Minoxidil  – Topical (Rogaine) vs Oral – Which should you choose?

I’ve been around in the world of dermatology for awhile now, over 20 years in my quiet corner of WV.  Over the years I’ve seen lots of things come and go.  I have often been so relieved that I avoided prescribing a trendy drug once they decided it wasn’t so great.  If you know me personally or professionally, trendy  is not a word that describes me, lol.  I tend to stick with what is tried and true and things for which there is good scientific evidence. Enter our topic for today.

While topical minoxidil is the tried and true treatment for many types of hair loss, oral minoxidil is making a resurgence.  Why?  My first guess is laziness.  It takes a lot of work to apply topical Rogaine/minoxidil every day.  But I often ask patients, what’s a good head of hair worth to you?  For me, I use my Rogaine everyday.

Oral minoxidil is how Rogaine was initially discovered. Minoxidil is a blood pressure pill.  As with many great scientific discoveries, it was observed that patients taking this medication had excess hair growth.  When given to treat blood pressure, minoxidil is given in doses of 10-40mg.  The more recent trend is low dose minoxidil (around 1-5 mg) to treat hair loss.   The popular online site “hims/hers” offers dosing between 1.25 and 5mg.  

PROS of Oral Minoxidil

–Avoiding daily topical application.

CONS of Oral Minoxidil

-Can lower blood pressure and accelerate heart rate.

-Other side effects include weight gain from fluid retention and a black box warning for pericardial effusion.

-Hair grows everywhere, not just where you want it. 

But does it really work BETTER than topical minoxidil?  Short answer.  NO.  While many studies have shown similar efficacy, no study to my knowledge has demonstrated increased efficacy for oral minoxidil.  When looking at the list of cons above, I will stick with recommending topical minoxidil/Rogaine.  I will continue to recommend patients desiring oral minoxidil to discuss that with their primary care physician and have them prescribe it. 

Trendy.  Yes.  Better. No.  Safer . No.  Recommended. No.

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