What is the use of Minoxidil (minoxidil) for female patients?

From the Guidelines

Minoxidil is a viable treatment option for women experiencing hair loss, and the 5% topical solution may aid in hair regrowth, as suggested by the most recent evidence 1. When considering minoxidil for women, it's essential to note that the treatment must be continuous to maintain its benefits. The application of minoxidil should be twice daily, with 1 mL of solution or half a capful of foam massaged into the scalp and allowed to dry completely. Some key points to consider when using minoxidil for women include:

• Results typically appear after 4 months of regular use, with maximum benefits seen at 8-12 months 1.
• Side effects may include scalp irritation, unwanted facial hair growth, and initial increased shedding during the first few weeks.
• Pregnant or breastfeeding women should avoid minoxidil.
• Minoxidil works by extending the growth phase of hair follicles and increasing blood flow to the scalp, which helps revitalize shrunken follicles. While the evidence from earlier studies, such as the British Association of Dermatologists' guidelines 1, may suggest varying degrees of effectiveness for minoxidil in treating alopecia areata, the most recent and highest quality study 1 supports its use in stimulating hair growth after chemotherapy-induced alopecia. Additionally, other guidelines, such as those from the ESMO clinical practice guidelines 1, also recommend considering minoxidil to stimulate hair growth after chemotherapy-induced alopecia, although the level of evidence is rated as IV, C. However, when prioritizing morbidity, mortality, and quality of life as outcomes, the most recent evidence 1 takes precedence, and the use of 5% topical minoxidil is recommended for women experiencing hair loss.

From the FDA Drug Label

Women should not use minoxidil topical solution 5% because studies have shown it works no better in women than minoxidil topical solution 2%. Some women may also grow facial hair In addition, minoxidil topical solution 5% may be harmful if used during pregnancy or breast-feeding. • you are a woman May be harmful if used when pregnant or breast-feeding.

Minoxidil for women is not recommended. The FDA drug label explicitly states that women should not use minoxidil topical solution 5% because it may not be effective and can cause unwanted facial hair growth, and it may be harmful during pregnancy or breast-feeding 2 2.

From the Research

Minoxidil for Women: Efficacy and Safety

• Topical minoxidil (5% foam, 5% solution, and 2% solution) is FDA-approved for androgenetic alopecia (AGA) in men and women, as stated in the study 3.
• Minoxidil acts through multiple pathways, including vasodilator, anti-inflammatory agent, inducer of the Wnt/β-catenin signaling pathway, and antiandrogen, which may affect the length of the anagen and telogen phases 3.
• Clinical efficacy of topical minoxidil has been demonstrated in both frontotemporal and vertex areas, with the 5% solution and foam showing similar efficacy to the 2% solution 3.

Oral and Sublingual Minoxidil

• Oral minoxidil 5 mg/day has been shown to be significantly more effective than topical 5% and 2% in male AGA, and low-dose 0.5-5 mg/day may also be safe and effective for female pattern hair loss and chronic telogen effluvium 3.
• Sublingual minoxidil may be safe and effective in male and female pattern hair loss, although more research is needed to confirm this 3.
• A pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone found that once daily minoxidil 0.25 mg and spironolactone 25 mg appeared to be safe and effective in the treatment of female pattern hair loss (FPHL) 4.

Combination Therapy with Spironolactone

• Spironolactone has been used off-label in FPHL for over 20 years and has been shown to arrest hair loss progression with a long-term safety profile, as well as achieving partial hair regrowth in a significant percentage of women 5.
• The combination of minoxidil and spironolactone may be an effective treatment option for FPHL, with a study showing significant reduction in hair loss severity and hair shedding scores after 12 months of treatment 4.

Alternative Treatments

• Low-level laser (light) therapy (LLLT) has been shown to stimulate hair growth in both men and women, with possible mechanisms including stimulation of epidermal stem cells in the hair follicle bulge and shifting the follicles into anagen phase 6.
• A botanical hair solution in combination with minoxidil 2% solution has been shown to be safe and effective in women with FPHL, with significant improvement in hair growth and overall treatment benefits observed as early as 6 weeks 7.