What is the optimal dose of minoxidil (Rogaine) for male androgenetic alopecia treatment?

From the Guidelines

The recommended dose of minoxidil for men seeking to regrow hair is 5% solution or foam applied twice daily to the scalp. This recommendation is based on the most recent and highest quality study available, which compared the efficacy of platelet-rich plasma (PRP) therapy to minoxidil therapy, and found that topical 5% minoxidil in combination with intradermal PRP has higher efficacy than topical 5% minoxidil alone in androgenetic alopecia (AGA) 1. Each application should use approximately 1 ml of solution or half a capful of foam, massaged into the affected areas of the scalp. For optimal results, minoxidil should be applied to a dry scalp and allowed to remain for at least four hours before washing.

Some key points to consider when using minoxidil for hair regrowth include:

• Consistent use for at least 4-6 months is necessary to see noticeable results, and continued application is required to maintain any regrown hair.
• Minoxidil works by extending the growth phase of hair follicles and increasing follicle size, which promotes thicker hair growth.
• It also improves blood flow to the scalp, delivering more nutrients to the hair follicles.
• Some men may experience initial shedding in the first few weeks, which is actually a sign the medication is working as new hairs push out older ones.
• Side effects may include scalp irritation, unwanted hair growth in adjacent areas, or dryness, but these are generally mild.
• If no improvement is seen after 12 months of consistent use, additional treatments may need to be considered, such as PRP therapy or other hair growth promoting agents 1.

It's worth noting that while PRP therapy has shown promise in treating AGA, the current evidence suggests that minoxidil remains a effective and well-tolerated treatment option for men seeking to regrow hair 1.

From the FDA Drug Label

For best results, apply 1 mL with applicator 2 times a day directly onto the scalp in the hair loss area. Using more or using more often will not improve results. The best dose of minoxidil for men to regrow hair is 1 mL, twice a day, applied directly to the scalp in the hair loss area 2.

• Key points:
  • Using more than the recommended dose will not improve results
  • Using the product more than twice a day may increase the chance of side effects
  • Each bottle should last one month, if used as directed

From the Research

Best Dose of Minoxidil for Men to Regrow Hair

• The most effective dose of minoxidil for men to regrow hair is 5% topical minoxidil, as it was significantly superior to 2% topical minoxidil and placebo in terms of change from baseline in nonvellus hair count, patient rating of scalp coverage and treatment benefit, and investigator rating of scalp coverage 3.
• A study comparing oral minoxidil, finasteride, and dutasteride for treating androgenetic alopecia found that oral minoxidil 5 mg/d may be effective for male AGA, but it is not FDA-approved and may cause hypertrichosis and cardiovascular system symptoms/signs in a dose-dependent manner 4.
• Topical minoxidil (5% foam, 5% solution, and 2% solution) is FDA-approved for androgenetic alopecia (AGA) in men and women, and it acts through multiple pathways to promote hair growth, including as a vasodilator, anti-inflammatory agent, inducer of the Wnt/β-catenin signaling pathway, and antiandrogen 5.
• Oral minoxidil 5 mg/day was significantly more effective than topical 5% and 2% in male AGA after 6 months of administration, but it is not FDA-approved and may cause side effects 5.
• The relative effectiveness of minoxidil and 5-alpha reductase inhibitors for female pattern hair loss has been studied, but the evidence for men is more established, with 5% topical minoxidil being a well-established treatment option 6, 7.

Side Effects and Considerations

• The use of 5% topical minoxidil may cause an increased occurrence of pruritus and local irritation compared to 2% topical minoxidil 3.
• Oral minoxidil may cause hypertrichosis and cardiovascular system symptoms/signs in a dose-dependent manner 4.
• The safety and efficacy of newer 5-α reductase inhibitors and androgen receptor antagonists for male androgenetic alopecia are being researched, but additional evidence is needed to confirm their effectiveness 7.