Minoxidil for Androgenetic Alopecia
Topical minoxidil 2-5% applied twice daily is the first-line treatment for androgenetic alopecia, and combining it with platelet-rich plasma (PRP) provides superior efficacy compared to minoxidil alone. 1, 2
Recommended Formulation and Dosing
For Men
- Apply topical minoxidil 5% solution or foam, 1 mL twice daily (morning and evening) directly to the affected scalp area 3
- The 5% concentration is FDA-approved and recommended over lower concentrations for male pattern hair loss 4
- Allow 2-4 hours for complete drying before going to bed when applying at night 3
- Each 60 mL bottle should last approximately one month with proper twice-daily use 3
For Women
- Topical minoxidil 2-5% applied twice daily is the American Academy of Dermatology's first-line recommendation 2
- Women should not use the 5% formulation marketed specifically for men, as studies show it works no better than 2% in women and may cause unwanted facial hair growth 3
Application Technique
- Part the hair and apply directly to the scalp (not the hair) in the area of thinning or loss 3
- Use the dropper applicator to measure exactly 1 mL per application 3
- Spread the solution evenly over the treatment area 3
- Wash hands immediately with soap and water after application if using fingers 3
- Allow at least 4 hours on the scalp before washing for optimal absorption 3
Treatment Timeline and Expectations
- Treatment must continue indefinitely - discontinuation reverses all hair growth benefits 1, 2
- Initial results may appear as early as 2 months with consistent twice-daily use 3
- Some patients require at least 4 months before seeing results 3
- Peak hair growth in males typically occurs at year one with 2% minoxidil, with potential decline in subsequent years 4
- Temporary increased shedding may occur in the first 2 weeks - this is expected as old hairs are shed to make way for new growth 3
Combination Therapy for Enhanced Efficacy
The combination of PRP with topical minoxidil shows superior efficacy compared to either treatment alone and represents the most effective approach. 1, 5
PRP Protocol When Combined with Minoxidil
- Apply topical minoxidil 5% (1 mL) twice daily 1
- Combine with monthly PRP injections for at least 3 sessions (3-5 sessions at 1-month intervals) 1
- Use 5-7 mL of PRP at a rate of 0.05 to 0.1 mL/cm² 1
- Inject at 90-degree angle, 2-4 mm depth, with injections spaced 1 cm apart 1
- Maintenance phase: 1 session every 6 months after initial treatment 1
- Apply pharmaceutical-grade topical anesthetic cream before injection due to significant pain 1
Monitoring Treatment Response
Evaluate treatment efficacy using multiple objective measures rather than relying solely on patient perception. 1, 2
- Standardized before-and-after photographs at baseline and follow-up visits 1, 2
- Trichoscopy to evaluate hair density and diameter 1, 2
- Hair pull tests to assess hair fragility 1
- Patient self-assessment questionnaires 1, 2
- Key indicators of positive response include increased hair density, increased hair shaft diameter, decreased proportion of telogen hairs, and improved patient satisfaction scores 1
Important Safety Considerations and Contraindications
Absolute Contraindications
- Pregnancy or breastfeeding - may be harmful 3
- Age under 18 years 3
- Scalp that is red, inflamed, infected, irritated, or painful 3
- Frontal baldness or receding hairline (minoxidil 5% is intended for vertex hair loss only) 3
Precautions
- Ask a doctor before use if you have heart disease 3
- Stop use immediately and consult a doctor if: chest pain, rapid heartbeat, faintness, dizziness, sudden unexplained weight gain, hand or foot swelling, scalp irritation/redness, or unwanted facial hair growth occurs 3
- Oral minoxidil (off-label use) can cause dose-dependent hypertrichosis 2
Common Side Effects
- Itching and skin irritation of the treated scalp area are the most common side effects 3
- The solution contains alcohol, which causes burning or irritation if it contacts the eyes - rinse immediately with large amounts of cool tap water if this occurs 3
- Some patients experience changes in hair color and/or texture 3
Practical Application Tips
Hair Care Products and Styling
- Use mild shampoo if washing scalp before application 3
- Hair sprays, mousses, conditioners, and gels may be used, but apply minoxidil first and allow it to soak into the scalp before using styling products 3
- Hair coloring, perms, and relaxers are permitted with precautions 3:
Missed Doses
- Do not make up for missed doses - simply continue with the next scheduled application 3
- Missing one day will not significantly affect hair regrowth results 3
- Do not use more than twice daily - more frequent use or larger doses do not speed up hair growth and may increase side effects 3
Alternative Formulations and Emerging Data
Oral Minoxidil (Off-Label)
- Low-dose oral minoxidil 0.5-5 mg/day may be safe and effective for female pattern hair loss and chronic telogen effluvium 4
- After 6 months, minoxidil 5 mg/day orally was significantly more effective than topical 5% and 2% in male AGA 4
- However, 1 mg daily oral minoxidil showed no significant difference compared to 5% topical solution in a randomized trial 6
Higher Concentration Topical Formulations
- Contrary to expectations, 10% topical minoxidil was not superior to 5% and caused more irritation and psychosocial stress from increased shedding 7
- The 5% concentration remains the optimal balance of efficacy and tolerability 7