounded low-dose oral Minoxidil (LDOM) often being of a much higher dosage due to compounding error. The generic versions at your local pharmacy are likely safe. However, taking this drug is no joke and it must be used under medical supervision.
Update: May 18, 2023
Oral Minoxidil and Hair Growth Updates
Update: May 19, 2023 — On today’s Bald Truth show, there were two highly encouraging updates on oral Minoxidil from callers. One (Greg, starting at 16:18) said that it has taken his hair quantity to almost how it was ten years ago. The other guy (starting at 57:13) who is 63 year old said that he was regrowing hair in the area of his scalp with scarring alopecia.
Update: April 20, 2023 — On today’s “The Mane Event” show at around 1:15:00, regular watcher “Andrew 12” said that after 14 years of finasteride and then dutasteride giving him good results, he started oral Minoxidil. He got the best ever hair growth results in his life. He later elaborated in the chat:
“I never regrew a single hair on fin or dut, it only maintained my hair. Oral minoxidil regrew hair.”
Update: April 4, 2023 — Per Dr. Ruth Williams:
“I had a lot of patients grow their hair back on this medication so I’m very familiar with it and I really think it works.”
Update: March 5, 2023 — In this post’s comments section, make sure to read my recent ones on: a long-time German reader who has been taking oral Minoxidil for 20 years (initially 5mg, and then 10mg); and on a reputable HLT forum member named “Kagaho” who is seeing great hair growth from LDOM.
Update: February 20, 2023 — Yet another great testimonial from a 75 year old patient. Below before and after photo is just after a few months use. His doctor Supriya Tomar is very pleased with oral Minoxidil and says that the pill is effective, safe and very cheap. She says that LDOM will not regenerate new hair follicles, but will maintain what you have. I think that besides maintenance, it also thickens what you have if you are one of the lucky ones. And since the topical version can grow new beard hair, I would not be surprised that some people even see new scalp hair.
Update: February 13, 2023 — In a response to a reader question on switching from topical to oral, Dr. William Rassman stated that:
“About 40% of men respond to topical minoxidil, but better than 90% respond to the oral.”
Make sure to read my post on sulfotransferase and Minoxidil to find out why so many people do not respond to the topical.
Update: February 12, 2023 — In a new Healio article, Dr. Ronda Farah states that oral Minoxidil is “awesome” and “we have tons of patients on it.”
Update: January 11, 2023 — Dr. Joyce Davis from New York just concluded that the use of low-dose oral Minoxidil for hair loss was the biggest news in dermatology in 2023. She has used it in both men and women with excellent results. Moreover, “you see results all over the scalp.”
Update: January 10, 2023 — The respected Dr. Bisanga of the BHR clinic in Belgium sent me some amazing 8-month before and after photos of a patient of his who is taking 5mg oral Minoxidil per day.
Update: November 21, 2022 — The below is an interesting quote from Dr. Rodney Sinclair in a new article on oral Minoxidil for hair growth. So “Quentin” who in 2021 pushed me into discussing amino acids (especially cysteine) for hair growth was perhaps justified.
“Minoxidil prolongs anagen duration (increasing hair length), increases fiber diameter, reduces breakage and reverses hair miniaturization. It does this by increasing the uptake of the amino acid cysteine into the hair bulb outer root sheath. Transport of cysteine into hair cortex keratinocytes in the emerging anagen fiber is the final step in hair keratinization and the rate-limiting step in hair growth.”
Update: November 9, 2022 — A highly encouraging anecdotal report from a long-time 74-year old reader (and hospital pharmacy consultant) who I fully trust. He has never seen a drug as effective as low-dose oral Minoxidil for hair growth, and he has tried them all. His past hair transplant surgeon who I know well also verified his legitimacy.
Update: October 13, 2022 — In a recent article from the prestigious Cleveland Clinic, Dr. Wilma Bergfeld is full of praise for oral Minoxidil. Key quote:
“It has really been the best drug we ever had for hair growth.”
Update: October 7, 2022 — How Australia is winning the hair loss battle. Dr. Rodney Sinclair is quoted as follows regarding low-dose oral Minoxidil:
“We’ve now treated 20,000 people with it. It’s been a game changer hair loss treatment. Minoxidil [as a pill] has pretty much 100 per cent success at stopping progression. Regrowth will be about 20 per cent of what they’ve lost.”
Really amazing if true. Dr. Sinclair’s patients are prescribed doses ranging from 1-5 milligrams of Minoxidil. This compares to 10-40 milligrams when used as a blood pressure treatment.
Update: August 25, 2022 — Yet another great video, with several impressive before and after photos. Courtesy of the well known hair transplant surgeon Dr. Nicole Rogers.
Update: August 18, 2022 — The New York Times just published an article on oral Minoxidil for hair loss. It describes the drug as an old medicine that grows new hair for pennies a day. It is becoming increasingly popular for off-label use in treating hair loss. Dr. Brett King makes an interesting point about their likely never being expensive clinical trials for such a low-cost product.
Compounding Dosage Errors
A new study finds that serious adverse side effects with low-dose oral Minoxidil for hair loss were due to compounding errors. After pharmacological lab analysis of formulated capsules, it was found that all the patients with serious side effects were receiving much higher doses than prescribed. This was due to compounding mistakes.
While the prescribed dose of oral minoxidil ranged between 0.5 and 1 mg, these patients were getting between 50 and 1000 mg per capsule. Please be careful if you ever go this route for your hair loss treatment.
Note that per the above article, doses of between 1.25 and 5 mg can be obtained by halving or quartering the marketed drug (Loniten®, Pfizer). The above issue is only with compounded LDOM of 1mg or lower. According to Dr. Robert Haber (US):
“I never recommend compounded minoxidil. Rather, I prescribe the 2.5mg tablet and have the patient cut them in half or quarters, depending on the dose.”
Update: March 4, 2022 — A new study (with Dr. Jerry Cooley as a co-author) concludes that oral minoxidil can be an effective treatment for androgenetic alopecia and telogen effluvium.
Update: January 10, 2022 — An interesting single-patient case report from India. He was put on combination therapy of 2.5 mg oral Minoxidil (tablet) once per day and Dutasteride 0.5 mg (tablet) every alternate day. The before and after 4 months results are excellent.
Update: January 5, 2022 — Coming full circle in the use of low-dose oral Minoxidil (LDOM) in the treatment of alopecia.
Oral Minoxidil versus Sublingual
Recently, “Nik” on our Discord group mentioned how sublingual Minoxidil (3 mg/day) was superior to oral Minoxidil in growing hair amongst his friends. Make sure to read my past post on Minoxidil as a sublingual tablet.
He then linked to this 2020 report on 64 patients where the dose was only 0.45 mg/day. The author is Dr. Rodney Sinclair of Australia, who I cover in detail at the bottom of this post. I posted about this on Twitter, and Dr. Corralo and Dr. Bhoyrul responded with very interesting comments:
Upon further research, I also found this newer August 2021 report from Dr. Sinclair. It entails a Phase 1B clinical trial, which is very encouraging news. Detailed summary from October 2021 can be read here. The interest in oral Minoxidil for hair growth has really taken of during the past few years. Online anecdotes indicate superiority over topical Minoxidil, but I am not yet 100 percent certain.
“Almost 67% of patients who received the 4.05 mg dose experienced improvements in frontal and vertex hair density. In the 0.45 mg dose group, phototrichograms showed a mean increase in terminal hair count/cm2 of 4 for the frontal and 9 for the vertex scalp. Treatment with the 1.35 mg dose resulted in a mean increased terminal hair count/cm2 of 10 and 26. The 4.05 mg dose led to a mean increase terminal hair count/cm2 of 38 for the frontal and 88 for the vertex scalp.“
According to Dr. Mirmirani’s succinct summary at the bottom of that page:
“Although the data in this study are positive, it will take more to convince me that it is significantly better than oral Minoxidil (OM). Very few of my patients on low-dose OM for hair loss discontinue the medication due to side-effects. The other consideration is cost. OM it is an inexpensive, generic drug, that is covered by medical benefits.”
Other Newer Studies
Update: October 2021 — New study finds that low-dose oral minoxidil increases hair density and thickness.
Update: August 2021 — A review of low dose oral Minoxidil treatment for hair loss.
Update: February 2021 — Safety of low-dose oral minoxidil (LDOM) for hair loss in 1404 patients. Multicenter study. The most frequent adverse side effect was hypertrichosis.
Since I first wrote this post on oral Minoxidil several years ago, a number of major new developments have occurred.
An October 2020 study of low-dose 1.25 mg nightly treatment with oral Minoxidil (Loniten) for three months concluded favorable increases in hair growth. More here. This is surprising, considering the low dose utilized relative to other studies. The hair loss patients included males and females of various ethnicities. Further treatment with 2.5 mg dosing was also analyzed.
In September 2020, a Thai study found good results for men taking oral Minox 5mg daily. In July 2020, a review of 16 studies encompassing 622 patients concluded that oral Minoxidil is an effective and well-tolerated hair loss treatment. However, more statistical data is still needed. Also see this June 2020 article that concludes low-dose 1.25 mg/day
In August 2019, Spanish researchers published positive findings on low-dose 5 mg per day oral Minoxidil. One of the results from this study can be seen in the above before and after hair growth photo. It was sent to me by Dr. Sergio Vañó.
Oral Minoxidil for Hair Loss
For many years, I have heard that oral Minoxidil results in even more hair growth compared to the topical version. This is true for both male and female pattern hair loss (often in combination with Spironolactone for women). However, I always assumed that the side effects from the oral medication would be much worse.
The health related side effects include blood pressure fluctuations, heart rate changes, and potential water retention. However, I was most concerned about the side effect of excess body hair growth from Minoxidil pills turning me into a werewolf. Make sure to read my post on topical Minoxidil and beard growth.
I have discussed Minoxidil (brand name Rogaine) many times on this blog in the past. It is one of only two drugs officially approved by the US FDA to treat male pattern hair loss. The other being Finasteride, which targets dihydrotestosterone (DHT) reduction.
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. Women tend to use the 2% topical formulation to regrow thinning hair. Until recently, very few people used oral Minoxidil to treat male androgenetic alopecia or female pattern hair loss. Some people use extra strength 15% topical Minoxidil to get more hair growth.
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. The below screenshot is from this 1980 report titled “Reversal of baldness in patient receiving minoxidil for hypertension.”
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. These include agonistic affects on adenosine-triphosphate (ATP)-sensitive potassium channels; prostaglandin stimulation in the dermal papillae; and anti-androgenic properties.
Low-Dose Oral Minoxidil Advantages over Topical Minoxidil
Among the advantages that oral Minoxidil has over topical Minoxidil include:
- Once a day pill is easier to remember than twice a day topical application.
- Less time consuming to just take a pill or tablet.
- No mess to deal with on the scalp.
- No side effects on the scalp such as itchiness, redness, irritation, greasiness, dry hair and so on.
- No need to wash hair to get rid of the product.
- No chance of the product getting into the eyes or dripping down forehead.
- Generic oral Minoxidil pills work out to be cheaper than topical Minoxidil foam.
Oral Minoxidil for Hair Loss: 2.5 mg versus 5 mg
Several years ago, I read a very lengthy and thoughtful comment by Thailand based hair transplant surgeon Dr. Damkerng Pathomvanich. He outlined why he prescribes oral Minoxidil to some of his patients. Low-dose oral Minoxidil (LDOM) for hair loss in select patients can be very effective. Moreover, in October 2020, another Thailand based doctor named Ratchathorn Panchaprateep also released positive findings in relation to this drug.
According to Dr. Path (as well as per other physicians that had given him feedback), 5 mg per day was an ideal dosage that did not change patient blood pressure readings significantly. Note that most US physicians seem to recommend 2.5 mg per day. In fact doses as low as 0.25 mg to 1.25 mg per day have shown hair growth results growth in some patients. Women tend to be put on lower doses than men due to the hirsutism side effect.
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.
Another major recent news story regarding oral Minoxidil also comes from Spain in August 2019. Apparently, 17 infant children were mistakenly given oral Minoxidil instead of heartburn medication.
Update: December 2020 — Over a year after the medical error, families of some children are complaining that the body hair keeps growing. Also from Spain, a September 2020 study on low-dose oral Minoxidil and hypertrichosis.
The children subsequently developed a condition called “werewolf syndrome” in which large parts of their bodies become covered in hair. This condition is also referred to as hypertrichosis.
Luckily, the body hair will disappear a few months after the children stop taking oral Minoxidil. Above photo is from the video of this shocking news story.
Dr. Rodney Sinclair Recommends Oral Minoxidil
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. He reaches this conclusion based on some clinical trials that his clinic is currently undertaking. Make sure to also check out my post on Dr. Sinclair’s Hairy Pill.
While the article describing the above interview states that side effects from oral Rogaine were not significant, 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.
Dr. Sinclair has also successfully tested oral Minoxidil and Spironolactone combination treatment in female pattern hair loss patients.
Update: Dr. Vikram Jayaprakash from Australia now also recommends oral Minoxidil for hair loss.
Note that oral Minoxidil is not currently FDA approved for treating hair loss.