Over 80% of men and just under 50% of women will experience hair loss as they age, according to NYU Langone Health. Women frequently experience hair thinning as well. It is usual to utilise topical treatments that promise to encourage hair growth or stop additional harm, such as lotions, shampoos, oils, and gels.
These medications commonly contain minoxidil, which is also known more generally as topical minoxidil.
Minoxidil is usually regarded as safe and well-tolerated because to its long history of use. Its success varies, though, says Sandeep Sattur, MD, a hair restoration surgeon at Mumbai, India's HairRevive Centre for Hair Restoration and Skin Rejuvenation. This sort of minoxidil may have unpleasant side effects in addition to other downsides.
Minoxidil is currently being prescribed orally to treat hair loss by some dermatologists, which may be the best course of action. Although the U.S. Food and Drug Administration (FDA) has not approved these drugs for hair loss, doctors are permitted to prescribe oral minoxidil for this off-label use. Read on for information if you or a loved one is having hair loss and is unsure whether minoxidil might be able to assist.
1. Although Topical Minoxidil Is Not Perfect, It Can Help Retain and Grow Hair
The FDA approved the first topical version of minoxidil to treat male pattern baldness in the late 1980s. Since then, the FDA has approved the use of minoxidil to treat female pattern hair loss, allowed manufacturers to produce it in higher quantities, and approved the over-the-counter sale of it without a prescription.
In a nutshell, topical minoxidil boosts hair growth or reduces balding when applied to the scalp once or twice a day.
Typically, minoxidil, which is either 2 or 5 percent, makes up the majority of these scalp treatments. They are easily accessible without a prescription, according to MedlinePlus, and work best for recent hair loss in people under the age of 40.
Topical minoxidil has been demonstrated in a number of research trials to help improve hair thickness in locations where hair loss has been seen in both men and women, according to data from the Center for Drug Evaluation and Research (PDF). According to numerous studies, the 5% drug concentration used in the extra-strength version outperforms the original recipe (which uses a 2 percent concentration).
However, as was already said, topical minoxidil has disadvantages. For instance, it may take several months to see results, and if the medication is stopped, any future hair growth will stop. Additionally, topical minoxidil isn't successful for all types of hair loss; for example, pattern baldness sufferers are unlikely to notice results from treatment, especially if they've had the issue for a while. It could also result in unfavourable side effects like uncomfortable scalp stickiness, itching, rashes, and irritation, according to the Mayo Clinic.
2. The Original Indication for Oral Minoxidil Was High Blood Pressure
The Mayo Clinic states that oral minoxidil, which came before topical minoxidil, was initially approved as a prescription drug for severe hypertension, or high blood pressure. The FDA initially approved minoxidil pills in the late 1970s as a treatment for severe hypertension, or high blood pressure, but they frequently had the unforeseen side effect of causing excessive hair growth. Drug manufacturers swiftly realised the possibility for this adverse effect and repackaged minoxidil as a topical treatment for hair loss, according to the American Academy of Dermatology Association (AAD).
Minoxidil is no longer commonly used to manage hypertension, according to Dr. Juan Jimenez Cauhe, a trichologist at Grupo Pedro Jaen Clinic and a dermatologist at Ramon y Cajal University Hospital, both in Madrid. It is only recommended for severe hypertension cases when patients don't respond to other medications or when people have kidney failure, according to the American Heart Association.
"It has been used increasingly frequently off-label for various forms of hair loss at low doses during the past seven years," he continues. Afterward, more on that.
3. Oral Minoxidil Is a "Off-Label" Hair Loss Treatment
The FDA states that "off-label" or "unapproved" might apply to a wide range of products. It might imply that medical professionals are administering a drug in a different way (for example, orally rather than topically), at a different dosage, or to treat a disease or condition for which it hasn't gained FDA approval.
The bulk of the side effects of minoxidil are negligible. Frequent adverse effects of minoxidil include dry skin, slight burning, and mild itching. Additionally, taking minoxidil may cause hair loss, especially in the beginning.
The FDA has currently approved minoxidil as an oral medication to treat high blood pressure as well as a topical hair loss treatment. To cure hair loss when taken orally, however, the medication has not yet received FDA approval; hence, any prescription for this use is regarded as "off-label."
4. There is a lack of research on using minoxidil orally to treat hair loss.
The use of oral minoxidil to treat hair loss hasn't been sufficiently supported by reliable research up to this point. However, a few small studies, according to Dr. Sattur, show that oral minoxidil helps treat hair loss and may even be more effective for some people than topical therapies in specific cases.
A daily pill containing 0.25 mg of minoxidil and 25 mg of spironolactone, for example, was found to be both safe and effective in treating female pattern hair loss in 100 women in one brief observational study. There was no control group employed in the study, thus it is difficult to say whether the medication is to blame for these results.
In July 2020, a later analysis that included 634 participants and 17 studies was published in the Journal of the American Academy of Dermatology. The study found that oral minoxidil was a typically effective and well-tolerated alternative for topical minoxidil, while experts emphasise that larger, controlled studies are needed.
5. The dosage for oral minoxidil is not standardized
The majority of these studies, according to Sattur, looked at doses between 0.25 mg and 5 mg, which are lower than those employed to treat hypertension. (The normal dosage range for treating hypertension in adults and children over the age of 12 is 5 to 40 mg.)
All over-the-counter drugs have the following drawback: There is no agreement on the appropriate dose among the published limited small sample studies, according to Sattur. Minoxidil does not have a suggested dose, so it is uncertain how much of it is safe to take while using it off-label.
6. Minoxidil Pill Side Effects Can Be Serious
When compared to systemic therapies like pills, which affect the entire body, side effects of topical treatments often pose less of a problem.
The more unusual side effects of topical minoxidil, according to the Mayo Clinic, include acne, inflammation, edoema, blurred vision, and chest pain. On the scalp, rashes or itching are frequent adverse effects.
The safety picture is significantly less clear for oral minoxidil for hair loss because it hasn't undergone the kind of extensive clinical testing required for FDA approval.
For instance, Sattur questions whether oral minoxidil in low doses for hair loss may have a negative impact on blood pressure in people who do not have hypertension. Sattur believes that it will need to be customised for each patient depending on the changes in the blood pressure and cardiovascular system.
According to the Mayo Clinic, minoxidil pills have a black box FDA warning (PDF) because they may raise your risk of pericardial effusion, which is the medical term for an excessive buildup of fluid around the heart.
Other negative effects in some individuals taking lower doses of oral minoxidil for hair loss include dizziness, heart palpitations, and fluid retention, says Dr. Jiménez Cauhé. While these adverse effects should disappear once patients stop taking the pills, Jiminez-Cauhe writes, "The probability of these issues is one reason why patients should get them prescribed by a doctor who has a thorough awareness of patients' existing medical circumstances and medical history."
7. Using Minoxidil While Pregnant Is Dangerous
Other negative effects in some individuals taking lower doses of oral minoxidil for hair loss include dizziness, heart palpitations, and fluid retention, says Dr. Jiménez Cauhé. While these adverse effects should disappear once patients stop taking the pills, Jiminez-Cauhe writes, "The probability of these issues is one reason why patients should get them prescribed by a doctor who has a thorough awareness of patients' existing medical circumstances and medical history."
8. Minoxidil Isn't Your Only Hair Loss Treatment Option
According to the AAD, patients have many therapy options for pattern hair loss besides minoxidil. Because certain procedures can leave men with facial hair and others are not recommended for women who are pregnant or breastfeeding, men and women have different treatment options.
The AAD states that in addition to minoxidil, further therapies for pattern baldness are available.
- Most men who use it can use the prescription medication finasteride to slow down their hair loss.
- artificial hair Using a procedure called platelet-rich plasma, hair plugs are transferred from one region of the scalp to another.
- a procedure that includes drawing plasma from patients' blood to inject into the scalp either alone or in conjunction with hair transplants
9. Topical Minoxidil Is Still the Gold Standard in Hair Loss Treatment
Dermatologists advise people who are considering minoxidil tablets for the first time to start with FDA-approved alternatives first. This includes topical minoxidil, which is provided in a variety of generic and brand-name versions, including Rogaine.
Finding a dermatologist with competence in identifying hair difficulties should be the first step for a patient considering about using low dose oral minoxidil, suggests Dmitri Wall, MD, a consultant dermatology and hair transplant surgeon at St. James' Hospital in Dublin.
According to Sattur, "the risk-benefit ratio of oral minoxidil as compared to topical minoxidil — plus the fact that the evidence available for oral minoxidil is not of very good quality" do not warrant routine use of oral minoxidil in the treatment of pattern hair loss. Topical minoxidil is still the mainstay of treatment.
