Before and After Using Oral Minoxidil

Oral minoxidil is growing in popularity as an off-label treatment option for both male and female pattern hair loss. In this article we’ll cover what patients can expect in terms of results while using oral minoxidil. We encourage patients to consult with their doctor or other licensed healthcare professional, if there are any concerns about the safety or efficacy of this treatment.

What is oral minoxidil?

Oral minoxidil is the oral format of topical minoxidil, recognizable by its over-the-counter brand name, Rogaine. Interestingly, when minoxidil was first developed, it was available only in oral format and was intended to help treat high blood pressure. It was only when researchers and clinicians noticed that patients were also seeing increased hair growth that drug developers pursued a topical format that could be applied directly to the scalp to help with thinning hair.

How does oral minoxidil work?

As a drug, minoxidil is an example of vasodilator, meaning it helps widen blood vessels to help promote blood flow. Oral and topical minoxidil work via similar mechanisms. It increases blood circulation to the hair follicles which promotes oxygen and nutrient exchange to growing cells. It’s also believed to act directly on the hair growth cycle, making the active growth phase (also known as anagen) last longer. These effects are responsible for the increased hair density and thickness that many patients report after using minoxidil.

Does oral minoxidil work differently than topical minoxidil?

Compared to topical minoxidil, oral minoxidil acts systemically. This means that it has a broader effect on the body compared to the topical format which is more localized to the scalp. Although systemic effects are sometimes associated with an increased risk in possible side effects, in the case of oral minoxidil, there is some evidence that systemic absorption could be beneficial for certain patients.

Something that you may not be aware of is the fact that minoxidil needs to be transformed into its active form, minoxidil sulfate, before it can have an effect on the body. This transformation is a chemical reaction called sulfation and involves the help of a specific enzyme.

When you use topical forms of minoxidil, this reaction takes place in the hair follicles. However, there can be significant variation in how much of this enzyme people produce. This is one reason why some people respond well to topical minoxidil while others don’t. Interestingly, when minoxidil is taken as a pill or tablet, this transformation takes place in the liver, where more enzyme is present and the process is usually more efficient—it's a possible explanation for why some people who don’t see results with topical minoxidil experience regrowth when they try oral minoxidil instead.

Oral minoxidil dosage for hair loss

Oral minoxidil isn’t FDA-approved to treat hair loss, so there are no standard dosages. Research studies have identified possible dosage ranges of 0.25 to 1.25 mg daily for female pattern hair loss and 2.5 to 5 mg daily for male pattern hair loss. These dosage strengths have been referred to as “lower dose” oral minoxidil (Ramirez-Marin and Tosti, 2022). This is in comparison to the regular dosage range for oral minoxidil, which is between 4 to 50 mg.

At XYON, licensed doctors can prescribe oral minoxidil ranging from 0.5 to 5 mg, depending on the needs of their patients and tolerance for potential side effects (e.g., dizziness, lightheadedness). Compounded options that include vitamin D are also available, for those patients seeking a more holistic approach to treating hair loss.

Clinical studies have shown that the effects of minoxidil are dose-dependent. This means that higher doses are generally more effective, but this doesn’t mean that all patients should automatically be prescribed a higher dose. Often, as with many medications, oral minoxidil is titrated, meaning a physician will start you at a lower dose and increase this based on your response.

Who is oral minoxidil for?

Oral minoxidil may be a reasonable option for patients who have already tried the topical format of the medication and weren’t satisfied with the results. It may also be a helpful combination therapy for people who are already taking another topical hair loss treatment, such as topical finasteride or topical dutasteride. Since topical treatments typically shouldn’t be mixed, oral minoxidil could be a practical way to incorporate another agent into your hair regrowth regimen.

There are some people who should avoid or exercise caution when it comes to taking oral minoxidil. This includes people:

• Who have a history of heart disease or abnormal heart rhythms (arrhythmias): because minoxidil can influence blood pressure and heart rate, patients who have a history of these conditions are advised to consult with their doctors about the potential risks and benefits.
• Who are pregnant or breastfeeding: minoxidil hasn’t been formally classified as a teratogen (harmful to a developing fetus), but there have been case studies of developmental abnormalities because of women taking oral minoxidil while pregnant. Because of the potential risk, oral minoxidil is not recommended to women who are trying to become or are pregnant.
• Who have a known allergy to minoxidil or are taking other supplements or medications that could interact with minoxidil: for your safety, make sure that you’re sharing with your doctor information about any supplements or medications you may be taking so that they can assess whether there’s a risk for a potentially dangerous interaction. For those who can’t take minoxidil, there are other options for hair loss treatment. The best course of action is to talk to a healthcare provider about your concerns and treatment goals. They’ll be able to make recommendations.
  
• Who have pets: minoxidil has been shown to be highly toxic to cats and dogs, so oral minoxidil may be a safer option because they it can't be accidentally licked-off, unlike topical formulations.

When should you consult a dermatologist about oral minoxidil?

If you’ve been prescribed oral minoxidil for hair loss, it’s important to stay in contact with your doctor, who can help assess how you’re responding to treatment and provide guidance if you’re concerned about or potentially experiencing side effects while taking this medication.

Like any other medication, oral minoxidil has side effects. Lower doses can reduce the risk, but how bodies respond to drugs is highly individual. Here are some of the more common side effects of oral minoxidil:

• Hypertrichosis: this refers to increased hair growth on parts of the body like the face or arms
• Edema: when your body retains water/fluid, specifically in the limbs or extremities
• Changes in heart rate or blood pressure: remember, oral minoxidil was first developed as a medication to help control blood pressure, so some patients may experience effects on the heart

This isn’t an exhaustive list, so if you want to learn more about minoxidil safety, head over to our dedicated blog article on the side effects of minoxidil.

Before and after photos: oral minoxidil results

Here is one great example of the results that a real patient was able to achieve while taking oral minoxidil:

Initial shedding and timeline

The timeline for oral minoxidil results can be broken down into three stages, each lasting a few months. Bear in mind that some people may notice results sooner or later than the timeframes indicated here. Results can also be affected by factors like stress, nutrition, illness or certain medications. If in doubt, we recommend talking to your doctor about any concerns about progress.

• 0–3 Months: Some people may notice an initial period of shedding. This happens because minoxidil works to reset the hair growth cycle, which involves pushing out old hairs. It’s a sign that the medication is having an effect and isn’t usually a cause for concern unless it lasts more than a few months.
• 3–6 Months: This is usually when patients start to notice visible signs of regrowth. Depending on how extensive the hair loss is, this could mean an increase in hair density and “filling in” of sparser areas. Some patients describe their regrowth as “baby hairs” during this stage.
• 6–12 Months: With consistent use of medication, patients can enjoy continued improvements in hair density and thickness.
  

Maintenance and permanence of oral minoxidil results

Like other hair loss treatments, the results and regrowth associated with taking oral minoxidil require patients to continue taking the medication indefinitely to maintain results. The reasons for this come down to the effects of the medication on hair growth and the hair growth cycle.

Minoxidil stimulates blood flow to the scalp and hair follicles which is important to ensure adequate oxygen and nutrient delivery to growing cells and stimulates the hair follicle itself to prolong the active growth phase of the hair growth cycle. These effects don’t last once you stop taking the medication. Because pattern hair loss is a progressive condition (i.e., it can’t be “cured”), it needs to be managed continuously.

What happens if you stop taking oral minoxidil? Hair loss is likely to resume, but it’s highly unlikely that you’ll lose all of your progress overnight. So, if you miss a dose or two, it’s not the end of the world, but make sure to resume regular dosing as soon as you’re able to. Don’t double up, as taking more medication than recommended in a single dose can increase your chances of experiencing side effects.

Some patients find that it’s easier to stick to a routine with oral minoxidil because they like the convenience of being able to take a pill. We wanted to mention this because results can be influenced by adherence, so when you’re consulting with your doctor about your options, make sure to also take into consideration what treatment would fit best with your lifestyle and routine.

Combining oral minoxidil with other hair loss treatments

Oral minoxidil can be combined with other hair loss treatments to maximize results. There is a considerable body of evidence that supports the use of minoxidil together with finasteride, a DHT (dihydrotestosterone) blocking medication. In fact, we’ve written an entire article about the potential benefits of using minoxidil while taking finasteride. Essentially, these medications target different mechanisms that contribute to hair loss, so combining them may help increase the chances of treatment success. A doctor can help you decide whether combination treatment could be beneficial.

Additionally, because oral minoxidil is taken as a tablet, it can be less stressful to use together with another topical treatment. In fact, to ensure that topical treatments work their best, it’s generally recommended to not mix them or to apply more than one topical formulation at the same time (space them out several hours). For those interested in a 2-in-1 topical formulation, XYON does offer a compounded Topical Finasteride and Minoxidil in SiloxysSystem™ Gel and a compounded topical finasteride and minoxidil solution.

As far as other hair regrowth treatments or strategies are concerned, it’s best to consult with your doctor.  Oral minoxidil is generally compatible with other treatments and therapies, but it’s important to work with a licensed healthcare professional who can take your specific goals for treatment into consideration and work with you to create an ideal treatment plan.

Takeaway

Oral minoxidil can be an effective solution for patients experiencing pattern hair loss and the fact that it’s available in lower doses is helpful for patients who are concerned about potential side effects. Like other hair loss treatments, consistency and time are important for results, and patients who are willing to stick with oral minoxidil for at least a few months can have great results. Oral minoxidil can generally be taken without serious side effects, but there are safety risks to be aware of, such as the growth of unwanted facial or body hair, and the potential for changes in blood pressure and heart rate. As with other hair loss treatments, oral minoxidil does need to be taken continuously in order to see and maintain full benefits.

To find out whether oral minoxidil might be an option for you, start a consultation today to connect with an expert.

 

Ramírez-Marín, H. A., & Tosti, A. (2022). Role of Oral Minoxidil in Patterned Hair Loss. Indian Dermatology Online Journal, 13(6), 729-733. https://doi.org/10.4103/idoj.idoj_668_21