Is oral minoxidil not superior to topical? Or vice versa?

Question

Hello, Hairloss Doctors. Is topical minoxidil better than oral? Or vice versa? There was study recently stating that oral minoxidil at 5mg was not superior to topical. I have never used minoxidil oral or topical, but want to start using one of the methods, but I prefer topical. So since 5mg oral is not superior is it wise to stick to topical? As less systemic side effects regarding edema, cardiovascular side effects etc. thank you https://pubmed.ncbi.nlm.nih.gov/38598226/

Anna Chacon, MD, FAAD · Answer

Both oral and topical minoxidil have their own advantages and considerations, and the choice between them often depends on individual preferences, tolerability, and specific medical conditions.

Topical Minoxidil is commonly used for treating hair loss and is applied directly to the scalp. It is widely available and tends to have fewer systemic side effects since it is not absorbed into the bloodstream as significantly as oral formulations. Common side effects are usually localized, such as scalp irritation or itching.

Oral Minoxidil is sometimes used off-label for hair loss and may be considered when patients do not respond to topical treatment. However, oral minoxidil can have more systemic side effects, including potential cardiovascular effects such as changes in blood pressure or edema.

The study you referenced suggests that oral minoxidil at 5mg may not be superior to topical applications in terms of efficacy. Given your preference for topical treatments and the concern about systemic side effects, it may be reasonable to start with topical minoxidil. This approach allows you to assess your response to treatment with a potentially lower risk of systemic side effects. Always consider monitoring for any side effects and evaluating treatment efficacy over time.

Anna Petropoulos, MD, FRCS · Answer

Hello Steven_gq, thank you for your question! You are correct that topical minoxidil typically has fewer systemic side effects compared to oral minoxidil, as it’s absorbed directly into the scalp and minimizes exposure to the rest of the body. This study suggests that oral minoxidil at 5 mg daily did not show superior results to topical application, which aligns with your preference for topical use. Topical minoxidil generally avoids the risks of edema, blood pressure fluctuations, and other cardiovascular side effects seen with oral minoxidil, making it a safer choice for many. Starting with a topical minoxidil might be wise, especially if systemic side effects are a concern. Alternative treatments for hair growth, aside from minoxidil, include:

Low-Level Laser Therapy (LLLT): Devices like laser combs or caps use low-level laser light to stimulate hair follicles, increase blood flow to the scalp, and promote hair growth. It’s non-invasive, generally well-tolerated, and works best with consistent use over several months.

Platelet-Rich Plasma (PRP) Therapy: PRP involves drawing a small amount of your blood, processing it to concentrate the platelets, and then injecting it into the scalp. Platelets release growth factors that can stimulate hair follicles, potentially promoting thicker and fuller hair. PRP is often used in combination with other treatments, like minoxidil, to enhance results.

Best of luck, I hope this helps!

Genie Alexander, RN BSN for Anna Petropoulos, MD FRCS at Center for Classic Beauty, Boston & Danvers, MA

Jeff Donovan, MD, PhD · Answer

Thanks for the question. It depends on the dose. 5 mg of oral minoxidil in males is not too different than 5 % twice daily but there was a trend in the study for oral to be a bit better. It all depends on the dose.  If 5 mg gives you palpitations and all you can tolerate is 2.5 mg then yes 5 % twice daily is probably similar. All in all, high doses of oral minoxidil are likely a bit better but only slightly. Remember too that these studies are only 24 weeks in duration so we have no clue what will happen over 24 years of use. Be sure to speak to your doctor.

Is oral minoxidil not superior to topical? Or vice versa?

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Is oral minoxidil not superior to topical? Or vice versa?

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