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Oral Minoxidil- What You Need To Know

    Quick Summary: Oral Minoxidil for Hair Growth

    Minoxidil Overview: Minoxidil, available in both oral and topical forms, it extends the hair’s growth phase, and reduces scalp inflammation. Oral minoxidil stimulates hair growth internally, but can result in more side effects compared to the topical form.

    Effectiveness: Studies suggest oral minoxidil may be as effective as topical minoxidil for treating hair loss, with benefits including ease of use and potentially greater effect due to better patient compliance.

    When to Consider Oral Minoxidil: If you’re experiencing significant hair loss and topical minoxidil is ineffective, or causing side effects like scalp irritation, oral minoxidil might be a better option.

    Other Treatments: Finasteride and dutasteride are alternatives mainly used for male pattern hair loss, focusing on hormonal control. Natural remedies and dietary supplements like rosemary oil, pumpkin seed oil, saw palmetto, and biotin may also support hair health.

    Lifestyle Factors: A balanced diet, stress management, and regular exercise contribute to overall hair health, helping maintain and potentially enhance hair growth.

    Consultation Is Key: Always discuss treatment options with a healthcare provider to choose the right method for you, and to manage any potential side effects.

    Did you know? Minoxidil, originally developed to treat high blood pressure, was discovered to promote hair growth as a surprising side effect. This coincidental finding has since made it a popular solution for combating hair loss. 

    In this blog, we will delve into how oral minoxidil works, compare it with its topical form, and evaluate its effectiveness and safety as a treatment option for those experiencing hair loss.

    How Oral Minoxidil Works

    Although topical minoxidil was first approved for treating hair loss in the 1980s, the exact ways it stimulates hair growth are still not fully understood. Research has uncovered several potential mechanisms through which minoxidil may enhance hair follicle activity and promote hair regrowth1:

    1. Vasodilation

    Minoxidil (or its active form minoxidil sulphate) is primarily a vasodilator, meaning it helps widen blood vessels. Relaxing the blood vessels increases blood flow to hair follicles. This enhanced circulation delivers the essential nutrients and oxygen crucial for promoting hair growth and extending the active growth phase of hair follicles (a.k.a the anagen phase). 

    1. Shortens Telogen Phase, Extends Anagen phase

    What minoxidil also does is modulate hair growth phases

    • It shortens the telogen phase, a resting phase where old hairs fall out and hair follicles are empty. 
    • It stimulates hair follicles to move into the anagen phase, the growth phase, where the hair follicles revitalises and allows hair to grow longer and thicker over time. 
    1. Stimulate Hair Follicle Regeneration

    Research shows that minoxidil can stimulate the production of new hair follicles by activating a pathway crucial for growth – the Wnt/β-Catenin pathway.2 The Wnt/β-catenin pathway is like a messenger system in our body that communicates with cells, telling them what to do. Specifically for hair, it’s a natural process that helps regulate hair growth by signalling hair follicles to grow and develop.

    1. Reduce Scalp Inflammation

    Inflammation of hair follicles is often associated with hair loss.3 Minoxidil is known to ease such inflammatory responses that can affect the scalp and hair health. 

    Topical Vs Oral Minoxidil

    Topical minoxidil is advantageous in hair loss due to its targeted effects on the area it’s applied to. In contrast, oral minoxidil has a “systemic”, or widespread bodily effect, which has a higher likelihood of causing side effects involving the rest of the body. 

    Oral minoxidil may be easier to take, as a pill is quicker and easier than applying a lotion or foam onto the hair. It serves as an alternative for people who have issues with topical application such as scalp irritation or odour. Moreover, individuals who do not respond to topical treatments might benefit from the systemic effects of oral minoxidil.

    To get a better idea, the table below summarises the main differences between oral and topical minoxidil1,4

    oral and topical minoxidil table

    Research Findings on Oral vs Topical Minoxidil:

    1. Effectiveness in Female Hair Loss: Studies have shown that taking 1mg of oral minoxidil daily can be as effective as applying a 5% topical solution for treating female pattern hair loss (FPHL). This suggests oral minoxidil is a useful alternative for hair loss, when compared to topical forms.5 
    2. Effectiveness in Male Pattern Hair Loss: Another similar study found that after six months of use, both oral minoxidil (5mg) and topical minoxidil (in 2% and 5% concentrations) were equally effective in preventing worsening hair loss and improving hair condition in men with androgenetic alopecia.6 Additional research highlighted significant improvements in participants at both 12 and 24 weeks when using oral minoxidil.7 
    3. Potential Treatment for Telogen Effluvium: A smaller dose of oral minoxidil, ranging from 0.5mg to 2.5mg per day, has been found safe and effective for treating chronic telogen effluvium, a condition characterised by excessive hair shedding.8 
    4. Overcoming Topical Challenges: Many people experience side effects like itching, skin irritation, and changes in hair texture from topical minoxidil. Oral minoxidil has proven to be an effective alternative for those who may have allergies or sensitivities to the topical form.9

    When To Consider Using Oral Minoxidil?

    Oral minoxidil may work better for individuals experiencing undesirable side effects from topical minoxidil, such as irritation or allergic reactions.
    When considering whether to give it a try, here are some signs of hair loss to watch out for that may indicate treatment is needed:

    In Men

    • Progressive Thinning: Notable thinning in the frontal hairline, temples and top of the head. This is typically a sign of male pattern baldness.
    • Rapid Hair Loss: Unexpected, rapid loss of hair in clumps, differing from the usual gradual thinning associated with genetic balding.

    In Women

    • Diffuse Thinning: Widespread thinning across the scalp, particularly noticeable at the part line, often without the frontal hairline receding as it might in men.
    • Visible Scalp: Increased visibility of the scalp through the hair or a widening part line, indicating significant thinning.

    Oral minoxidil is currently only approved as a medication for treating blood pressure. However, it is given off-label for treatments of hair loss conditions and is supported by clinical studies4,8,10,11:

    Androgenetic Alopecia:

    The majority of studies done on hair loss involve this characteristic type of hair loss. It is often called male or female pattern baldness, this condition involves hair thinning and/or a receding hairline due to genetics and hormones. Oral minoxidil can promote hair growth and slow hair loss by enhancing the growth phase of hair follicles.

    Alopecia Areata:

    This autoimmune condition causes sudden, patchy hair loss. Oral minoxidil may help by stimulating hair regrowth and reducing inflammation.

    Telogen Effluvium:

    This condition is characterised by excessive hair shedding caused by sudden stressors or hormonal changes. Oral minoxidil can help by shortening the resting (telogen) phase of hair, encouraging faster regrowth.

    Cicatricial Alopecia (Scarring alopecias):

    These conditions destroy hair follicles and replace them with scar tissue, leading to permanent hair loss. Minoxidil’s antifibrotic properties may help prevent further scarring.

    Hair Shaft Disorders (A series of conditions, some inherited, that cause hair to be brittle and break off easily):

    • Loose Anagen Hair Syndrome: Hair is easily pulled out due to weak follicle grip. Oral minoxidil might strengthen the attachment of hair to the scalp.
    • Monilethrix: A genetic disorder causing hair to be brittle with periodic thinning. 
    • Oral minoxidil can help improve hair strength by promoting growth of healthier hair follicles, and therefore consistent hair growth.

    Traction Alopecia:

    Hair loss caused by styles that pull the hair tight. Oral minoxidil can encourage hair regrowth in the affected areas.

    Alopecia due to Chemotherapy: 

    Hair loss due to cancer treatments. Oral minoxidil might support faster hair recovery and regrowth post-therapy.

    For all these conditions, oral minoxidil might offer a more robust treatment option in cases of extensive or rapid hair loss, potentially providing quicker and more widespread results. However, given that the use of oral minoxidil for hair loss is still being researched and is considered an off-label treatment, it’s crucial to start it under professional guidance. Starting oral minoxidil should be closely monitored by a healthcare professional to manage potential side effects like changes in blood pressure or an increase in heart rate, particularly in patients with underlying heart conditions. A GP, dermatologist or hair specialists like our team can evaluate your specific type of hair loss, explain potential side effects, and determine if oral minoxidil is appropriate for your health profile and medical history.

    Side Effects of Oral Minoxidil

    Common Side Effects1,4:

    • Hypertrichosis (Excessive Hair Growth): More hair than usual may grow on the face and body, especially with higher doses of oral Minoxidil. Many people manage this with regular hair removal methods.
    • Heart-Related Symptoms: Includes mild symptoms like hypotension (low blood pressure), edema (swelling), and tachycardia (fast heart rate). These symptoms are less common than hypertrichosis and tend to increase with higher doses.

    Less Common Side Effects:

    • Headaches and Dizziness: A few people might feel headaches and/or mild blood pressure changes. 
    • Heart Rhythm Changes (on the ECG): Changes in heart rhythm might be observed (e.g. tachycardia, premature ventricular contractions), but these are generally mild and uncommon.
    • Temporary Hair Shedding: Few people experience this when they start using the medication, and most patients don’t find it severe enough to discontinue treatment. After an initial shedding phase, hair growth resumes as normal.

    Rare Side Effects:

    • Pericardial Effusion (Fluid Around the Heart): An extremely rare condition where fluid builds up around the heart. This is more likely in people with kidney problems, or those on certain types of kidney treatments like dialysis.
    • Widespread Body Swelling: Also extremely rare, this involves swelling across the body.

    Managing Side Effects:

    When managing side effects, please make sure to check with healthcare professionals prior to taking any new medications or therapies. If you start to get side effects please contact your Doctor immediately.

    • For Light-headedness: Taking the medicine before bed can help, as can standing up slowly from a sitting or lying position.
    • For Swelling: Please stop using the medication and contact your Doctor immediately.
    • For Tachycardia: Please stop using the medication and contact your Doctor immediately.

    Things to Remember:

    • Lower Doses for Hair Loss: The amount of minoxidil used for hair loss is much lower than that for treating blood pressure, which helps to minimise serious side effects.
    • Regular Check-ups: It’s important to have regular visits with your doctor to keep an eye on any side effects and adjust treatment if needed.

    Other Treatment Options

    Apart from minoxidil, there are several other options that can also help promote hair growth:

    1. Other Prescription Medications for Hair Loss
    • Finasteride – Primarily used for male pattern baldness, finasteride works by inhibiting the production of dihydrotestosterone (DHT), a hormone associated with hair loss. It can be taken as a tablet, or used as a topical solution for the scalp. It is generally not prescribed in women due to potential birth defects.
    • Dutasteride – Similar to finasteride but potentially more effective, dutasteride inhibits more types of DHT-producing enzymes. It is also used primarily for male pattern hair loss.
    1. Natural Remedies and Supplements12
    • Rosemary Oil – Some studies suggest that rosemary oil can stimulate hair growth as effectively as minoxidil. It can be applied topically and is also known for its anti-inflammatory properties.
    • Pumpkin Seed Oil and Saw Palmetto – Both have been studied for their potential to reduce DHT levels, similar to finasteride and dutasteride, offering a natural approach to managing hair loss.
    • Biotin – Often touted for its hair growth benefits, biotin (Vitamin B7) is believed to strengthen hair and improve its thickness. However, research shows its effectiveness is only noticeable in people who have biotin deficiencies (which can be rare due to biotin’s wide availability in our diet).
    1. Lifestyle changes
    • Diet – Ensuring a well-balanced diet rich in vitamins and minerals can support hair growth. Vitamins A, B, C, D, E, zinc, iron, omega-3 fatty acids, and proteins are essential for a healthy scalp and healthy hair.
    • Managing Sleep and Stress – Adequate sleep and stress management are crucial for maintaining overall health, including hair health. Sleep promotes cell regeneration and repair, while managing stress through relaxation techniques can prevent stress-induced hair loss.
    • Adding In Healthy Workouts – Incorporating regular exercise into your routine can enhance blood circulation to both the body and scalp, promoting hair growth. Activities like yoga and aerobic exercises not only improve overall health, but also reduce stress, further supporting hair health.

    While oral minoxidil and other treatments mentioned above offer non-invasive options to combat hair loss and promote hair regrowth, they may not be suitable for everyone.
    In those with advanced hair loss or those seeking more permanent solutions, a hair transplant could be a better alternative, providing results that are both natural-looking and long-lasting. To learn about hair transplants, check out our blog post “When Should I Get A Hair Transplant?” or get in touch directly with our friendly team. 

    Conclusion 

    To sum up, whether you’re considering oral or topical minoxidil, understanding the differences and effects of each can guide you in choosing the most suitable option for your hair loss situation.
    Oral minoxidil offers a convenient alternative to topical applications, however it is important to discuss this treatment with a healthcare provider, such as your GP, dermatologist, or hair specialists like our team, to ensure it’s appropriate for your specific health needs and to monitor any potential side effects.

    Beyond minoxidil, exploring other treatments like finasteride or natural remedies may offer additional benefits. At The Treatment Rooms, we prioritise a holistic approach to hair health and will always encourage a healthy lifestyle with proper diet, stress management, and regular exercise – these can also play a crucial role in maintaining and enhancing your hair health. If you are facing significant hair loss and are looking into treatment options, feel free to contact us with your concerns and we will be more than happy to help you.

    References

    1. Ramírez-Marín, H. A., & Tosti, A. (2022). Role of Oral Minoxidil in Patterned Hair Loss. Indian dermatology online journal, 13(6), 729–733. https://doi.org/10.4103/idoj.idoj_246_22 
    2. Ramírez-Marín, H. A., & Tosti, A. (2022). Role of Oral Minoxidil in Patterned Hair Loss. Indian dermatology online journal, 13(6), 729–733. https://doi.org/10.4103/idoj.idoj_246_22 
    3. Peyravian, N., Deo, S., Daunert, S., & Jimenez, J. J. (2020). The Inflammatory Aspect of Male and Female Pattern Hair Loss. Journal of inflammation research, 13, 879–881. https://doi.org/10.2147/JIR.S275785 
    4. Gupta, A. K., Talukder, M., Shemer, A., Piraccini, B. M., & Tosti, A. (2023). Low-Dose Oral Minoxidil for Alopecia: A Comprehensive Review. Skin appendage disorders, 9(6), 423–437. https://doi.org/10.1159/000531890 
    5. Ramos, P. M., Sinclair, R. D., Kasprzak, M., & Miot, H. A. (2020). Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. Journal of the American Academy of Dermatology, 82(1), 252–253. https://doi.org/10.1016/j.jaad.2019.08.060 
    6. Jimenez-Cauhe, J., Saceda-Corralo, D., Rodrigues-Barata, R., Hermosa-Gelbard, A., Moreno-Arrones, O. M., Fernandez-Nieto, D., & Vaño-Galvan, S. (2019). Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. Journal of the American Academy of Dermatology, 81(2), 648–649. https://doi.org/10.1016/j.jaad.2019.04.054 
    7. Panchaprateep, R., & Lueangarun, S. (2020). Efficacy and Safety of Oral Minoxidil 5 mg Once Daily in the Treatment of Male Patients with Androgenetic Alopecia: An Open-Label and Global Photographic Assessment. Dermatology and therapy, 10(6), 1345–1357. https://doi.org/10.1007/s13555-020-00448-x 
    8. Perera, E., & Sinclair, R. (2017). Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study. F1000Research, 6, 1650. https://doi.org/10.12688/f1000research.11775.1 
    9. Therianou, A., Vincenzi, C., & Tosti, A. (2022). How safe is prescribing oral minoxidil in patients allergic to topical minoxidil?. Journal of the American Academy of Dermatology, 86(2), 429–431. https://doi.org/10.1016/j.jaad.2020.04.027 
    10. Awad, A., Chim, I., Sharma, P., & Bhoyrul, B. (2023). Low-dose oral minoxidil improves hair density in traction alopecia. Journal of the American Academy of Dermatology, 89(1), 157–159. https://doi.org/10.1016/j.jaad.2023.02.024 
    11. Ly, N., McClure, E. M., Hordinsky, M. K., Farah, R. S., & Park, S. Y. (2024). Safety and Efficacy of Minoxidil Treatment in Scarring Alopecia: A Scoping Review. Journal of drugs in dermatology : JDD, 23(3), 146–151. https://doi.org/10.36849/jdd.7743 
    12. Hosking, A. M., Juhasz, M., & Atanaskova Mesinkovska, N. (2019). Complementary and Alternative Treatments for Alopecia: A Comprehensive Review. Skin appendage disorders, 5(2), 72–89. https://doi.org/10.1159/000492035 

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