What is the recommended treatment regimen for androgenetic alopecia using Minoxidil (minoxidil)?

Minoxidil Treatment Regimen for Androgenetic Alopecia

For androgenetic alopecia, topical minoxidil 5% should be applied twice daily (1 mL per application) directly to the scalp in the hair loss area, allowing it to dry completely before styling or sleeping. 1, 2

Proper Application Technique

• Dosage: Apply 1 mL with the dropper applicator twice daily (morning and night)
• Application method:
  • Part hair in thinning areas
  • Apply directly to scalp (not on hair)
  • Spread evenly over affected areas
  • Allow 2-4 hours to dry completely before bedtime 2
• Duration: Each bottle should last approximately one month when used as directed 2
• Washing: If washing hair before application, use a mild shampoo 2

Treatment Expectations and Timeline

• Initial response: May begin at 2 months with consistent twice-daily use 1, 2
• Full evaluation period: Some men may need at least 4 months before seeing results 2
• Early shedding: Temporary increased hair loss during first 2 weeks is normal and indicates the treatment is working 2
• Maximum results: Peak hair growth typically occurs at 6-12 months 1
• Maintenance: Continuous use is required to maintain results; discontinuation leads to loss of newly regrown hair within 3-4 months 2

Efficacy Considerations

• Topical minoxidil 5% provides 45% more hair regrowth than 2% formulations at 48 weeks 1
• Minoxidil works best for:
  • Hair loss on the vertex (crown) of the scalp
  • Gradual thinning patterns
  • Men with less extensive hair loss 1, 2
• Not effective for frontal baldness or receding hairlines 2

Combination Therapy Options

For enhanced results, consider combination with:

• Finasteride: The combination of minoxidil and topical finasteride produces significantly higher hair density increases (+81 hairs/cm² after 6 months) with 79% of patients achieving visible improvement versus 41% with minoxidil alone 1, 3
• Platelet-rich plasma (PRP): Shows improved efficacy when combined with topical minoxidil, particularly beneficial for poor responders to conventional therapy 1

Important Precautions

• Avoid use if:
  • Under 18 years of age
  • Hair loss is sudden or patchy
  • Scalp is red, inflamed, infected, or irritated
  • Using other medications on the scalp 2
• Side effects to monitor:
  • Scalp irritation or redness
  • Unwanted facial hair growth (especially in women)
  • Rare cardiovascular effects (chest pain, rapid heartbeat, dizziness) 2

Hair Care During Treatment

• Hair styling products can be used, but apply minoxidil first and allow it to dry completely 2
• For hair coloring or perming:
  • Wash off minoxidil completely before chemical treatments
  • Do not apply minoxidil on the same day as chemical treatments
  • Wait 24 hours after chemical treatments before resuming minoxidil 2
• Use sulfate-free shampoos and hydrating formulas to support fragile hair 1

Common Pitfalls to Avoid

1. Inconsistent application: Missing applications reduces efficacy; consistency is crucial for results
2. Insufficient treatment duration: Abandoning treatment before 4-6 months may miss potential benefits
3. Excessive application: Using more than recommended does not improve results and may increase side effects 2
4. Unrealistic expectations: Complete hair restoration is unlikely; maintenance of existing hair and modest regrowth is considered successful 1
5. Improper application technique: Ensure the solution reaches the scalp, not just the hair

Remember that baseline photos should be taken before starting treatment, with evaluation at 3 months for initial response, critical evaluation at 6 months, and comprehensive assessment at 12 months to determine continuation 1.