Treatment of Androgenetic Alopecia with Minoxidil
For androgenetic alopecia, topical minoxidil 5% solution or foam applied twice daily is the recommended first-line treatment, with oral minoxidil at 2.5-5 mg daily as an alternative off-label option for those who don't respond to topical therapy. 1, 2, 3
Topical Minoxidil Treatment Protocol
Dosage and Application
- Topical 5% solution/foam: Apply 1 mL directly to the scalp in the hair loss area twice daily (morning and night) 2
- Allow 2-4 hours for the solution to dry completely before going to bed 2
- Each bottle should last approximately one month when used as directed 2
- Continue application consistently - missing occasional doses is acceptable, but do not make up for missed doses 2
Efficacy
- 5% topical minoxidil is significantly superior to 2% formulation, providing 45% more hair regrowth at 48 weeks 4
- Results may appear as early as 2 months but may take up to 4 months to show efficacy 1, 2
- Initial hair growth is often soft, downy, and colorless (like peach fuzz) 2
- A temporary increase in hair shedding during the first 2 weeks is normal and expected 2
Important Considerations
- Hair regrowth has not been shown to last longer than 48 weeks in large clinical trials 2
- Continuous use is necessary to maintain results - discontinuation leads to loss of newly regrown hair within 3-4 months 2
- Approximately 1.4% of topical minoxidil is absorbed through the skin 3
- Response varies between individuals based on sulfotransferase activity (enzyme that converts minoxidil to its active form) 3
Oral Minoxidil (Off-Label Alternative)
Dosage
- Initial dose: 2.5 mg daily, which may be increased to 5 mg daily if needed 5
- Low-dose options (0.5-5 mg/day) may be effective for both male and female pattern hair loss 3
- Recent evidence suggests 1 mg daily oral minoxidil may be as effective as topical 5% solution 6
Efficacy
- After 6 months, 5 mg/day oral minoxidil has shown significantly better results than topical 5% and 2% formulations in male AGA 3
- Efficacy ranking places oral minoxidil 5 mg/day after dutasteride 0.5 mg/day and finasteride 5 mg/day, but ahead of finasteride 1 mg/day 7
Side Effects
- Main adverse effect is hypertrichosis (unwanted hair growth)
- Less common: dizziness, lower limb edema 5
- Monitor for cardiovascular symptoms as side effects occur in a dose-dependent manner 7
Combination Therapy
- Combining minoxidil with finasteride produces higher hair density increases (+81 hairs/cm² after 6 months) 1
- 79% of patients achieved significant visible improvement with combination therapy versus 41% with minoxidil alone 1
Treatment Evaluation Timeline
- Take baseline photos before starting treatment
- Evaluate initial response at 3 months
- Critical evaluation at 6 months
- Comprehensive assessment at 12 months to determine continuation 1
- If no results are seen after 4 months of consistent use, consider discontinuing minoxidil 2
Contraindications and Precautions
- Not for use by women (5% solution not shown to be more effective than 2% in women) 2
- Not for use in individuals under 18 years of age 2
- Avoid use on red, inflamed, infected, irritated, or painful scalp 2
- Do not use if hair loss is sudden, patchy, or without family history 2
- Discontinue if chest pain, rapid heartbeat, faintness, dizziness, unexplained weight gain, or swelling occurs 2
Minoxidil remains the cornerstone of androgenetic alopecia treatment with well-established efficacy and safety profiles, particularly in the 5% topical formulation for men.