Topical formulations have been used for years to prevent hair loss and help regrow hair, but research shows off-label oral minoxidil may also be an effective treatment. Find out if either option is right for you.
Hair loss isn’t just an issue for men — it also affects 1 in 4 women under the age of 50. Known as androgenetic alopecia, female pattern hair loss causes thinning hair at the top of the head, which results in a widening of the part. In male pattern hair loss, it looks a little different — men typically develop a receding hairline above the temples and thinning hair at the top.
If treated early, hair loss can be stopped or even reversed. Dermatologists often prescribe topical minoxidil (Rogaine), which is approved by the U.S. Food and Drug Administration (FDA) to help both women and men grow hair on their scalp. It’s also used off-label for other types of hair loss, including after chemotherapy or a hair transplant, says Erika Elliott, MD, a dermatologist and associate program director of dermatology at Tufts University School of Medicine in Boston.
But researchers are discovering that oral minoxidil — which is prescribed off-label — can also be an effective treatment for hair loss. In clinical trials for Loniten, which is oral minoxidil that’s used to treat severely high blood pressure — 80 percent of patients experienced hair growth within six weeks after starting treatment.
It’s not clear why minoxidil is effective, but one theory is that it keeps hair in its natural growth phase, which is also known as the anagen phase. Remaining in that growth stage helps the hair become longer and thicker. At any time, “80 to 90 percent of the hairs on our scalp should be in the growth phase,” says Dr. Elliott. But “in people with female pattern hair loss, the hairs shift out of the anagen phase.”
When that happens, the hair that falls out isn’t replaced with normal new hair, but with thinner, finer strands of hair, particularly on the areas of the scalp that are more prone to androgenetic alopecia, such as near the hair part, she says. Oral and topical minoxidil can prevent that thinning from happening.
Minoxidil is available in both topical and oral forms. As a topical, it’s available over the counter (OTC) as a foam or a liquid solution in differing strengths.
In pill form, it’s only available by prescription.
If you’re experiencing hair loss, talk to your doctor before starting any drug — even if it’s OTC minoxidil. Elliott says there are various causes of hair loss that are best evaluated with an in-person exam where the hair follicles, scalp, and hair texture can be examined.
During that appointment, your healthcare provider may recommend blood work to check for a vitamin D, zinc, or iron deficiency. Those labs can also test for underlying conditions such as thyroid disorders, which also may be contributing to hair loss, says Elliott.
In stores, a 2 percent topical solution is marketed to women, and 5 percent solutions are marketed to both men and women. But some dermatologists tell women to choose the 5 percent solution, since it’s more effective, says Chris Adigun, MD, a dermatologist at Dermatology and Laser Center of Chapel Hill, in North Carolina. Both the liquid and foam options are effective; it’s a matter of preference which one you want to apply, says Elliott.
People who can’t tolerate the topical version of minoxidil may be good candidates for oral minoxidil, says Dr. Adigun. Some topical users experience side effects like scalp itching or aren’t able to apply the topical solution to their scalp twice a day (as the medication can require).
It typically takes two to four months of regularly applying topical minoxidil to have an effect on hair loss. Adigun notes that it can take six months to see results from topical minoxidil, and one study found it takes roughly that same amount of time for oral minoxidil to work too.
“Hair loss and hair regrowth is very slow,” says Adigun.
Beyond using topical or oral minoxidil, there are other strategies to help minimize hair loss:
Use a conditioner after you shampoo. Conditioner helps prevent split ends and keeps hair from breaking.
Don’t put chemicals on your hair. This includes hair dye, perms, chemical straighteners, and relaxers.
Limit heat. Avoid curling irons, flat irons, and hot rollers whenever you can. If you need to blow-dry your hair, use the lowest setting possible.
Wear your hair down. Pulling your hair into a bun, ponytail, or braids can cause hair loss. Also try not to twist or pull at your hair, which can weaken strands and lead to more breakage.
Oral minoxidil may lead to hair growth on your face and temples, and it can also make fine body hair darker and thicker. Other side effects include:
Hair regrowth can vary from person to person. Adigun says that some people will have excellent results and others will not. Even if you’re satisfied with the effects of minoxidil, you’ll need to stay on the medication indefinitely prevent further hair loss.
If you aren’t satisfied with the results, your doctor may recommend other treatments, including the prescription oral medication finasteride (Propecia), which is used off-label to treat hair loss in women. Other options include platelet-rich plasma treatments, where your blood is drawn and injected into your scalp to stimulate hair regrowth and red light therapy.
Oral minoxidil is prescribed off-label to help regrow hair in both women and men. Topical minoxidil is FDA approved for hair loss, and it’s available over the counter. Both types of treatment can be effective if started early.
It’s not clear exactly how minoxidil works, but it may do so by keeping hair in its natural growth phase. Both topical and oral minoxidil can cause side effects like headaches, nausea, dizziness, or fainting.
If you’re experiencing hair loss, see a dermatologist before starting any treatment — even if it’s sold over the counter.
