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

Minoxidil for Androgenetic Alopecia

Recommended Treatment and Dosing

For androgenetic alopecia, use topical minoxidil 5% solution at 1 mL applied twice daily directly to the scalp in the hair loss area, which must be continued indefinitely as discontinuation leads to reversal of hair growth benefits within 3-4 months. 1, 2

Topical Minoxidil Protocol

Standard dosing:

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

Important application guidelines:

• Using more than the recommended dose or applying more frequently does not improve results and may increase side effects 1
• If you miss doses, simply continue with the next scheduled application—do not double up 1
• Allow minoxidil to soak into the scalp for at least 4 hours before washing hair 1
• Hair styling products can be used after minoxidil has been absorbed into the scalp 1

Oral Minoxidil as Alternative

Low-dose oral minoxidil (≤5 mg daily) is an effective off-label alternative with improved patient compliance compared to topical formulations, showing 61-100% of patients with objective clinical improvement in androgenetic alopecia. 3

• Oral minoxidil 1 mg daily demonstrates comparable efficacy to topical 5% solution, with over 60% patient satisfaction in both groups 4
• Doses range from 0.25 to 5 mg daily in clinical practice 3, 5
• The optimal dose has not been definitively established, though low doses (≤5 mg) show better safety profiles than higher doses 6

Combination Therapy for Enhanced Results

Combining platelet-rich plasma (PRP) with topical minoxidil 5% provides superior outcomes compared to minoxidil alone, with 1.74 times increase in hair density and 14.3 times increase in hair diameter. 7, 2

Recommended combination protocol:

• Apply topical minoxidil 5% (1 mL) twice daily 2
• Add monthly PRP injections for at least 3 sessions spaced one month apart 2
• Use 5-7 mL of PRP at 0.05 to 0.1 mL/cm², injected at 1 cm intervals at 2-4 mm depth 2
• Maintenance phase consists of 1 session every 6 months after initial treatment 2
• 83% of patients achieve negative hair pull test with this combination, indicating reduced hair fragility 2

Alternative combination:

• Topical minoxidil 5% plus topical finasteride 0.25% shows significantly higher efficacy than either monotherapy, with 79% of patients achieving excellent response (GPAS score ≥2) at 6 months versus 8% with finasteride alone and 41% with minoxidil alone 8

Expected Timeline and Outcomes

Hair regrowth typically begins at 2 months with twice-daily use, though some patients require at least 4 months of continuous treatment to see results. 1

• Maximum response with topical minoxidil has been demonstrated up to 48 weeks of continuous treatment 1
• Treatment must be continued indefinitely—stopping results in loss of newly regrown hair within 3-4 months 1, 2
• In clinical trials, total hair counts increased from baseline mean of 61-65 hairs to 180-191 hairs at 12 months with 2-3% topical minoxidil 9

Monitoring Treatment Response

Evaluate treatment efficacy using standardized before-and-after photographs, trichoscopy to assess hair density and diameter, and patient self-assessment questionnaires. 2

Key indicators of positive response include:

• Increased hair density 2
• Increased hair shaft diameter 2
• Decreased proportion of telogen (resting phase) hairs 2
• Improved patient satisfaction scores 2

Safety Considerations and Adverse Effects

Common adverse effects with topical minoxidil include hypertrichosis (unwanted facial/body hair growth), scalp irritation, and contact dermatitis. 1, 9

Topical minoxidil warnings:

• Do not use if hair loss is on the front of the scalp (frontal baldness/receding hairline), as minoxidil is not intended for this pattern 1
• Stop use and consult a physician if chest pain, rapid heartbeat, faintness, dizziness, sudden weight gain, or hand/foot swelling occurs 1
• Avoid contact with eyes; rinse thoroughly with cool water if accidental contact occurs 1
• The product is flammable—keep away from fire or flame 1

Oral minoxidil adverse effects:

• Hypertrichosis is the most common side effect with low-dose oral minoxidil 3, 5
• Postural hypotension can occur 3
• Higher doses (>5 mg) show increased adverse effects including tachycardia (3.5% of patients) and more frequent hypertrichosis (17.5%) 6
• Two cases of impotence were reported with topical use, which resolved within days of discontinuation 9

Special Populations and Contraindications

Topical minoxidil 5% is FDA-approved for use by men only; women should not use the 5% formulation per FDA labeling. 1

• Do not use in pregnancy or breastfeeding—may be harmful 1
• Not approved for use in individuals under 18 years of age 1
• Do not use on inflamed, infected, irritated, or painful scalp 1

Hair Care During Treatment

Hair coloring, perming, and relaxers can be used while on minoxidil, but specific precautions are necessary to avoid scalp irritation. 1

Protocol for chemical hair treatments:

• Wash all minoxidil off hair and scalp before applying color or perm chemicals 1
• Do not apply minoxidil on the same day as chemical treatments 1
• Wait 24 hours after chemical treatment before resuming minoxidil to ensure no scalp irritation has occurred 1
• Use mild shampoo if washing scalp before minoxidil application 1

Critical Clinical Pitfalls

The most common mistake is discontinuing treatment prematurely—patients must understand that stopping minoxidil results in complete reversal of hair growth benefits within 3-4 months. 1, 2

• Inadequate follow-up to assess treatment response leads to suboptimal outcomes 2
• Before starting treatment, check for underlying causes such as thyroid dysfunction or iron deficiency 7
• Treatment efficacy decreases with severity and duration of alopecia—earlier intervention yields better results 2
• Missing one day of application will not significantly affect results, but patients should not attempt to "catch up" with extra doses 1