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

Minoxidil Treatment for Androgenetic Alopecia

For androgenetic alopecia, apply topical minoxidil 5% (1 mL) twice daily directly to the scalp in areas of hair loss, and continue treatment indefinitely as discontinuation reverses all benefits within 3-4 months. 1, 2

Sex-Specific Dosing

• Women: Use topical minoxidil 2-5% applied twice daily as first-line treatment per the American Academy of Dermatology 1
• Men: Use topical minoxidil 5% applied twice daily 2
• The 5% formulation provides more hair regrowth than the 2% formulation in men 2
• Women can use 5% foam once daily as an alternative to 2% solution twice daily, with noninferior efficacy and better tolerability (less pruritus and dandruff) 3

Application Protocol

• Apply exactly 1 mL twice daily (morning and evening) directly onto the scalp in the hair loss area 2
• Allow 2-4 hours for complete drying before washing hair or lying down 2
• The nighttime application should occur 2-4 hours before bed 2
• Using more than twice daily does not improve results and may increase side effects 2
• If you miss doses, simply continue with the next scheduled application—do not double up 2

Timeline for Results

• Hair regrowth may begin as early as 2 months with twice-daily use 2
• Some patients require at least 4 months of continuous use before seeing results 2
• Peak hair growth typically occurs around 12 months 1
• If no results are seen after 4 months, discontinue treatment 2
• Initial increased shedding for up to 2 weeks is expected and indicates the medication is working (shedding old hairs to make room for new growth) 2

Combination Therapy for Enhanced Efficacy

The combination of platelet-rich plasma (PRP) with topical minoxidil 5% is significantly more effective than minoxidil alone and should be considered for patients seeking optimal results. 4, 5, 1

PRP Protocol When Combined with Minoxidil:

• Continue topical minoxidil 5% (1 mL) twice daily 4
• Add PRP injections: minimum 3-5 sessions at 1-month intervals 4
• Use 5-7 mL PRP per session at 0.05-0.1 mL/cm², injected at 90-degree angle, 2-4 mm depth, 1 cm apart 4
• Maintenance phase: 1 PRP session every 6 months after initial treatment 4
• Apply pharmaceutical-grade topical anesthetic cream before PRP injection due to significant pain 4
• Use 30G × 4 mm needles to minimize discomfort 4

Alternative Combination:

• Topical finasteride 0.25% spray (evening) combined with 5% minoxidil (morning) showed significantly higher efficacy than either monotherapy, with 79% of patients achieving marked improvement versus 41% with minoxidil alone and 8% with finasteride alone at 6 months 6

Hair Care Compatibility

• Use mild shampoo if washing scalp before application 2
• Hair sprays, gels, mousses, and styling products can be used after minoxidil has dried 2
• Hair coloring, perms, and relaxers are permitted with precautions: wash off all minoxidil before chemical treatment, avoid minoxidil on the same day as chemical treatment, and wait 24 hours after chemical treatment before resuming minoxidil 2

Monitoring Treatment Response

• Assess efficacy using standardized before-and-after photographs 4, 1
• Use trichoscopy to evaluate hair density and diameter 4, 1
• Employ patient self-assessment questionnaires 4, 1
• Key indicators of positive response: increased hair density, increased hair shaft diameter, decreased proportion of telogen hairs, and improved patient satisfaction 4
• Evaluate response after one year of combination therapy with PRP 4

Critical Warnings and Contraindications

• Women should not use 5% minoxidil solution (FDA-approved formulation for men only), though 5% foam is acceptable for women 2, 3
• Do not use if under 18 years of age 2
• Contraindicated in pregnancy and breastfeeding (may be harmful) 2
• Stop immediately if chest pain, rapid heartbeat, faintness, dizziness, sudden weight gain, or hand/foot swelling occurs 2
• Discontinue if unwanted facial hair growth or scalp irritation develops 2
• Not for frontal baldness or receding hairline—minoxidil works primarily on vertex (crown) hair loss 2

Common Pitfalls to Avoid

• Inadequate follow-up leads to suboptimal outcomes—regular monitoring is essential 4
• Treatment efficacy decreases with severity and duration of alopecia, so earlier intervention is better 4
• Patients must understand that treatment is lifelong; discontinuation results in loss of all newly regrown hair within 3-4 months 1, 2
• Applying to damp scalp or washing too soon after application (within 4 hours) reduces efficacy 2
• Hair regrowth has not been shown to last longer than 48 weeks in large clinical trials, emphasizing the need for continuous treatment 2