Low dose MINOXIDIL for hair thinning - what you need to know
Since the NYTimes article “An old medicine grows new hair for pennies a day, doctors say” came out on August 18, 2022, so many people have asked me about low dose oral minoxidil for hair loss and hair thinning. The article presents oral minoxidil as a miracle cure-all. But hair loss is COMPLICATED and there is no magic wand. Plus, there is one bad side effect (keep reading to find out!) that I have seen over and over again since August from new female patients who have been prescribed low dose oral minoxidil coming to me for a second opinion.
What is Minoxidil?
Minoxidil is not a new drug as it has been available as an anti-hypertensive since 1979 and as a topical form for hair loss since 1988. When it was first brought to market for blood pressure, clinicians noted the side effect of hair growth in balding patients, which led to the development of the topical form.
The mechanism of action is not fully understood but could be due to its ability to dilate blood vessels, resulting in increased cutaneous blood flow with resultant increase in oxygen and growth factor delivery to the hair follicles. The reason why minoxidil may work better for some and not others is because its success depends on the presence of an enzyme called sulfotransferase – located in the outer root sheath of hair follicles. Some people inherently have more than others. But the first publication on oral minoxidil for hair loss was not until December 2017 in Australia.
Several serious side effects you need to know about
Oral minoxidil is not FDA approved for hair loss but it has been shown in various scientific studies to cause hair growth. Many dermatologists have been using oral minoxidil for their patients with success. However, there are several serious side effects that I want you to know before you decide if it is right for you. As a hypertensive medicine, the doses are much higher (5-40mg daily), and side effects such as sodium and fluid retention, ischemic heart disease, pericardial effusion, and pulmonary hypertension have been reported. Fortunately, these side effects are rare with low dose minoxidil, but there is a case report in the October 2022 JAAD (Journal of the American Academy of Dermatology) of a woman who was taking 0.25mg of Minoxidil daily and hospitalized with full body edema with fluid collections in her pericardium, pleural space, and abdomen.
Not all doom and gloom, but you need to be careful
On the other hand, there are 17 studies published that demonstrate low dose minoxidil to be safe and effective at doses of 0.25 to 1.25mg daily, but with the following uncommon adverse events: lightheadedness (1.7% of patients), fluid retention (1.3%), tachycardia (0.9%), headache (0.4%), periorbital edema (0.3%), and insomnia (0.2%). Please be careful about starting oral minoxidil if you have any issues with blood pressure, and especially if you are already on many other medications.
The most surprising side effect of all
But what I want you to know about is – HYPERTRICHOSIS! This can occur in 15% of patients! I have had several new female patients (coming to my office for a second opinion) with a FULL MUSTACHE that developed just weeks after starting oral minoxidil at 0.25mg daily. Not a desired look, for sure. So please, always weigh all of the pros and cons before starting any medication and seek the counsel of a board certified physician (beyond social media) to make the most informed decision.
What does Dr. Kim think?
The other important learning point is that dermatologists use oral minoxidil in COMBINATION with other interventions because hair loss is extremely difficult and stubborn. Did you know that a treatment course for oral minoxidil is 10-12 months before seeing visible signs of hair growth on scalp? It is long. One of my favorite technologies for hair loss (due to its phenomenal results!) is micro-injection of EXOSOMES directly into the scalp – more on this in another SkinJournal entry. If you or a loved one are struggling with hair thinning, come talk to us about all of the different options. We are here to help.
Depending on the theme of each newsletter, and only if appropriate and helpful, I will include highlights of products that I believe will serve you in achieving your skin goals.
Remember, having healthy beautiful skin requires a 360 degree approach or a multifaceted strategic action plan. Topicals are super fundamental but they are only a part of the holistic regimen. For truly optimal results, we must combine daily lifestyle commitments that include consciousness in morning & evening skin routine, diet, sleep, exercise, stress-levels (try meditation and nurturing self-care), and regularly scheduled proactive and preventative in-office medical procedures and technologies.