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

Minoxidil Treatment for Androgenetic Alopecia

For androgenetic alopecia, apply topical minoxidil 5% solution or foam (1 mL) twice daily to the affected scalp areas, and strongly consider combining it with platelet-rich plasma (PRP) injections monthly for at least 3 sessions to achieve superior hair regrowth compared to minoxidil alone. 1, 2

First-Line Treatment Protocol

Topical Minoxidil Application

• Apply 1 mL of 5% minoxidil solution or foam twice daily (morning and evening) directly to the dry scalp in areas of hair thinning or loss 3
• Allow 2-4 hours for complete drying before going to bed when applying the evening dose 3
• Use the dropper applicator to apply small amounts at a time, spreading evenly over the hair loss area to prevent runoff 3
• Continue treatment indefinitely - discontinuation leads to reversal of hair growth benefits within months 2
• Wash hands immediately after application if using fingers 3

Expected Timeline and Response

• Initial results may appear at 2 months, but most patients require at least 4 months of consistent twice-daily use to see meaningful regrowth 3
• Temporary increased shedding during the first 2 weeks is normal and expected - this represents old hairs being replaced by new growth 3
• Peak efficacy in males occurs around 12 months with gradual decline thereafter 4
• Initial regrowth appears as soft, downy, colorless hairs that gradually become thicker and pigmented 3

Combination Therapy (Superior Efficacy)

PRP Plus Minoxidil Protocol

The combination of PRP with topical minoxidil 5% demonstrates significantly superior efficacy compared to minoxidil monotherapy and represents the optimal treatment approach. 1, 2, 5

• Administer PRP injections at 5-7 mL per session at a rate of 0.05-0.1 mL/cm² 2
• Space injections at 1 cm intervals at a depth of 2-4 mm across the affected scalp 2
• Perform 3-5 treatment sessions spaced one month apart as the initial phase 2
• Continue maintenance phase with 1 session every 6 months 2
• Apply topical minoxidil 5% (1 mL) twice daily throughout the entire treatment course 2
• Use pharmaceutical-grade anesthetic cream before PRP injections to minimize pain 2

Topical Finasteride Combination (Alternative)

• The combination of 5% minoxidil (morning application) plus 0.25% topical finasteride spray (evening application) shows significantly higher efficacy than either monotherapy 6
• This combination achieved +81 hairs/cm² increase at 6 months versus minimal changes with monotherapies 6
• 79% of combination therapy patients achieved excellent response (GPAS ≥2) versus only 8-41% with monotherapies 6

Treatment Efficacy by Location

• Minoxidil 5% foam is effective in both frontotemporal and vertex regions with similar responses in hair density and width 7
• Frontotemporal areas show significant improvement in scalp coverage after 24 weeks of twice-daily application 7
• The vertex region typically shows more robust response than frontal areas 3

Monitoring Treatment Response

Assessment Methods

Use multiple evaluation tools to track progress objectively: 2

• Standardized before-and-after photographs at baseline, 3 months, and 6 months
• Trichoscopy to measure hair density (hairs/cm²) and hair shaft diameter
• Hair pull test to assess decreased fragility and improved anchoring
• Patient self-assessment questionnaires for satisfaction scores

Key Response Indicators

• Increased hair density (primary outcome measure) 2
• Increased hair shaft diameter indicating terminal hair conversion 2
• Decreased proportion of telogen (resting phase) hairs 2
• Improved patient satisfaction scores 2

Important Precautions and Contraindications

Who Should NOT Use Minoxidil 5%

• Women should not use 5% formulation - studies show it works no better than 2% solution in women and may cause unwanted facial hair growth 3
• Children under 18 years of age 3
• Pregnant or breastfeeding women (may be harmful) 3
• Patients with red, inflamed, infected, or irritated scalp 3
• Those with sudden or patchy hair loss (suggests alternative diagnosis) 3
• Patients with no family history of gradual hair loss 3

Common Pitfalls to Avoid

• Do not apply more than twice daily - increased frequency does not improve results and may increase side effects 3
• Do not apply to damp scalp or wash hair within 4 hours of application - this reduces efficacy 3
• Avoid contact with eyes; if contact occurs, rinse immediately with cool tap water 3
• Allow complete drying before wearing hats or lying on pillows to prevent staining 3

Hair Care Compatibility

• Use mild shampoo if washing scalp before application 3
• Hair coloring, perms, and relaxers are permitted but ensure all minoxidil is washed off first 3
• Wait 24 hours after chemical treatments before resuming minoxidil 3
• Hair styling products (sprays, gels, mousses) can be used after minoxidil has soaked into scalp 3

Side Effects and When to Stop

Common Side Effects

• Scalp itching and irritation (most common) 3
• Increased hair greasiness 8
• Temporary increased shedding in first 2 weeks 3
• Contact dermatitis (rare, confirmed by patch testing) 8

Stop Treatment and Seek Medical Attention If:

• Chest pain, rapid heartbeat, faintness, or dizziness occurs 3
• Sudden unexplained weight gain 3
• Swelling of hands or feet 3
• Persistent scalp irritation or redness 3
• Unwanted facial hair growth 3
• No hair regrowth after 4 months of consistent use 3

Alternative Formulations

Oral Minoxidil (Off-Label)

• Low-dose oral minoxidil 1 mg/day shows comparable efficacy to topical 5% solution with no significant difference in outcomes 9
• Oral minoxidil 5 mg/day demonstrates superior efficacy to topical formulations after 6 months 4
• Consider oral formulation for patients with poor adherence to topical application or scalp sensitivity 9, 4

Treatment Expectations

• Not everyone responds to minoxidil - response rates vary and cannot be predicted 3
• Better results occur with shorter duration of hair loss and less extensive balding 3
• Minoxidil is unlikely to restore all lost hair but can significantly improve density and coverage 3
• Efficacy decreases with severity and duration of alopecia 2
• Each bottle should last approximately one month when used as directed 3