Rachel Murphy is a Kansas City, MO, journalist with more than 10 years of experience.

Nick Blackmer is a librarian, fact-checker, and researcher with more than 20 years’ experience in consumer-oriented health and wellness content.

If shampoo commercials are to be believed, all that’s needed for thick, lustrous hair is a bottle of suds. But for thousands with hair loss, regrowing thinning hair is tough to do.

Now, dermatologists are rediscovering an existing treatment—minoxidil—and prescribing it in a different form. A growing number of doctors have begun prescribing low doses of oral minoxidil instead of topical minoxidil after years of trial and error, and a scientific review points to its efficacy.

A 2020 review published in the International Journal of Dermatology found that between 61% and 100% of patients with androgenetic alopecia saw significant improvement with a low dose between .25 mg and .5 mg of oral minoxidil. The report indicated that part of the success may be linked to greater patient compliance since the oral method lacks the mess and potentially irritating side effects that can occur with topical use.

Minoxidil was originally developed as a blood pressure medication and used to combat hypertension. The medication was effective but yielded a curious side effect: hypertrichosis, or extra hair growth. Unfortunately, at the originally prescribed dosage, that hair growth could happen all over the body, changing the color, texture, and thickness of the hair.

After observing the stimulated hair growth, doctors experimented with using the drug topically so that patients could control where they tried to regrow hair. Minoxidil was approved topically for hair loss treatment by the Food and Drug Administration (FDA) in 1988, becoming the active ingredient in products like Rogaine and eventually becoming available over the counter.

Minoxidil is still prescribed for hypertension, but in much higher doses than used for hair growth.

Minoxidil stimulates hair growth by pushing hair follicles into their anagen phase, according to Geeta Yadav, MD, board-certified dermatologist and founder of FACET Dermatology.

“Anagen is the growth phase of the hair follicle,” Yadav told Verywell. “Catagen is the stable phase and telogen is the shedding phase. Minoxidil shifts follicles into the anagen phase indefinitely.”

When patients first start using minoxidil, they may actually start noticing more shedding, Yadav said. In the first two months of use, users may see more shedding since the follicle has to go through the entire cycle before the follicles can return to the anagen phase of growth.

Once in anagen, it still may take months to see results, depending on the rate of hair growth.

Yadav said that at an average growth of one centimeter a month, it would take at least six months to notice a great deal of progress, and if the patient stops using the medication, all progress will be lost in a few months time.

“Minoxidil is not a cure. It has a good efficacy rate, it’s the first-line standard of care, but it’s a commitment,” Yadav said.

If topical minoxidil works, why the sudden interest in oral treatments? Although oral use has made headlines lately, physicians have been investigating its use for some time now, with notable studies attesting to its efficacy dating back to 2019.

Although oral minoxidil for alopecia isn’t FDA-approved, the preponderance of evidence is encouraging many doctors to experiment off-label with pills in dosages that work for their patients.

Off label use refers to the use of a medication for something other than its intended purpose. Minoxidil was intended to treat hypertension, but researchers observed that it also caused increased hair growth. Instead of running testing specifically for that outcome, doctors prescribe it “off label” as a way of harnessing a positive side effect without going through the costly and time consuming process of FDA approval for a drug that has already been deemed safe for a different use.

Yadav said that while topical minoxidil has great efficacy rates, it’s not the most convenient to use. Minoxidil is generally prescribed in either a 2% or 5% formulation that must be applied to the scalp daily. Some patients tire of the mess or find that they have a skin sensitivity to the foam, making it irritating to apply. Some patients have also reported that hair texture can change and become dry and prone to breakage.

“The oral formulation is sometimes just a bit simpler and more straightforward to take,” Yadav said. “If you can dose it properly, you’ll generally see mild side effects; it’s effective and well-tolerated.”

That dosage is very low. According to the International Society of Hair Restoration Society (ISHRS), dermatologists are prescribing dosages below 5 milligrams (mg) daily in concert with spironolactone, another antihypertension drug often prescribed for the treatment of acne and androgenic alopecia.

In addition to being easy to use, oral minoxidil is cost-effective. A quick search reveals that even without insurance, a bottle of 30 pills of minoxidil 2.5 mg is less than $5.

While oral minoxidil has made headlines recently, it’s not necessarily the first choice of many dermatologists. Jeannette Graf, MD, assistant clinical professor of Dermatology at the Mount Sinai School of Medicine, told Verywell via email that she would more likely prescribe minoxidil as a topical agent first.

Graf was in medical school when the discovery of its hair-growing properties was first discovered, and remembers its subsequent discontinuation of minoxidil orally because of extreme hair growth in women in unexpected places.

“Women’s pattern hair loss starts at the temples. Depending on the degree of severity, it involves the entire top of the scalp, including the frontal and parietal areas,” Graf said. “I recommend topical minoxidil 5% and am very exact as to its use: no dripping, wash hands after. Although there are many good physicians who use higher doses in women, I tend to remain at 5% since I have seen hypertrichosis at higher doses.”

Graf said that while she’s found success with topical minoxidil, she often prescribes it compounded with other medications in an effort to reduce skin irritation.

Although topical minoxidil is now available over the counter, oral minoxidil is only available through a prescription. Those already in treatment for hair loss can consult their dermatologist for a prescription for the minoxidil for off-label use.

Graf and Yadav agree that before trying any pharmaceutical for hair growth, it’s important to pinpoint the cause behind hair loss. For women especially, hormonal changes can have a big impact.

“Women who are experiencing hair loss should first have a medical workup in order to rule out any potential medical issues which can be contributing factors such as thyroid, autoimmune disease, hormonal issues, etc.,” Graf said.

Those contributing factors can mean that different treatments are more effective. Yadav said there are over 10 different types of alopecia, which are grouped as scarring or non-scarring alopecia. Even in men and women who have male or female pattern baldness, also known as androgenic alopecia, there is a point where even minoxidil may not help.

“Androgenic alopecia, which is what Rogaine or minoxidil treats, is a non-scarring alopecia, but the follicles are miniaturized,” Yadav said. “The longer that follicle is miniaturized, the less likely you’ll be able to stimulate hair growth. It’s possible, but it’s less likely.”

Depending on the cause of hair loss, there are a variety of treatments available, including platelet-rich plasma applied via injection and oral medications such as spironolactone and dutasteride. Effective medications may also vary from men to women.

Minoxidil has been an effective treatment for hair loss for decades now, but it can be messy and irritating to apply topically. Taken orally and in very low doses, minoxidil can be effective, cost-efficient, and convenient, but it will require a doctor’s prescription. Talk to your dermatologist about whether oral minoxidil is the right treatment for your thinning hair.

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;59(8):1013-1019. doi:10.1111/ijd.14933

Ashique S, Sandhu NK, Haque SkN, Koley K. A systemic review on topical marketed formulations, natural products, and oral supplements to prevent androgenic alopecia: a review. Nat Prod Bioprospect. 2020;10(6):345-365. doi:10.1007/s13659-020-00267-9

National Library of Medicine: DailyMed. Minoxidil tablet [drug label].

By Rachel Murphy Rachel Murphy is a Kansas City, MO, journalist with more than 10 years of experience.

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