I originally wrote this post in 2017 (see the bottom of this page). However, since an August 2022 NY Times article on low-dose oral minoxidil (LDOM) for hair loss went viral, the media keeps covering this topic regularly. And major new studies on this subject keep getting published at least a few times per year. I cover these in all the regular updates you see below.

When I first wrote this post, 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 got into the game. It is only in 2022 that this option really took off in the US and much of Western Europe.

Update: April 18, 2026

Low-Dose Oral Minoxidil: Hair Growth May Peak After 6 Months

In a retrospective review of 178 patients from the US, it was found that the hair growth results from low-dose oral minoxidil peaked after 6 months.

More specifically:

• Mean hair density increased significantly from baseline at 3-6 months (16.1 hairs/cm²). It then remained at a similar level at 6-12 months (16.2 hairs/cm²). This was followed by a modest increase from 12-36 months (19.0 hairs/cm²).
• Mean hair diameter improved significantly from baseline at 3-6 months (3.0 μm). And at 6-12 months (2.4 μm), but not at 12-36 months.

Note that the median LDOM starting dose was only 1.25 mg/day, though 65.2% of patients underwent dose escalation during treatment.

Update: September 20, 2025

Oral Minoxidil 2.5 mg/day shows Similar Efficacy to 5 mg/day

A September 2025 study from Brazil has found that oral minoxidil 2.5 mg/day showed a similar efficacy to 5 mg/day in the treatment of male androgenetic alopecia. Moreover, the lower dose had a better safety profile compared to the higher dose, as would be expected.

Higher Dose Oral Minoxidil

Interestingly, just a month earlier, scientists from Spain and Brazil published a report on the rare use of higher-dose oral minoxidil (greater than 5 mg/day) to treat androgenetic alopecia. They found that 17.5% of patients got a significant (over 50%) improvement in hair growth on the higher dose; and another 17.5% saw modest (under 10%) improvement.

Update: March 30, 2025

Oral Minoxidil Significantly Raises VEGF Levels

A study from Iraq finds that oral minoxidil substantially raises serum VEGF levels. Moreover, hair count and hair diameter also improved significantly.

Update: December 1, 2024

Low-Dose Oral Minoxidil Speeds up both Nail and Hair Growth

In an interesting small study of 10 adult men, it was found that low-dose oral minoxidil increased the rate of both hair and nail growth drastically. Minoxidil 2.5 mg increased nail growth speed by 50.7%. minoxidil 1 mg and 2.5 mg increased hair growth speed by 16.5% and 35.9%, respectively.

Oral Minoxidil and Hair Growth Older Updates

Update: April 11, 2024 — According to a new study from Brazil, oral minoxidil 5 mg (once per day) for 24 weeks did not demonstrate superiority over topical minoxidil 5% (twice per day) in men with androgenetic alopecia. Oral minoxidil was superior to topical minoxidil on the vertex (crown), but not on the frontal region of the scalp. It should ne noted that only 68 of the 90 participants completed the study, and 33 of those 68 were enrolled in the low-dose oral minoxidil group.

Update: June 2, 2023 — Make sure to also check out my post on oral minoxidil before and after results from Reddit. I selected some of the best hair regrowth results that I have seen during the past year from people taking oral minoxidil.

Update: May 18, 2023 — Joe Tillman interviews Dr. Bevin Bhoyrul of Sinclair Dermatology (Australia) in regards to using oral minoxidil to fight hair loss.

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 (Edit: link no longer working), 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); 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. The 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.

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 in the treatment of alopecia.

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 for hair loss in 1404 patients. Multicenter study. The most frequent adverse side effect was hypertrichosis.

Update: October 2020 — 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.

September 24, 2020 — A study from Thailand found good results for men taking oral Minox 5mg daily.

Update: April 9, 2020 — Dr. Vikram Jayaprakash from Australia now also recommends oral minoxidil for hair loss.

Update: May 2, 2019 — Spanish researchers published positive findings on low-dose 5 mg per day oral minoxidil. One of the hair growth results from this study can be seen in the photo on the right.

October 8, 2017

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 used 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, edema, and potential water and fluid retention. However, all of these are rare on low doses of oral minoxidil. I was most concerned about the more common side effect of hypertrichosis (excessive body hair growth) from minoxidil pills. My post on topical minoxidil and beard growth made me especially wary, since I already have an annoyingly expanding and fast growing beard.

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.”

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.

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.

Dr. Sinclair has also successfully tested oral minoxidil and Spironolactone combination treatment in female pattern hair loss patients.

Oral Minoxidil versus Sublingual Minoxidil versus Extended Release Minoxidil

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 (from Sinclair Dermatology) where the dose was only 0.45 mg/day. 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.”

Also of note, new 2025 Phase 2 clinical trial findings from Veradermics (US) suggest that extended-release oral minoxidil could be even superior to oral minoxidil in growing scalp hair.

Oral Minoxidil for Hair Loss: 2.5 mg versus 5 mg

A few years ago, I read a very lengthy and thoughtful comment by the respected Thailand based hair transplant surgeon Dr. Damkerng Pathomvanich. He outlined why he prescribes oral minoxidil to some of his patients. Dr. Pathomvanich has been doing so for over 20 years and even wrote a book chapter on this very subject. Moreover, a number of other Thailand based doctors have published positive findings in relation to this drug in recent years.

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. In an online version of Dr. Path’s 2010 textbook chapter, it says the following:

“Overall, we observed more significant hair growth with oral dosage than after the use of the topical preparation. Although topical minoxidil has been reported to work mainly on the crown, those taking the tablets also observed significant hair growth in the front”.

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.

Excess Body Hair Growth Side Effect

In August 2019, a major news story broke out in Spain regarding oral minoxidil and excess body hair growth. Apparently, 17 infant children were mistakenly given oral minoxidil instead of heartburn medication.

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. The above photo is from the video of this shocking news story.

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.

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.”

Always consult your physician before taking off-label oral or sublingual minoxidil to treat your hair loss. One of the studies I discuss in this post warns on the dangers of compounded low-dose oral minoxidil 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.

Note that oral minoxidil is not currently approved by the US FDA for treating hair loss. It is prescribed off-label for that purpose.