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

Minoxidil for Androgenetic Alopecia

For androgenetic alopecia, apply topical minoxidil 5% solution (1 mL) twice daily directly to the scalp, and for optimal results, combine with platelet-rich plasma (PRP) injections given monthly for 3 sessions. 1

Topical Minoxidil Dosing and Application

Standard Regimen

• Apply exactly 1 mL of 5% minoxidil solution twice daily (morning and evening) directly onto the scalp in areas of hair loss 2
• The nighttime application must occur 2-4 hours before bedtime to allow complete drying 2
• Each 60 mL bottle should last approximately one month when used as directed 2
• Using more than the recommended dose or applying more frequently does not improve results and may increase side effects 2

Application Technique

• Part hair in the area of thinning/loss and apply solution directly to the scalp, not the hair 2
• Use the dropper applicator: squeeze bulb, insert into bottle, release to fill to 1 mL line 2
• Apply small amounts at a time to prevent solution from running off the scalp 2
• Allow 4 hours on the scalp before washing for optimal absorption 2
• Wash hands immediately after application if using fingers 2

Expected Timeline and Results

Response Patterns

• Initial results may appear at 2 months, but most men require at least 4 months of twice-daily use to see visible improvement 2
• Peak hair growth typically occurs within the first year of treatment 2
• Temporary increased hair loss may occur during the first 2 weeks as old hairs shed to make way for new growth—this is expected and indicates the medication is working 2
• If no improvement is seen after 4 months, discontinue use 2

Hair Growth Characteristics

• Initial regrowth appears as soft, downy, colorless hairs (peach fuzz) 2
• With continued use, these hairs may become thicker and pigmented 2
• Hair regrowth has not been shown to last longer than 48 weeks in large clinical trials with continuous treatment 2
• Discontinuing minoxidil results in loss of newly regrown hair within 3-4 months, requiring indefinite use to maintain results 2, 1

Combination Therapy with PRP (Superior Efficacy)

Treatment Protocol

The combination of topical minoxidil 5% with PRP injections is significantly more effective than either treatment alone 3, 1

• Apply topical minoxidil 5% (1 mL) twice daily as described above 1
• Add PRP intradermal scalp injections: 3 sessions spaced 1 month apart during initial treatment phase 1
• PRP dose: 5-7 mL per session, using 0.05-0.1 mL/cm² 1
• Injection technique: 90-degree angle, 2-4 mm depth, injections 1 cm apart 1
• Maintenance phase: 1 PRP session every 6 months after completing initial treatment 1
• Apply pharmaceutical-grade topical anesthetic cream before PRP injections due to significant pain 1

Expected Outcomes with Combination Therapy

• 83% of patients achieve negative hair pull test (reduced hair fragility) 1
• Combination therapy shows the highest increase in hair density compared to monotherapy 3
• Improvement visible at 3 months, with continued enhancement through 6 months 3

Oral Minoxidil (Off-Label Alternative)

Dosing

• Low-dose oral minoxidil ≤5 mg/day has shown efficacy with fewer side effects than higher doses 4
• In one study, oral minoxidil 5 mg once daily for 24 weeks significantly increased total hair counts (mean change +35.1 hairs/cm² at 24 weeks) 5
• Oral minoxidil 5 mg/day was significantly more effective than topical 5% and 2% formulations in male AGA after 6 months 6

Safety Considerations for Oral Formulation

• Use cautiously in men with severe hypertension or increased cardiovascular risk 5
• Common side effects: hypertrichosis (93% of patients), pedal edema (10%) 5
• Monitor with physical examinations and laboratory investigations 5

Important Contraindications and Precautions

Do NOT Use Topical Minoxidil If:

• Under 18 years of age 2
• Hair loss is on the front of the scalp (frontal baldness or receding hairline)—minoxidil is intended for vertex (crown) hair loss only 2
• Scalp is red, inflamed, infected, irritated, or painful 2
• No family history of hair loss 2
• Hair loss is sudden and/or patchy 2
• Women should not use 5% minoxidil—studies show it works no better than 2% formulation in women, and may cause unwanted facial hair growth 2

Cardiovascular Warnings

• Stop use immediately and seek medical attention if: chest pain, rapid heartbeat, faintness, dizziness, sudden unexplained weight gain, or swelling of hands/feet occurs 2
• These symptoms may indicate serious cardiovascular effects requiring immediate evaluation

Compatibility with Hair Care Products

Styling Products and Treatments

• 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 2
• Use mild shampoo if washing scalp before application 2

Chemical Treatments (Coloring, Perms, Relaxers)

• Wash all minoxidil off hair and scalp before using color or perm chemicals 2
• Do not apply minoxidil on the same day as chemical treatments 2
• Wait 24 hours after chemical treatments before resuming minoxidil to ensure no scalp irritation 2
• Missing one day of minoxidil will not affect overall results 2

Common Pitfalls to Avoid

Application Errors

• Do not apply to other body parts—for scalp use only 2
• Avoid contact with eyes; if contact occurs, rinse with large amounts of cool tap water 2
• Do not make up for missed doses by applying extra amounts 2
• Minoxidil is flammable—keep away from fire or flame 2

Monitoring and Discontinuation

• If temporary hair shedding continues beyond 2 weeks, consult a physician 2
• Stop use if scalp irritation, redness, or unwanted facial hair growth occurs 2
• Inadequate follow-up can lead to suboptimal outcomes—regular monitoring is essential 1

Treatment Response Factors

• Efficacy may decrease with severity and duration of alopecia 1
• Response is better in those with recent onset hair loss and less extensive balding 2
• Not all men will respond to minoxidil—individual results vary significantly 2

Monitoring Treatment Efficacy

Assessment Methods

• Standardized before-and-after photographs at baseline, 3 months, and 6 months 1
• Trichoscopy to evaluate hair density and diameter 1
• Hair pull tests to assess hair fragility 1
• Patient self-assessment questionnaires 1
• Key indicators: increased hair density, increased hair shaft diameter, decreased proportion of telogen hairs, improved patient satisfaction 1