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Are you looking for a treatment for your hair loss? Torn between oral minoxidil vs topical?
Well you've come to the right place! But before we dive in....Always discuss any changes you're interested in making to your hair loss treatment regimen with your physician first.
When prescribed as an antihypertensive the doses range between 5-40mg daily. Recently there has been lots of buzz around off-label low dose oral minoxidil (<5mg) for treating many forms of alopecia.
The goal of the lower dose (<5mg) being to promote hair growth while minimizing potential adverse reactions.
I even saw the New York Times picked up the story. You can find the article linked HERE.
I have yet to try oral minoxidil but do use topical minoxidil nightly, and stick with the 5% foam and have had zero loyalty to brands.
Just some background in case you aren't familiar with minoxidil...
Topical minoxidil is the only US FDA approved drug for the treatment of female pattern hair loss (FPHL).
Oral minoxidil vs Topical: First off how is minoxidil even thought to work?
You know we love to get into mechanism of action on this blog...But it turns out we still don't completely understand how it works to improve alopecia. Some of the proposed mechanisms include:
Vasodilatory effects which may result in increased oxygen and growth factor delivery to the hair follicle (1)
Minoxidil may also lead to hair follicle postassium activation impacting how long hair follicles remain in the anagen phase (1)
Minoxidil may also suppress certain T cells of the immune system which may explain its effect in autoimmune alopecias (1)
When applied on the scalp it is converted to minoxidil sulfate which is its active form by sulfotransferase enzymes located in the outer root sheath. Based on your genetics your level of activity of these enzymes may vary which might explain why some individuals respond better to topical minoxidil than others (2). For example: 5% minoxidil topical foam is only effective at re-growing hair in a minority of women (approximately 40%) (3).
Oral Minoxidil vs Topical: What does the data tell us about the efficacy and safety of low dose oral minoxidil?
One review comprising 10 articles totaling 19,218 patients (215 women and 19,003 men) found the best efficacy in patients with androgenic alopecia and alopecia areata respectively, with 61–100% and 18–82.4% of patients demonstrating objective clinical improvement (1).
Treatment regimen doses varied with ranges of low dose oral minoxidil from 0.25-5mg daily to twice daily. The most common adverse effects with oral minoxidil included hypertrichosis and postural hypotension.
If you aren't familiar with these terms:
Hypertrichosis---excessive hair growth on the body
Postural hypotension--is when your blood pressure drops when you go from lying down to sitting up, or from sitting to standing. This may result in the increased likelihood of a fall, if you have less blood going to muscles/organs
In another review a total of 16 studies were compiled with 622 patients utilizing low dose oral minoxidil as the primary treatment for hair loss. Androgenic alopecia was the most studied with results finding it to be an effective and well-tolerated treatment alternative for healthy patients struggling with topical formulations due to things like scaling and contact dermatitis (I discuss this more below when I detail my own experience) (4).
In this review (above) there were no severe side effects reported. But the authors still caution when using low dose oral minoxidil to monitor patients blood pressure, heart rate, and assess fluid retention.
Things you may want to consider when deciding between oral minoxidil vs topical
Above was just a brief summary of the reviews around the use of low dose oral minoxidil use. The majority of the cases looked at were in patients with androgenic alopecia. Keep in mind that many of these cases are using different treatment criteria Ex: dosing and frequency etc.
What type of person are you? Do you think you could stay consistent and take a pill daily or twice daily?
Do you have a sensitive scalp? If so, minoxidil formulations applied topically may be irritating... If so you can also search for a topic solution designed for sensitive scalps like Lipogaines formulation.
Or would it be easier for you to just apply a topical solution to your scalp?
From experience, I can say that the minoxidil solutions I've used do leave my hair a bit greasy. So styling may be a concern if you go for a topical solution.
If you're worried about your hair getting greasy, consider using adding liquid minoxidil and using a roller device for application. You can part your hair and add the roller directly to the scalp. This way less liquid gets on your hair. But keep in mind... liquid minoxidil is a little harsher/more irritating to the scalp.
Oral vs Topical minoxidil: My own experience with side effects from topical minoxidil
When I read through posts on reddit I see a ton of women discussing their apprehension to start topical minoxidil treatment because of their fears around the "dread-shed"---If you aren't familiar this is a common side effect resulting in a brief period of increased hair loss shortly after treatment initiation.
I wanted to make sure I called this out because I know it is a topic that comes up a bunch. Unfortunately, because I've used topical minoxidil for years I really don't remember what my experience was like with the dread-shed...So I'm sorry I can't provide more insight around this topic but it is definitely something to be aware of. It just didn't stop me from going full steam ahead with this treatment option.
In the past I have reacted to some topical minoxidil formulations. I believe that this came from years of use which eventually resulted in my scalp becoming red, itchy and inflamed. After talking with my dermatologist she informed me that the type of reaction I as experiencing was called contact dermatitis. This was the main reason I decided to search for other minoxidil formulations that were gentler on the scalp.
Eventually I landed on Lipogaine’s 3% minoxidil formulation for sensitive scalps. I applied this topically two times per day. I loved that Lipogaine would dry quickly and was not greasy unlike some of the other minoxidil formulations I had tried.
After using this product for about a year, I eventually switched back to the 5% minoxidil foam and have been able to tolerate this formulation pretty well (over the past year). I do still experience some scalp itching and dryness but it is much milder than what it was before.
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References:
1. Sharma AN, Michelle L, Juhasz M, Muller Ramos P, Atanaskova Mesinkovska N. Low-dose oral minoxidil as treatment for non-scarring alopecia: a systematic review. Int J Dermatol. 2020 Aug;59(8):1013-1019. doi: 10.1111/ijd.14933. Epub 2020 Jun 9. PMID: 32516434.
2. Roberts J, Desai N, McCoy J, Goren A. Sulfotransferase activity in plucked hair follicles predicts response to topical minoxidil in the treatment of female androgenetic alopecia. Dermatol Ther. 2014 Jul-Aug;27(4):252-4. doi: 10.1111/dth.12130. Epub 2014 Apr 28. PMID: 24773771.
3. McCoy J, Goren A, Kovacevic M, Shapiro J. Minoxidil dose response study in female pattern hair loss patients determined to be non-responders to 5% topical minoxidil. J Biol Regul Homeost Agents. 2016 Oct-Dec;30(4):1153-1155. PMID: 28078868.
4. Beach RA, McDonald KA, Barrett BM. Tolerated, Effective, Successful: Low Dose Oral Minoxidil for Treating Alopecia, A 3-Year North American Retrospective Case Series. J Am Acad Dermatol. 2020 Oct 21:S0190-9622(20)32844-9. doi: 10.1016/j.jaad.2020.10.032. Epub ahead of print. PMID: 33098962.