Minoxidil Treatment for Androgenetic Alopecia
For androgenetic alopecia, topical minoxidil 5% solution or foam applied twice daily (1 mL per application) directly to the scalp in the affected area is the recommended first-line treatment. 1, 2
Dosage and Application
- Apply 1 mL of 5% minoxidil solution twice daily (morning and night)
- Nighttime application should be 2-4 hours before bedtime to allow for drying
- Ensure the solution contacts the scalp directly, not just the hair
- Allow the solution to remain on the scalp for at least 4 hours before washing
- Each bottle should last approximately one month with proper usage
Efficacy and Expectations
- Results may begin to appear after 2 months of consistent twice-daily use
- Some patients may require at least 4 months before seeing noticeable results 2
- 5% minoxidil is significantly more effective than 2% formulation (45% more hair regrowth at 48 weeks) 3
- Initial increased hair shedding may occur in the first 2 weeks of treatment - this is normal and indicates the medication is working 2
- Continuous use is required to maintain results; discontinuation leads to loss of newly regrown hair within 3-4 months 2
Mechanism of Action
Minoxidil works through multiple pathways:
- Prolongs the anagen (growth) phase of hair follicles
- Increases hair follicle size
- Acts as a vasodilator
- Has anti-inflammatory properties
- Induces Wnt/β-catenin signaling pathway 4
Important Considerations
- Minoxidil 5% is FDA-approved for male pattern baldness
- Works best for hair loss at the vertex (crown) of the scalp
- Less effective for frontal baldness or receding hairline
- Response varies between individuals; not everyone will respond to treatment
- Hair regrowth has not been shown to last longer than 48 weeks in large clinical trials 2
Potential Side Effects
- Local irritation or pruritus (itching) of the scalp
- Unwanted facial hair growth (if the solution contacts facial skin)
- Temporary increased hair shedding initially
- Rare systemic effects may include chest pain, rapid heartbeat, dizziness, or swelling of hands/feet (discontinue use and seek medical attention) 2
Contraindications
- Not for use by women (women should use 2% formulation)
- Not for use by individuals under 18 years of age
- Not for use on inflamed, infected, irritated, or painful scalp
- Not for use with other medications applied to the scalp
- Caution in patients with heart disease 2
Adjunctive Treatments
For patients with inadequate response to topical minoxidil alone, consider:
- Combination with oral finasteride 1mg daily (for men)
- Low-level laser therapy (3 times weekly)
- Platelet-rich plasma therapy (3-5 sessions at 4-6 week intervals) 1
Consistent application and patience are key to achieving optimal results with minoxidil treatment for androgenetic alopecia.