What is the use of Minoxidil (Rogaine)?

From the Guidelines

Minoxidil is an effective treatment for hair loss and hypertension, but its use should be carefully considered due to potential side effects and interactions, and it is recommended to use it under the guidance of a healthcare professional, starting with a low dose of 5mg daily for hypertension and 2% or 5% topical solution for hair loss, with regular monitoring of blood pressure and scalp condition 1. When used for hair loss, minoxidil is available as a topical solution, typically 2% for women and 5% for men, applied twice daily to the scalp, with results usually appearing after 4-6 months of consistent use. For hypertension, minoxidil comes in oral tablet form, usually starting at 5mg daily and potentially increasing to 40mg if needed, with careful monitoring of blood pressure and potential side effects such as dizziness and hirsutism 1. The medication works by widening blood vessels, which improves blood flow to hair follicles when applied topically, promoting hair growth, and helps lower blood pressure in cases of hypertension. Common side effects include scalp irritation, unwanted hair growth in adjacent areas, and dizziness with oral use, and users should understand that results require consistent long-term application, and hair loss typically returns if treatment is stopped 1. Those with cardiovascular conditions, pregnancy, or scalp irritation should consult a doctor before using minoxidil, as should anyone experiencing chest pain, rapid heartbeat, or severe dizziness while using the medication 1. Recent studies have also explored the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) as alternative treatments for hair loss, with some studies suggesting that PRP and PRF may be effective in promoting hair growth, although more research is needed to fully understand their effects and optimal treatment protocols 1.

From the FDA Drug Label

Minoxidil topical solution 5% is a colorless liquid medication containing 5% minoxidil for use only on the scalp to help regrow hair in men Minoxidil topical solution 5% is for use only by men. Minoxidil topical solution 5% may be appropriate for you if you are a male at least 18 years old and experiencing gradually thinning hair or gradual hair loss on the top of the scalp (vertex only, as shown below). The main use of minoxidil is to help regrow hair in men with gradually thinning hair or gradual hair loss on the top of the scalp.

• Key points:
  • Minoxidil is for use only by men.
  • Minoxidil is for men with hair loss or thinning hair that begins on the vertex of the scalp.
  • Minoxidil may not work for men with more extensive hair loss.
  • Minoxidil may not work for women 2

From the Research

Minoxidil Overview

• Minoxidil is an antihypertensive vasodilator known to stimulate hair growth 3
• It is FDA-approved for androgenetic alopecia (AGA) in men and women, with topical formulations including 5% foam, 5% solution, and 2% solution 4

Mechanism of Action and Pharmacokinetics

• Minoxidil acts through multiple pathways, including as a vasodilator, anti-inflammatory agent, and inducer of the Wnt/β-catenin signaling pathway 4
• Approximately 1.4% of topical minoxidil is absorbed through the skin, and it is metabolized by follicular sulfotransferase to minoxidil sulfate (active form) 4

Clinical Efficacy

• Topical minoxidil has been shown to cause hair regrowth in both frontotemporal and vertex areas, with the 5% solution and foam being similarly effective to the 2% solution 4
• Oral minoxidil 5 mg/day has been found to be significantly more effective than topical 5% and 2% minoxidil in male AGA 4
• Minoxidil has been found to be effective in promoting hair growth in men and women with androgenetic alopecia, with low-level laser light therapy and finasteride also being effective treatments 5

Safety and Adverse Events

• Common side effects of oral minoxidil include hypertrichosis and pedal edema, while topical minoxidil can cause skin irritation and other local reactions 3, 4
• Minoxidil should be used carefully in men with severe hypertension and increased risk for cardiovascular events 3

Current Guidance and Unmet Needs

• Topical minoxidil and oral finasteride are traditionally the standard of care for androgenetic alopecia, but new treatments such as low-level laser therapy, microneedling, and platelet-rich plasma are being studied 6
• Novel therapies such as oral minoxidil, topical finasteride, and stem cell therapy offer alternative treatment options, but more research is needed to fully assess their efficacy and safety 6