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

Minoxidil for Androgenetic Alopecia

Topical minoxidil 5% applied twice daily is the recommended first-line treatment for male androgenetic alopecia, with results typically visible after 2-4 months of continuous use, and treatment must be continued indefinitely to maintain benefits. 1, 2, 3

Treatment Protocol for Men

Standard Topical Minoxidil Regimen

• Apply 1 mL of 5% minoxidil solution twice daily (morning and evening) directly to the affected scalp areas using the dropper applicator 3
• Allow 2-4 hours for complete drying before lying down or wearing a hat, particularly for the nighttime application 3
• Each bottle should last approximately one month when used as directed 3

Expected Timeline and Results

• Initial results may appear as early as 2 months, but some men require at least 4 months of twice-daily use before seeing improvement 3, 4
• Early hair growth typically appears as soft, downy, colorless "peach fuzz" hairs that gradually become thicker and pigmented 3
• A temporary increase in hair shedding during the first 2 weeks is normal and indicates the transition from old to new hair growth 3
• Peak efficacy in males occurs around one year of treatment 5

Who Should Use Minoxidil

• Men 18 years or older with gradual hair thinning or loss on the vertex (top of scalp), particularly those with a family history of androgenetic alopecia 3
• Minoxidil is not intended for frontal baldness or receding hairline 3
• Men with more extensive hair loss than vertex thinning may not respond as well 3

Enhanced Treatment Options

Combination with Platelet-Rich Plasma (PRP)

• The combination of topical minoxidil 5% with PRP injections demonstrates superior efficacy compared to minoxidil monotherapy, representing the most effective evidence-based approach for androgenetic alopecia. 1, 6
• Apply minoxidil 5% (1 mL) twice daily while receiving monthly PRP injections for at least 3 sessions 1
• PRP protocol: 5-7 mL per session, injected at 0.05-0.1 mL/cm² intervals, 1 cm apart, at 2-4 mm depth, using 30G × 4mm needles 1
• Maintenance phase consists of one PRP session every 6 months after the initial treatment series 1
• Pharmaceutical-grade topical anesthetic cream should be applied before PRP injection due to significant pain 1

Combination with Topical Finasteride

• The association of 5% minoxidil with 0.25% topical finasteride spray shows significantly higher clinical efficacy than either monotherapy, with 79% of patients achieving marked improvement (GPAS score ≥2) at 6 months versus 41% with minoxidil alone 7
• This combination increases hair density by +81 hairs/cm² at 6 months compared to baseline 7
• Apply minoxidil in the morning and finasteride spray in the evening 7

Low-Level Laser Therapy (LLLT)

• LLLT at 655-nm wavelength used three times per week is an additional evidence-based option 8, 1
• Treatments must be continued indefinitely, similar to minoxidil 8

Treatment for Women

• Women should use topical minoxidil 2-5% twice daily as first-line therapy, not the male-specific 5% formulation discussed above. 2
• The 5% male formulation works no better in women than 2% and may cause unwanted facial hair growth 3
• Women who are pregnant or breastfeeding should not use minoxidil as it may be harmful 3

Monitoring Treatment Response

Assessment Methods

• Use standardized before-and-after photographs for visual comparison 1, 2
• Perform trichoscopy to evaluate hair density, diameter, and the presence of miniaturized vellus hairs 8, 1
• Measure hair shaft diameter with specialized tools; increases indicate positive response 8
• Conduct hair pull tests to assess hair fragility; fewer hairs coming out indicates improved strength 8
• Utilize patient self-assessment questionnaires for satisfaction and subjective improvement 8, 1, 2

Key Response Indicators

• Increased hair density (number of hairs per cm²) 8, 1
• Increased hair shaft diameter 8, 1
• Decreased proportion of telogen (resting phase) hairs 1
• Improved patient satisfaction scores 1

Important Precautions and Adverse Effects

Contraindications

• Do not use if you are a woman (for the 5% male formulation) 3
• Do not use if under 18 years of age 3
• Do not use if scalp is red, inflamed, infected, irritated, or painful 3
• Do not use if hair loss is sudden, patchy, or of unknown cause 3
• Do not use on other body parts or if you have no family history of hair loss 3

Common Side Effects

• Scalp itching and irritation are the most common adverse effects 3, 4
• Increased hair greasiness may occur 4
• Unwanted facial hair growth can occur, particularly in women (rare but reversible) 3
• Contact sensitization to minoxidil is possible but uncommon 4

Serious Warnings

• Stop use immediately and consult a doctor if you experience chest pain, rapid heartbeat, faintness, dizziness, sudden unexplained weight gain, or swelling of hands/feet 3
• The product is flammable; keep away from fire or flame 3
• Avoid eye contact; if accidental contact occurs, rinse with large amounts of cool tap water 3

Practical Application Tips

Hair Care Compatibility

• Use mild shampoo if washing scalp before application 3
• Hair sprays, mousses, gels, and styling products may be used after minoxidil has dried completely 3
• Hair coloring, perming, and relaxers are permitted but require precautions: ensure all minoxidil is washed off before chemical treatments, avoid applying minoxidil on the same day as chemical treatments, and wait 24 hours after chemical treatments before resuming minoxidil 3

Missed Doses

• If you miss one or two doses, simply continue with the next scheduled application without making up for missed doses 3
• Do not use more than twice daily; increased frequency does not accelerate results and may increase side effects 3

Critical Limitation

• Discontinuation of minoxidil reverses all hair growth benefits, requiring indefinite continuation to maintain results. 1, 2
• If no improvement is seen after 4 months of consistent twice-daily use, discontinue treatment and consult a physician 3

Alternative Formulations

Oral Minoxidil (Off-Label)

• Low-dose oral minoxidil (0.5-5 mg/day) may be effective for androgenetic alopecia but is not FDA-approved for this indication 5
• Oral minoxidil can cause dose-dependent hypertrichosis (unwanted body hair growth) 2
• One study showed 1 mg daily oral minoxidil had similar efficacy to topical 5% solution, though topical showed better overall therapeutic effect 9