Low Dose Oral Minoxidil for Hair Loss

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. Please read the bottom part of this post for the original version.

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 or dermatologist 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.

Oral Minoxidil and Hair Growth Updates

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.

Oral Minoxidil Before After Older Male.
Oral Minoxidil before and after in an older 75-year old male. Source: WPBF 25.

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.

Oral Minoxidil 5mg Before After.
Oral Minoxidil 5mg per day. Before and after scalp hair growth after 8 months.
LDOM 5mg Before After.
Low-dose oral Minoxidil 5mg per day hair growth after 8 months. Top view.

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 5, 2022 — Coming full circle in the use of low-dose oral Minoxidil (LDOM) in the treatment of alopecia.

Oral Minoxidil versus Sublingual

Oral Minoxidil Generic 5 mg.
Oral Minoxidil 5 mg.

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:

Sublingual vs Oral Minoxidil

Sublingual Minoxidil Sulfate

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.

Oral Minoxidil Hair Growth
Oral Minoxidil Hair Growth Before and After. Source: JAAD.

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.

Introduction

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.”

Minoxidil Hypertension Hair Growth.
A 1980 paper first mentioned that a patient taking oral Minoxidil to treat his high blood pressure saw extraordinary hair growth. The new growth was in totally bald areas of his scalp.

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.

Side Effects

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.

Oral Minoxidil Hypertrichosis Body Hair Side Effect.
Oral Minoxidil Excessive Body Hair Increase Side Effect.

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.

UK Oral Minoxidil Prescriptions

If you live in the UK, Dr. Steven Edgar will prescribe you oral Minoxidil for hair loss via the below banner link. Make sure to use the promo code “LDOM” in your communication with him. Dr. Edgar is a UK based practicing GP who has been helping patients for over a decade with prescriptions for Finasteride and Dutasteride.

Oral Minoxidil

OliX Pharmaceuticals RNAi Hair Growth Trials in 2023

In 2021, I wrote a post on microRNA (miRNA) and hair growth. In there, I also discussed a new company working on messenger RNA (mRNA) based hair regeneration. And now we have RNA interference (RNAi) as a hair loss treatment, thanks to OliX Pharmaceuticals (South Korea) and its small interfering RNA (siRNA) based product.

Also not to forget, most recently, we have become excited by CosmeRNA, a SAMiRNA based hair loss treatment that targets the androgen receptor. SAMiRNA is a new type of siRNA nanoparticle that does not result in innate immune stimulation. The number of different acronyms containing “RNA” that are being developed for hair loss treatments is mind boggling.

Update: March 10, 2023

Olix Pharmaceuticals Clinical Trials

OliX just got approval from Australia’s Human Research Ethics Committees (HREC) to begin a phase 1 clinical trial of OLX72021. This candidate “inhibits the activity of hormones that cause male hair loss”. The effect lasted for more than three weeks in animal tests.

So far, we have only heard about Olix’s RNAi based candidate for the treatment of male pattern hair called OLX104C. It reduces the expression of the androgen receptor via small interfering RNA (siRNA). Neither of these products is as yet listed on the company’s pipeline page. Perhaps the new product is just the old one renamed. I will update this post when I find out.

Asymmetric siRNA Targeting  of the Androgen Receptors

On November 22, 2022, OliX published preclinical research on its androgenetic alopecia treatment program, OLX104C. The results are very encouraging. Actual study is here and the researchers demonstrated:

“Efficacy of androgen receptor (AR) reduction, hair loss inhibition, and long duration of action in primary cultured human follicle dermal papilla cells (HFDPC) and rodent models of hair loss.”

They call this technology “cp-asiRNA targeting AR” and “AR-targeting asiRNA (cp-asiAR)”. The asiRNA stands for asymmetric small interfering RNA.

Olix siRNA Hair Growth
Olix siRNA Hair Growth. Source: Molecular Pharmaceutics.

In May 2022, OliX raised $45 million and announce that its androgenetic alopecia product (OLX104C) will enter clinical trials later this year. Moreover, in August 2021, OliX obtained a Notice of Allowance from the US Patent and Trademark Office for OLX104C.

In June 2021, OliX signed an agreement with LGC Biosearch Technologies to accelerate production of asymmetric siRNA for the treatment of androgenic alopecia. Olix CEO Dong-ki Lee also presented at SMi’s 12th Annual RNA Therapeutics virtual conference.

OliX Pharma’s RNAi Hair Loss Product OLX104C

OliX Pharmaceuticals (South Korea) just made a major announcement. Their RNAi based hair loss product OLX104C successfully grew back hair in mice following just one single injection. The mice were suffering from androgenetic alopecia due to them being given excess dihydrotestosterone (DHT).

“We are advancing a novel and potentially durable approach to treating hair loss” — CEO Dong Ki Lee

OliX Pharmaceuticals RNAi Hair
OliX Pharmaceuticals and its RNAi product OLX104C. Before and after hair growth in mice.

In this preclinical study, OLX104C was administered topically to a mouse model via an injection. The before and after photos are amazing. Interestingly, they compare the results to the anti-androgen Flutamide.

More importantly, OliX is the real deal. Their news page is very impressive with regular significant developments. This includes raising $37.2 million in December 2020. They also received US FDA Phase 2a approval in November, 2020 to treat hypertrophic scars.

siRNA

On OliX’s pipeline page, they state that small interfering RNA (siRNA) has limitations in terms of stability, delivery and toxicity. This is not a problem with RNAi therapeutics. Edit: Per the patent, they are using asymmetric siRNA to inhibit male pattern hair loss gene expression.

Hundreds of millions of people around the world took mRNA vaccines during the past few years. Even thought they did not go through rigorous clinical trials for five plus years. In effect, this will speed up scientific progress. Many people will no longer worry about long-term side effects for newer such RNA related drug candidates. Perhaps a mistake, but I will not complain too much if it speeds up the realization of a hair loss cure.

Hair loss cure and treatment news updates.