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Oral minoxidil has become a widely used off-label option for androgenic alopecia (AGA) in men and women, despite initially being approved only as an antihypertensive medication decades ago.

Oral minoxidil is increasingly offered to address specific unmet needs in AGA treatment: 

• Topical non-responders: Some people don’t see satisfactory results with topical minoxidil, possibly due to inadequate absorption, variations in scalp skin properties, or genetic factors affecting drug metabolism.
• Scalp sensitivity/irritation: Topical minoxidil can cause local side effects such as itching, flaking, or dermatitis due to the vehicle (especially propylene glycol) or the active ingredient itself. Switching to oral minoxidil bypasses these local reactions.
• Simpler routines/adherence: Oral dosing eliminates the need for daily topical application, which can be messy, time-consuming, or interfere with hair styling. For some, this leads to better long-term adherence and quality of life.

Regrowth with oral minoxidil can be variable, however. This variability mainly stems from biological differences between patients. Because minoxidil is a prodrug that requires conversion by the enzyme sulfotransferase (SULT1A1) into its active form, individual variation in enzyme activity strongly influences response.^[1]Ramos, P.M., Goren, A., Sinclair, R., Miot, H.A. (2020). Oral minoxidil bio-activation by hair follicle outer root sheath cell sulfotransferase enzymes predicts clinical efficacy in female pattern … Continue reading  

Interested in Oral Minoxidil?

Low-dose oral minoxidil available, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

Click Here For 15% Off

*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Unfortunately, what most people see online are extremely successful oral minoxidil before and after photos (which you’ll see below), which can lead people to believe that they will experience more regrowth than they actually might.

In this article, we will explore what the likely (not just possible) results are and what the clinical trials show.

But first, let’s have a quick refresher on what oral minoxidil is.

What is Oral Minoxidil?

Oral minoxidil is a tablet medication originally developed as a vasodilator for severe hypertension, but now increasingly used off-label at low doses to treat AGA and other hair loss conditions. It enhances scalp flow and prolongs the growth phase (anagen) of hair follicles, primarily by increasing prostaglandin E2 and vascular endothelial growth factor (VEGF). 

Oral minoxidil acts by opening ATP-sensitive potassium channels in vascular smooth muscle, which increases perifollicular blood flow. It also prolongs the anagen phase of the hair cycle. Unlike topical minoxidil, which requires local sulfotransferase enzyme activity in the scalp for conversion to its active form, oral minoxidil is metabolized systemically via hepatic sulfotransferase, potentially bypassing poor scalp enzyme activity in some individuals.^[2]Kaiser, M., Abdin, R., Gaumond, S.I., Issa, N.T., Jiminez, J.J. (2023). Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs. Clinical, Cosmetic and Investigational Dermatology. 16. … Continue reading 

For hair loss, oral minoxidil is prescribed at significantly reduced dosages compared to antihypertensive therapy – typically:

• 0.25 mg – 1.25 mg for women
• 2.5 mg – 5 mg for men
• Adverse effects are much less frequent at these low doses but may include hypertrichosis (excess unwanted body hair), fluid retention, and, rarely, cardiovascular effects.^[3]Bloch, L.D., Carlos, R.M.D. (2024). Side Effects’ Frequency Assessment of Low Dose Oral Minoxidil in Male Androgenetic Alopecia Patients. Skin Appendage Disorders. 11(1). 14-18. Available at: … Continue reading 

While oral minoxidil is not FDA-approved for hair loss, a number of studies show its efficacy. 

The Evidence

You can see a complete table of oral minoxidil studies here, but we have picked a few to show.

Study One – AGA (Female)

Vahabi-Amlashi et al (2021) conducted a triple-blind, randomized clinical trial in 72 women with female pattern hair loss, comparing oral minoxidil 0.25 mg daily to 2% topical minoxidil twice daily over 36 weeks.^[4]Vahabi-Amlashi, S., Layegh, P., Kiafar, B., Hoseininezhad, M., Abbaspour, M., Khaniki, S.H., Forouzanfar, M., Sabeti, V. (2021). A randomized clinical trial on the therapeutic effects of 0.25 mg oral … Continue reading 

• Measured outcomes included hair shedding, Sinclair scores by three independent evaluators, trichoscopy assessments of hair density and diameter, and safety labs (liver, kidney, electrolytes).
• Both groups showed significant improvement in hair diameter and density:
  • Group 1 (oral): 13% improvement in hair density.
  • Group 2 (topical): 6% improvement in hair density.
• Sinclair and shedding scores decreased significantly in both groups by the end of the study.
• There was no significant difference between groups in any measured endpoint. 
• Oral minoxidil showed slightly better improvement in hair density; topical minoxidil showed slightly better improvement in hair diameter.
• Adverse events:
  • Group 1 (oral): hirsutism (7.7%), gastrointestinal intolerance (7.7%), weight gain (3.8%), hypotension (3.8%), leading to withdrawal.
  • Group 2 (topical): hirsutism (8%).

Study Two – AGA (Male)

Panchaprateep and Lueangarun (2020) conducted an open-label, prospective single-arm study in 30 men with AGA, treated with 5 mg oral minoxidil once daily for 24 weeks.^[5]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 … Continue reading

• Statistically significant increase in total hair count at 24 weeks (+35.1±18.9 hairs/cm2; p=0.003).
• Hair diameter improved by 15.2% from baseline (p<0.001).
• Global photographic assessment: 43% of patients achieved an “excellent improvement” score by study end.
• High rate of hypertrichosis (93.3% at 24 weeks); pedal edema was reported in 3 patients, resolving after 2-3 months in all cases.
• No serious cardiovascular side effects were observed.

Study Three – AGA and TE (Male and Female)

Feaster et al. (2023) performed a multicenter retrospective study in 210 patients (50 men, 160 women) with AGA and/or telogen effluvium (TE), comparing low-dose oral minoxidil (0.625 – 2.5 mg daily) to a control (no minoxidil or other non-minoxidil treatments) over 52 weeks.^[6]Feaster, B., Onamusi, T., Cooley, J.E., McMichael, A.J. (2023). Oral minoxidil use in androgenetic alopecia and telogen effluvium. Archives of Dermatological Research. 315(2). 201-205. Available at: … Continue reading 

• Group 1 (oral minoxidil): 52.4% of patients showed clinical improvement in hair growth; 41.9% had hair loss stabilization; 5.7% experienced worsening.
• These results were significantly better than the control group (p=0.001). 
• The mean duration of oral minoxidil use was 25.1 months (range 12-54); the most common dose was 1.25 mg daily.
• Adverse effects were uncommon (9.5% of patients), generally mild, and included:
  • Hypertrichosis (4.8%)
  • Edema (1.9%)
  • Hair shedding (1%)
  • Lower extremity cramping (1%)
  • Palpitations (1%)
  • Scalp dysesthesia (1%)
• There were no serious side effects or study withdrawals due to adverse events in the analyzed population.

Overall, these studies demonstrate that oral minoxidil is an effective and generally well-tolerated treatment option for both AGA and TE in men and women. Across the studies, clinical improvements were observed, with similar efficacy to topical minoxidil.

However, the results that people show online are usually more dramatic than what is seen in clinical studies. 

What’s Possible ≠ What’s Probable

When reviewing outcomes, such as oral minoxidil before and after photos, it’s essential to distinguish what can happen from what is likely to happen. Take a look at the example we have created below. The scattered data points represent the full spectrum of possible individual results, while the central trendline shows the average, reflecting the most common or expected response.

These anecdotes (arrows on the graphs) often highlight “hyper-responders”. These are individuals who experience notably dramatic hair regrowth. They may have higher SULT1A1 activity, leading to higher levels of minoxidil activation.

These accounts, although genuine, illustrate results that surpass what most people can achieve. Problems can then arise when people fixate on these exceptional outcomes and assume that their experience will be similar. If their own hair growth is slower or less impressive, they might discontinue treatment early, or wrongly conclude that it isn’t working.

Impressive results are more frequently shared than modest improvements as a result of survivorship bias. This bias happens when only the most impressive successes receive attention, while the many cases with typical or less remarkable outcomes are overlooked or not reported.

Survivorship bias can distort our understanding of how hair loss treatments perform. Online narratives often draw attention to the most extreme cases, either astonishing successes or clear failures, while the more typical moderate outcomes that most people experience are rarely seen or discussed.

Now that we have covered the clinical evidence, strategies, and reasonable expectations for oral minoxidil, let’s now look into 10 firsthand accounts of oral minoxidil before and after photos shared by real users on Reddit.

Oral Minoxidil Success Stories

Keep in mind that the experiences below are purely anecdotal in nature and are not subject to any independent verification. They strictly reflect the individual journeys of each poster and should not be construed as reliable clinical evidence or medical advice.

Case 1: Male (29), Oral minoxidil monotherapy (11 months, 5 mg nightly)

This Redditor began oral minoxidil monotherapy at a dose of 2.5 mg before increasing to 5 mg once nightly. He had switched from topical minoxidil after a year of subpar results. He experienced shedding in the early months of therapy, with visible regrowth by month 3, and a major improvement in hair density by 11 months. Overall, the patient was satisfied with thicker scalp coverage, a fuller beard and brows, and did not report any significant side effects.

Case 2: Male (26), finasteride and oral minoxidil (2 years total; 1 mg finasteride and 2.5 mg oral minoxidil daily)

This 26-year-old used a combination of 1 mg finasteride and 2.5 mg oral minoxidil once daily, having switched from topical to oral minoxidil one year into treatment. He reported notable improvement one year into therapy, with visible regrowth by the 4-month mark. He did not report any shedding or other side effects after switching from topical to oral formulations. After two years of treatment, the patient reported marked hair thickening and cosmetic improvement.

Case 3: Female, oral minoxidil monotherapy (2 years; 2.5 mg daily, titrated up from 1.25 mg)

This user reported one her progress with oral minoxidil monotherapy over 2 years. She started at a daily dose of 1.25 mg, before increasing to 2.5 mg. She had tried vitamins, spironolactone, oils, and Nioxin/Nizoral without benefit for one year prior. Shedding started shortly after beginning the protocol and normalized by the fourth month. She reported visible improvement within one year, and by the end of the second year, she had notable improvement in ponytail thickness and part density. She also reported that her hair looked and felt close to pre-loss baseline. The user did not report any significant side effects.

Case 4: Female (24), Oral and topical minoxidil (9 months topical 5% foam; 6 months oral 0.625 – 1.25 mg nightly)

This 24-year-old began minoxidil monotherapy with 5% foam nightly, before adding oral minoxidil 0.625 mg three months later, and titrating to 1.25 mg nightly the following month. She continued both nightly for six months. She did not note any noticeable shedding on the foam, nor after incorporating 0.625 mg orally. She reported steady baby hairs and a reduction in hair loss at ~6-9 months alongside thickening compared to the baseline, and mentioned that her hair felt and looked much closer to its pre-loss condition overall. She also reported faster growth of facial/body hair (hypertrichosis), water retention, and bloating after salt meals, and occasional stronger heartbeat at night, after incorporating oral minoxidil, though this last symptom did resolve.

Case 5: Male, oral minoxidil (6 weeks shown; 5 mg daily) and weekly microneedling

This male Redditor used oral minoxidil 5 mg once daily in addition to microneedling once weekly with a pen device. The poster also noted no side effects from finasteride, implying that they might have used it alongside the other treatments. He reported an initial shedding phase at around week 3 and rapid visible coverage by week 6 into treatment. In commenting on the progress to date, he noted fuller coverage compared to baseline and said his beard was slightly thicker without any apparent increase in body hair. He did not report any side effects.

Case 6: Female, oral minoxidil + spironolactone (1 year; 1.25 mg oral minoxidil daily, 50 mg spironolactone daily)

The poster took oral minoxidil 1.25 mg once daily, in addition to spironolactone 50 mg once daily (started at 100 mg but reduced the dose due to drowsiness). She noted visible improvement after about 5 months of consistent use, with shedding slowing markedly around weeks 7-8. At the one-year mark, she reported noticeably fuller hair at the part and temples, with ongoing gradual thickening, and “good hair days”. She reported increased body and facial hair from oral minoxidil, which she managed by waxing, and did not report any noticeable weight gain or low-blood-pressure symptoms. 

Case 7: Female, oral minoxidil monotherapy (6 months; 1.25 mg daily, titrated from 0.625 mg)

This female Redditor took oral minoxidil 1.25 mg once daily for six months, having started from the initial dose of 0.625 mg. She supplemented with vitamin B12 injections every two weeks for pernicious anemia, daily shampooing, higher protein intake, and therapy/stress management. She reported steady improvement in hair through month 6, despite a brief “dread shed” in the initial month. Unfortunately, the images don’t show the same hair pulled back, so we can’t see exactly how much improvement was gained. She did report increased facial hair, which she has been managing by shaving/dermaplaning.

Case 8: Female, oral minoxidil monotherapy (1 year; 1.25 mg daily)

This user took oral minoxidil 1.25 mg once daily for one year. She also used Nizoral shampoo on the same timeline. Her hair loss was first diagnosed as telogen effluvium that did not resolve, and she now suspects AGA. She reported modest shedding in the first 2 months, then gradual thickening over the year. The photos showed some improvement, but the patient stated that she is not fully back to baseline. Regarding side effects, she noted increased body hair growth and mild dizziness in the first month that resolved.

Case 9: Male, self-made oral minoxidil (3 months; ingested diluted topical solution)

This male Redditor switched from applying topical minoxidil to drinking a diluted solution mixed with water. He reported taking “a few drops” per dose, having discontinued application of the topical preparation to the scalp. At the three-month mark, the Redditor reported clearly greater overall density and said results were still improving. He did not report any side effects, except for some extra body hair. 

We should mention that we do not recommend ingesting topical minoxidil – if oral therapy is pursued, it is advised to use a prescribed oral dose under medical supervision to control dosing and avoid health risks.

Case 10: Female, oral minoxidil monotherapy (12 months; dose not reported)

This user reported taking oral minoxidil at an unspecified dose for about one year. The photos show modest improvements around the parting. The poster did not report any side effects. Notwithstanding the sparse information provided by this Redditor, multiple commenters observed hair thickening and density gains in the before-and-after photos.

Strategies to Optimize Oral Minoxidil Response

To maximize the benefits of oral minoxidil, consistent use and patience are essential as optimal regrowth often takes 6-8 months to fully manifest. Combining oral minoxidil with other treatments like finasteride or dutasteride, platelet-rich plasma (PRP), or low-level laser therapy (LLLT) can improve results for those who do not respond sufficiently to minoxidil alone. Recent studies support the efficacy of combination regimens, particularly oral minoxidil plus finasteride, with one retrospective study finding significant and clinically meaningful improvements.^[7]Johnson, H., Huang, D., Clift, A.K., Bersch-Ferreira, A., Guimaraes, G.A. (2025). Effectiveness of Combined Oral Minoxidil and Finasteride in Male Androgenetic Alopecia: A Retrospective Service … Continue reading 

People using oral minoxidil, especially at 2.5 mg or more and in combination with other treatments, should keep an eye on potential side effects. This can help catch rare but potentially serious side effects like edema or changes in blood pressure. Regular follow-ups can ensure that any adverse effects are detected early and that the regimen can be safely adjusted to maintain a balance between safety and efficacy. This patient-tailored management increases the likelihood of achieving the best possible outcomes while minimizing health risks.

Probable Regrowth Timeline

Based on the available evidence, the expected regrowth timeline for oral minoxidil is around 8 months.

Months 0-3: Possible increased shedding; no visible gains

• Temporary shedding can occur as follicles transition into a new growth cycle.
• This process often resolves within the first 4-8 weeks and is seen as an early sign that the treatment is starting to take effect.

Months 3-6: First positive density changes for many

• Early visible improvements, such as reduced shedding and appearance of fine new hairs, can be expected.
• Thicker, darker regrowth starts to become apparent for most users during this period.

Months 6-8: Maximal visible benefits

• Cosmetic changes peak, with stronger hair, increased density, and the greatest coverage observed. 
• This is the period of maximum regrowth for most individuals. 

Months 8-12+

• Further gains plateau.
• Continued daily use is needed to maintain improvements.
• Some might consider combination treatment at this point to increase growth outcomes.

Safety and Side Effects

While oral minoxidil can avoid local irritation occurring with the topical formulation, some safety concerns do remain.

Oral minoxidil use does carry a risk of cardiovascular issues like pericardial effusion, especially at the high doses used for blood pressure control. At hair loss doses (0.25 – 5 mg), such events are rare and tend to be individual rather than predictable. 

The majority of side effects, such as excess body hair, mild ankle swelling, lightheadedness, or palpitations, are mild and usually resolve with dose adjustments or stopping the medication. 

Large safety studies have shown that serious side effects are exceedingly rare in otherwise healthy individuals taking low-dose oral minoxidil, with only a small percentage discontinuing treatment due to adverse effects. 

A gradual dose escalation is recommended to minimize side effects with oral minoxidil. Recent studies have shown that a 2.5 mg daily dose is as effective as 5 mg for treating male pattern hair loss, but with a better safety profile, and this supports 2.5 mg as a preferred starting dose for men.^[9]Fonseca, L.P.C., Miot, H.A., Chaves, C.R.P., Ramos, P.M. (2025). Oral Minoxidil 2.5 mg vs 5 mg for Male Androgenetic Alopecia: A Double-Blind Randomized Clinical Trial. Journal of the American … Continue reading 

If you want to use a higher dose, sublingual minoxidil may be beneficial for reducing the risk of cardiovascular side effects.^[10]Gupta, A.K., Bamimore, M.A., Williams, G., Talukder, M. (2025). Comparative Efficacy of Minoxidil and 5-Alpha Reductase Inhibitors Monotherapy for Male Pattern Hair Loss: Network Meta-Analysis Study … Continue reading 

Practical Takeaways

• Oral minoxidil is an effective and generally well-tolerated alternative for people who cannot use topical minoxidil or do not respond to it.
• Clinical trial results typically show stabilization or modest regrowth. Hyper-responder cases seen online are possible but not common. 
• Careful dose selection (0.25 – 2.5 mg daily) minimizes side effects while maintaining efficacy.
• Consistent, long-term use is key; optimal results generally take 6-8 months to appear and require ongoing treatment to maintain gains.
• Combining oral minoxidil with other therapies such as finasteride, dutasteride, PRP, or LLLT may improve outcomes for partial responders.

Final Thoughts

Oral minoxidil use is growing, but should be recognized as an off-label option (albeit backed by a solid body of emerging evidence.. Most users can expect stabilization or noticeable yet modest regrowth rather than dramatic transformation. The best outcomes come with realistic expectations, consistent use over several months, and regular medical supervision to ensure safety. By focusing on average, evidence-based results rather than rare hyper-responder anecdotes, patients can make balanced decisions and maintain long-term adherence to their treatment plan.

Topical minoxidil has been a cornerstone of androgenic alopecia (AGA) treatment since its FDA approval in the 1980s. With millions of users worldwide, it stands as one of the most widely adopted therapies for hair loss, supported by decades of clinical evidence, and an enormous body of real-world anecdotes, reviews, and before-and-after photos. 

However, results with minoxidil can be highly variable, and this variability can be traced in part to biological differences, particularly in the activity of the sulfotransferase enzyme (SULT1A1), which is responsible for converting minoxidil into its active form. Not everyone sulfates minoxidil effectively, meaning that while some achieve meaningful regrowth, others see little to no improvement. 

Interested in Topical Minoxidil?

High-strength topical minoxidil available, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

Click Here For 15% Off

*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Adding to this challenge is the influence of online topical minoxidil before and after photos (like you can see below), which can create inflated expectations compared to the more modest, probable outcomes seen in practice. 

This article will break through that noise to answer a critical question: when it comes to minoxidil, what is actually the most probable result, not just possible? 

First, let’s take a look at what topical minoxidil is.

Refresher: What is Topical Minoxidil?

Topical minoxidil was the first therapy ever approved by the FDA for the treatment of AGA, making it a landmark in the medical management of pattern hair loss.^[1]Suchonwanit, P., Thammarucha, S., Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. 13. 2777-2786 Introduced in the 1980s, it has since become one of the most widely available and researched treatments across the globe. Its primary action is as a potassium channel opener, which helps to stimulate blood flow, prolong the hair’s growth phase (anagen), and increase follicle size, mechanisms that together can support thicker, denser hair regrowth over time.^[2]Messenger, A.G., Rundegren, J. (2004). Minoxidil: mechanisms of action on hair growth. British Journal of Dermatology. 150(2). 186-194. Available at: https://doi.org/10.1111/j.1365-2133.2004.05785.x

Minoxidil is known as a “pro-drug”, meaning that it needs to be activated within the body to exert its effect. The enzyme responsible for this is called sulfotransferase or, more specifically, SULT1A1. The level of sulfotransferase activity differs depending on the individual, which means that the effectiveness of treatment also differs depending on who you are.^[3]Pietrauszka, K., Bergler-Czop, B. (2020). Sulfotransferase SULT1A1 activity in hair follicle, a prognostic marker of response to the minoxidil treatment in patients with androgenetic alopecia: a … Continue reading 

Formulations typically come in 2% and 5% strengths. The 2% solution was originally FDA-approved for women, while the 5% concentration was approved for men; however, both are now commonly used off-label across genders. Beyond these standard strengths, compounding pharmacies have made higher concentrations available for patients seeking more individualized treatment approaches, with some online telehealth providers (such as Ulo) offering customized formulations. Standard dose topical minoxidil is available over-the-counter in most countries, ensuring accessibility without the need for a prescription.

The Evidence

Topical minoxidil’s robust efficacy for hair regrowth is supported by dozens of high-quality randomized controlled trials (RCTs) and meta-analyses across men and women, consistently demonstrating average increases in hair count of around 10-20% over 6-12 months. 

We have collated many of these studies into a table, which you can look at here. However, we have summarised some of the most recent topical minoxidil studies.

Liang et al. (2022)

• Prospective, evaluator-blinded RCT with 120 women with female pattern hair loss (FPHL) assigned to three groups: 5% topical minoxidil alone; 5% minoxidil + oral spironolactone (80-100 mg); and 5% minoxidil and microneedling every 2 weeks.^[4]Liang, X., Chang, Y., Wu, H., Liu, Y., Zhao, J., Wang, L., Zhuo, F. (2022). Efficacy and Safety of 5% Minoxidil Alone, Minoxidil Plus Oral Spironolactone, and Minoxidil Plus Microneedling on Female … Continue reading
• Duration: 24 weeks; outcomes measured included dermascope, ultrasound biomicroscopy, physician, and patient assessments.
• Effective rate at week 2:
  • 55.27% (topical minoxidil)
  • 86.49% (topical minoxidil and oral spironolactone)
  • 95% (topical minoxidil and microneedling)
• Combo therapies (Groups 2&3) outperformed topical minoxidil alone for hair density, shaft diameter, scalp/thickness, shedding, and quality of life; Group 3 showed the greatest benefit.
• Adverse effects were reported across all groups; more menstrual disorders were reported in the spironolactone group. Main limitations: small sample, exclusion of severe cases, possible bias from unblinded treatments.

Hassan et al. (2022)

• Comparative study in 60 women with FPHL: 5% minoxidil topical foam and oral vitamin D3, minoxidil foam only, or vitamin D3 for 12 weeks (plus 15 controls for vitamin D comparison).^[5]Hassan, G.F.R., Sadoma, M.E.T., Elbatsh, M.M., Ibrahim, Z.A. (2022). Treatment with oral vitamin D alone, topical minoxidil, or combination of both in patients with female pattern hair loss: A … Continue reading 
• Primary outcomes: reduction in thin hair count and Ludwig stage improvement via clinical and dermoscopic evaluation. 
• Best results from combination therapy (minoxidil foam and vitamin D3), followed by minoxidil foam alone; vitamin D3 monotherapy had minimal effect.
• Vitamin D3 appeared to enhance minoxidil efficacy, though the sample size was small, and adverse events were not reported. 

Bao et al. (2022)

• RCT with 71 men, split into: 5% topical minoxidil twice daily, electrodynamic microneedling every 3 weeks, or topical minoxidil and microneedling combined.^[6]Bao, L., Zong, H., Fang, S., Zheng, L., Li, Y. (2019). Randomized trial of electrodynamic microneedling combined with 5% minoxidil topical solution for treating androgenetic alopecia in Chinese males … Continue reading
• Follow-up: 24 weeks, with an additional 6-month observation period.
• All treatments increased non-vellus hair density; the combined group had the greatest improvements in hair density and diameter. 
• The combination group received additional scalp massages (potential confounder); 12 participants experienced adverse reactions (dermatitis, dandruff, lymph node enlargement), none severe.

Singh et al. (2020)

• Double-blind, placebo-controlled RCT in 80 men: Groups received either 5% topical minoxidil, 5% topical minoxidil and PRP injections, placebo, or PRP alone.^[7]Singh, S.K., Kumar, V., Rai, T. (2020). Comparison of efficacy of platelet-rich plasma therapy with or without topical 5% minoxidil in male-type baldness: A randomized, double-blind placebo control … Continue reading
• 12 weeks’ treatment with 2-month follow-up; outcome: changes in total, terminal, vellus, and non-vellus hair density, pigmentation, and global assessments.
• Highest hair density and satisfaction with topical minoxidil and PRP; both monotherapies are better than placebo, but the combo was most effective.
• Limitations: short-term follow-up, some subjective outcomes; low adverse event rate (mostly mild, e.g., scalp pruritus, facial hair growth).

Overall, when you look across all of the data, consistent benefits are seen with topical minoxidil usage. However, these results are variable. The key reason for this is differences in sulfotransferase activity. As we mentioned before, minoxidil is a pro-drug, and it needs to be enzymatically activated to exert its effect. We will go into more detail about this below.

What’s Possible ≠ What’s Probable

When evaluating treatment outcomes, especially online minoxidil before and after photos, it’s important to separate possibility from probability. The scattered data points below show the full range of what might occur for individuals, while the central trendline reflects the average outcome (i.e., what typically happens).

Online anecdotes often showcase what we would call “hyper-responders” – people who experience dramatic results. These people may also have higher levels of sulfotransferase activity.

These stories, while real, represent outcomes that are well above average. The issue arises when patients focus only on these peak results and expect the same for themselves. If their own progress seems slower or less dramatic, they may stop prematurely or mistakenly believe the treatment is ineffective.

Dramatic results are often showcased more than modest outcomes because of survivorship bias. This bias occurs when only the most striking successes are noticed or shared, while the many average or less impressive results go unreported.

Why Results Are Variable: The SULT1A1 Enzyme

Minoxidil must be converted into minoxidil sulfate by the sulfotransferase enzyme SULT1A1, which is present in the outer root sheath of hair follicles, to become pharmacologically active and stimulate hair growth. 

Several peer-reviewed studies confirm that the level of SULT1A1 activity in scalp follicles is a key determinant of how well a patient responds to minoxidil therapy.^[9]Goren, A., Castano, J.A., McCoy, J., Bermudez, F., Lotti, T. (2014). Novem enzymatic assay predicts minoxidil response in the treatment of androgenetic alopecia. Dermatologic Therapy. 27(3). 171-173. … Continue reading Enhancing SULT1A1 activity, such as by using enzyme-boosting adjuvants, has been shown in recent trials to convert a majority of prior non-responders into responders, further confirming the mechanistic role of this enzyme.^[10]Chandrashekar, B.S., Chandu, M., Shenoy, C., Chander, A., Roopa, M.S. (2024). SULT1A1 enzyme booster to amplify topical minoxidil response in androgenic alopecia: a single-center prospective study. … Continue reading 

This enzyme-based variability explains why two people can apply minoxidil in the same way but see very different outcomes, and why more than half of users may see only limited or no benefit despite consistent application.

Fixing the Enzymatic Problem

A number of evidence-based strategies exist to improve minoxidil response. These include microneeding, retinoic acid co-application, formulation changes, consistency, and combination therapy.

Microneedling

Multiple systematic reviews and clinical trials confirm microneedling significantly improves minoxidil efficacy. A 2023 meta-analysis showed that combining the two led to a significantly greater increase in hair count compared to minoxidil alone, regardless of needle depth or device used. Hair count improvements are notable after 12 to 24 weeks of combined treatment.^[11]Ahmed, K.M.A., Kozaa, Y.A., Abuawwad, M.T., Al-Najdawi, A.I., Mahmoud, Y.W., Ahmed, A.M., Taha, M.J.J., Fadhli, T., Giannopoulou, A. (2025). Evaluating the efficacy and safety of combined … Continue reading 

You can read more about how microneedling improves minoxidil efficacy here.

Retinoic Acid (Tretinoin)

Topical tretinoin has been shown in peer-reviewed studies to upregulate follicular SULT1A1, thereby enhancing the conversion of minoxidil to its active form. In a 2019 study, tretinoin not only improved clinical response in difficult cases but also increased scalp SULT1A1 activity, supporting its role as a mechanistic booster.^[12]Sharma, A., Goren, A., Dhurat, R., Agrawal, S., Sinclair, R., Trueb, R.M., Vano-Galvan, S., Chen, G., Tan, Y., Kovacevic, M. (2019). Tretinoin enhances minoxidil response in androgenetic alopecia … Continue reading

You can see the benefits of adding retinoic acid in our Compare Treatments graph below.

Learn more about retinoic acid and its effects on sulfotransferase here.

Formulation Adjustments (Foam vs. Solution 2% vs. 5%)

Clinical research shows that 5% minoxidil is more effective than 2% for both men and women. Foam is as effective as a solution but better tolerated, with reduced risk of contact dermatitis due to the absence of propylene glycol. Some evidence suggests liquid formulations might yield slightly higher absorption, but both forms are clinically comparable.^[13]Purnak, T., Senel, E., Sahin, C. (2011). Liquid formulation of minoxidil versus its foam formulation. Indian Journal of Dermatology. 56(4). 462. Available at: https://doi.org/10.4103/0019-5154.84714 

Consistency and Adherence

Missed doses can reduce topical minoxidil efficacy. Some clinical guidance suggests that missing minoxidil applications even once per week can diminish results, and consistent, daily use is necessary to achieve and maintain hair regrowth.^[14]Shadi, Z. (2023). Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia. Dermatology and Therapy. 13(5). 1157-1169. Available at: … Continue reading 

Combination Therapy

Combining minoxidil with finasteride/dutasteride, PRP, low-level laser therapy (LLLT), or, in resistant cases, oral minoxidil, provides superior results versus monotherapy. Meta-analyses and randomized trials consistently find greater improvement in hair density, count, and patient satisfaction when using combination regimens.^[15]Xia, Y., Chen, H., Chen, Y., Chen, Z. (2025). Relative efficacy of minoxidil in combination with other treatments for androgenic alopecia: a network meta-analysis based on randomized controlled … Continue reading 

So, what do online topical minoxidil before and after photos look like?

Online Topical Minoxidil Successes

Now that we have discussed how topical minoxidil works, potential regimens, and likely timelines, here are 10 reports published by Reddit users with before and after photos.

Disclaimer: The stories below are unverified anecdotes. Consequently, they illustrate individual outcomes and should not be construed as clinical proof or medical advice.

Case 1: Male (age unknown), 6 months on topical minoxidil monotherapy (5% once daily)

This individual applied 5% topical minoxidil once daily for six months. They chose topical minoxidil out of a general preference for avoiding oral medications. From the before-and-after photos, diffuse thinning can be observed from the center of the crown, and the protocol yielded a noticeable increase in crown density by month six. No side effects or early shedding have been reported.

Case 2: Female (age unknown), about 5 months on topical minoxidil monotherapy (5% once nightly)

This user applied 5% topical minoxidil once nightly for about 5 months, using a liquid solution that she purchased over the counter after a telemedicine consult. She stated that she had AGA and did not note any other treatment. Based on both her comments and photos, she experienced marked improvement in hair density and coverage, stating that minoxidil “saved her hair” and that she wishes she had started earlier. She did not describe any notable early shedding, but noted dry scalp and some dandruff as potential side effects.

Case 3: Male (age unknown), 60 days on topical minoxidil monotherapy (5% foam nightly)

This Redditor applied 5% minoxidil foam once nightly before bed for two months without any concurrent treatment. He reports the typical amount applied daily as “one cap-full”, rinsed out the next morning. The user has Crohn’s disease with prior nutrient absorption issues, and chose to avoid ifnasteride due to side-effect concerns. He had about one year of noticeable thinning before starting. Upon starting minoxidil, shedding increased for the first two weeks, then eased. The first measurable improvement was visible by day 30, with clear density gains at day 60. The crown region improved the fastest, while hairline changes were slower.

Case 4: Female (age unknown), 1 year 5 months on topical minoxidil foam (5% once daily)

This user had AGA with prior telogen effluvium, reporting diffuse thinning along the part and temples and a reportedly high daily shedding. She began therapy with Rogaine Men’s Foam 5% once nightly, supported by Ketoconazole 2% shampoo once weekly. At 2 months of treatment, “peach fuzz”/baby hairs were visible at the hairline and temples. At 6 months, there was a noticeable density across the top with new hairs evident but still short. After 1 year and 5 months of therapy, she notes ongoing thickening and widespread new hair growth. She also reported that her shower shed decreased from ~70 hairs to ~10-15, with visual density improving at the part and temples. She reported a mild scalp itch at the start and subtle peach-fuzz on the upper lip and chin as side effects. 

Case 5: Male (age unknown), 2.5 months on topical minoxidil (5% liquid 1 mL twice daily)

This male user, likely with AGA, reported recession at the hairline and thinning at the crown after 2.5 months of using a Rogaine-style 5% liquid at 2 mL/day, without any concurrent DHT blocker. He experienced an early shedding phase ~1 month into treatment, which stabilized with continued use. He exhibited visible thickening at the hairline and crown by 2.5 months of therapy. He did not report any systemic or local side effects and plans to continue minoxidil while considering adding weekly microneedling and/or topical finasteride if progression resumes. 

Other Redditors have used combination treatments to further improve their hair regrowth. As you can see below, some of the results look dramatic.

Case 6: Male (age unknown), 3 months on topical combo (minoxidil 5% and finasteride 0.1% once nightly)

This user had thinning at the hairline and vertex areas of the scalp and began treatment to improve hair density and maintenance. He applied a single compounded solution (Novegrow) containing minoxidil 5% and finasteride 0.1%, once nightly, for three months before reporting on progress. Additionally, he dermarolled his scalp with a 0.5 mm needle twice weekly and supplemented with daily biotin and a multivitamin. He reported mild shedding in the first two weeks of therapy, and by month 3, he noted visible thickening and improved coverage. He did not report any side effects and added that the once-daily schedule was practical and helped with adherence.

Case 7: Male (25), 11 months on combination therapy (finasteride 1 mg daily and topical minoxidil foam 5% once daily)

This Redditor exhibited typical AGA with frontal recession and diffuse vertex thinning. His core regimen is oral finasteride 1 mg daily and minoxidil 5% foam (Kirkland) once daily. He noted he took regular ice/cold baths, ensured an increased water intake, engaged in exercise, avoided junk food, and did not smoke. He saw noticeable thickening from around 6 months after several shedding cycles. By month 11, he experienced substantial cosmetic improvement, with some commenters even comparing the results to transplant-level density. He did not report any adverse effects from finasteride or minoxidil, and subjectively felt less “brain fog” after starting finasteride.

Case 8: Male (37), 4 months on topical minoxidil 5% and topical finasteride 0.1% (1 mL nightly)

This male had crown-predominant thinning with a stable hairline at baseline. His core regimen is a single combined solution containing minoxidil 5% and finasteride 0.1%, applied to the crown only. He did not report any microneedling or supplementation. He reported that shedding began around week 3 and was “heavy” for approximately 4 weeks. The shedding tapered and largely stopped at the 2.5-month mark. By month 4, he achieved visible crown regrowth and thickening compared to the baseline, despite the application being limited to the crown. He perceived an increase in overall density and did not report any side effects.

Case 9: Male (34), about 12 months on topical finasteride 0.3% and minoxidil 6% (twice daily)

This male reported on his progress after using a combination of topical finasteride 0.3% and minoxidil 6% treatment twice daily for nearly one year. He first experienced hair thinning and hairline recession beginning in his late 20s. Alongside the topical treatments, he also applied a dermastamp at approximately 1.5 mm every 10 days. He reported significant shedding during the first two months of treatment along with mild chest tenderness in the first month, which resolved after temporarily halving the topical dose. He reported month-on-month thickening, with clear improvement by months 7-8 and robust density by the one-year mark.

Case 10: Male (22), 90 days on finasteride 1 mg and minoxidil 5% twice daily plus dermarolling

This user with early temple recession began a combination therapy of finasteride 1 mg oral daily, minoxidil 5% foam twice daily, and dermaoll 1.5 mm weekly. He experienced noticeable shedding at weeks 3-6 of therapy, and at the 90-day progress mark, he reported visible filling in of the temple and general thickening of the hair. He did not report any side effects and noted that pushing through the initial shedding phase was crucial to his progress thus far.

Probable Regrowth Timeline

Based on the available evidence, we have mapped out a likely regrowth timeline (although some may experience results faster or later).

Months 0-3: Initial shedding

• Temporary shedding may occur as follicles shift into a new growth phase.
• This usually resolves within the first 4-8 weeks.

Months 3-6: Early cosmetic improvements

• Early visible improvements, such as reduced shedding and appearance of fine new hairs, can be expected.
• Thicker, darker regrowth starts to become apparent for most users during this period.

Months 6-12: Peak cosmetic changes

• Cosmetic changes peak, with stronger hair, increased density, and the greatest coverage observed.
• This is the period of maximum regrowth for most individuals.

Months 12+: Plateau, maintenance, & slight regression

• Further gains plateau, with 5-year studies showing hair counts remaining above baseline –– but with some loss in “peak” results from year one. Continued daily use is needed to maintain improvements, as stopping treatment leads to a gradual reversal within a few months.

Safety and Side Effects

Local side effects are relatively common with topical minoxidil, especially with the liquid formulations. The principal culprits are propylene glycol and ethanol, which frequently cause redness, itching, dryness, and a dandruff-like scaling of the scalp.^[16]Makhlouf, A., Elnawawy, T. (2023). Hair regrowth boosting via minoxidil cubosomes: Formulation development, in vivo hair regrowth evaluation, histopathological examination and confocal laser … Continue reading Patients with sensitive skin are particularly prone to these adverse reactions and may experience contact dermatitis, which can make long-term use uncomfortable.

The foam formulation is generally better tolerated because it lacks propylene glycol. Most clinical trials and user surveys report fewer cases of scalp irritation, itching, or flaking with foam compared to the liquid version.^[17]Purnak, T., Senel, E., Sahin, C. (2011). Liquid formulation of minoxidil versus its foam formulation. Indian Journal of Dermatology. 56(4). 462. Available at: https://doi.org/10.4103/0019-5154.84714 

While systemic absorption of topical minoxidil is rare, some users may experience unwanted side effects such as dizziness and the growth of facial or body hair away from the application site. These effects are more likely if the medication is used excessively or applied to broken or abraded skin, which can increase absorption. We do not recommend using topical products if you have an inflammatory scalp condition – deal with that problem first, and then take a look at topical hair regrowth products.

Overall, when used as directed, topical minoxidil has a strong safety profile, with most side effects limited to mild local irritation.

Practical Takeaways

• Topical minoxidil is effective and well-established, but clinical results vary between individuals.
• Most patients achieve stabilization of hair loss with modest regrowth, though complete restoration is uncommon.
• Response depends partly on scalp sulfotransferase enzyme activity, which explains why some non-responders see little or no improvement.
• Best results come with consistent, long-term use and may be enhanced by adjuncts such as microneedling or topical retinoids to improve absorption and efficacy.

Final Thoughts

When evaluating minoxidil, it is important to recognize it as the most widely accessible and evidence-backed treatment for androgenetic alopecia. While outcomes can vary, most users see stabilization and modest regrowth rather than dramatic reversal. Success depends on realistic expectations, consistent use, and optimized regimens that may include adjunctive therapies. Applying a framework that emphasizes the likely trendline over anecdotal extremes can help you stay committed, avoid discouragement, and make informed decisions grounded in evidence and personal treatment goals.

Oral finasteride has long been the mainstay for androgenic alopecia (AGA), but many patients and clinicians have turned to dutasteride, a more potent 5ɑ-reductase inhibitor, in pursuit of superior hair growth. 

Oral dutasteride (0.5 mg daily) can reduce dihydrotestosterone (DHT) by 90% or more (compared to ~70% with finasteride), and clinical studies show it grows more hair than finasteride. In fact, a 24-week trial found that oral dutasteride 0.5 mg significantly outperformed finasteride 1 mg in increasing hair counts.^[1]Shanshanwal, S.J.S., Dhurat, R.S. (2017). Superiority of dutasteride over finasteride in hair regrowth and reversal of miniaturization in men with androgenetic alopecia: A randomized controlled … Continue reading

However, dutasteride’s very potency raises concerns: will it also increase side effects like decreased libido or hormonal disturbances? Interestingly, research so far suggests that dutasteride has a similar tolerability profile to finasteride with no clear increase in sexual side effects despite its stronger DHT suppression.^[2]Almudimeegh, A., Almutairi, H., AlTassan, F., AlQuraishi, Y., Nagshabandi, K.N. (2024). Comparison between dutasteride and finasteride in hair regrowth and reversal of miniaturization in male and … Continue reading 

Even so, oral dutasteride’s reputation (it’s approved for prostate enlargement and used off-label for hair loss) makes some men uneasy, especially those who experienced side effects on finasteride. This has led to rising interest in topical dutasteride formulations. By delivering dutasteride directly to the scalp, the goal is to concentrate its DHT-blocking action where it’s needed (hair follicles) while limiting how much enters the bloodstream. The questions we need to answer are:

• Does topical dutasteride work?
• Does it match or even exceed the efficacy of oral treatments?
• Can it maintain these benefits with a more favorable side effect profile?

Ulo offers dutasteride options that range from low to high dose dutasteride – allowing you to be flexible in your treatment choices.

Interested in Topical Dutasteride?

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Oral vs. Topical Dutasteride

Early evidence indicates that topical dutasteride can indeed improve hair growth, in some cases achieving results comparable to oral therapy but with lower systemic DHT reduction. 

Study One

One study tested dutasteride solutions of 0.01%, 0.02%, and 0.05% against a placebo (and an active control) over 24 weeks. All dutasteride groups showed significant increases in hair count versus placebo, and the 0.05% topical solution actually showed more efficacy than oral finasteride (1 mg/day) in promoting regrowth.^[3]Panuganti, V.K., Madala, P.K., Grandhi, V.R., Alluri, C.V., Mohammed, J., Rao, S., Dundigalla, M.R. (2025). A Randomized, Double-Blind, Placebo and Active Controlled Phase II Study to Evaluate the … Continue reading

Study Two

A recent randomized controlled study compared oral dutasteride (0.5 mg daily) to topical dutasteride (0.02% administered via monthly microneedling), both combined with daily topical minoxidil 5%. The trial found that all groups (including minoxidil alone) saw improvement, but the topical dutasteride via microneedling group demonstrated results comparable to the oral dutasteride group in terms of increased hair density and width, with the added advantage of fewer systemic side effects.^[5]Obeid, M.N.A., Fatteh, N.S.A., Elfangary, M.M., Husseni, R.M.A. (2024). Comparison between Topical Minoxidil 5% Alone versus Combined with Dutasteride (Topical 0.02% through Microneedling or Oral 0.5 … Continue reading  

Patient satisfaction and physician assessment favored the microneedling + topical dutasteride group, suggesting that this method may offer similar efficacy to systemic dutasteride, but with reduced risk of systemic adverse effects. The study included both men and women with AGA.

How Does Dutasteride Work?

Dutasteride is a potent inhibitor of the enzyme 5ɑ-reductase, which exists in multiple isoforms in the body. Unlike finasteride (which selectively targets the type II isoenzyme), dutasteride blocks both type I and type II 5ɑ-reductase.^[6]Botto, H., Lan, O., Poulain, J-E., Comenducci, A. (2005). Effect of dutasteride on reduction of plasma DHT following finasteride therapy in patients with benign prostatic hyperplasia. Progrés en … Continue reading 

Type II is abundant in hair follicles and the prostate, while Type I is found in skin, sebaceous glands, and liver. By inhibiting both, dutasteride more completely prevents the conversion of testosterone to DHT.

At a standard oral dose of 0.5 mg/day, dutasteride can drive serum and scalp DHT levels down by ~90% or more.^[7]Ding, Y., Wang, C., Bi, L., Du, Y., Lu, C., Zhao, M., Fan, W. (2024). Dutasteride for the Treatment of Androgenetic Alopecia: An Updated Review. Dermatology. (5-6). 833-843. Available at: … Continue reading This is a more extensive suppression than finasteride achieves at typical doses. This dramatic drop in DHT removes the androgenic stimulus that causes susceptible hair follicles to shrink and enter shorter growth phases, thereby slowing hair loss and allowing follicles to recover over time. 

Topical dutasteride aims to harness this same mechanism locally. When applied on the scalp, dutasteride penetrates into the skin and hair follicle, binding to 5ɑ-reductase enzymes in the dermis and around the follicle bulb. Inhibiting local DHT production creates a scalp environment more conducive to hair growth. 

Pharmacokinetic studies of dutasteride demonstrate parallel linear and nonlinear elimination, with nonlinear (saturable) pathways dominating at low doses. These pathways quickly become saturated, so even small concentrations can lead to substantial enzyme inhibition. As drug concentrations rise and saturate the target enzyme, higher doses yield diminishing increases in effect.^[8]Gisleskog, P.O., Hermann, D., Hammarlund-Udenaes, M., Karlsson, M.O. (1999). The pharmacokinetic modelling of GI198745 (dutasteride), a compound with parallel linear and nonlinear elimination. … Continue reading

Therefore, topical dutasteride at 0.01-0.05% may achieve a large fraction of the DHT reduction that an oral dose would, as long as it reaches the target tissue. This is why even leakage of a small dose into circulation can suppress serum DHT measurably.

Another factor is dutasteride’s long half-life, about 4-5 weeks.^[9]Azzouni, F., Godoy, A., Li, Y., Mohler, J. (2011). The 5 Alpha-Reductase Isozyme Family: A Review of Basic Biology and Their Role in Human Diseases. Advances in Urology. 2012(530121). 1-18. Available … Continue reading This prolonged half-life means that any dutasteride absorbed systemically will accumulate with continued use. From a mechanism standpoint, this is a double-edged sword: 

• It ensures continuous enzyme inhibition (dutasteride remains bound to 5ɑ-reductase).
• But it also means systemic exposure is amplified over time if absorption isn’t minimized. 

What the Science Says

Research on topical dutasteride is not as extensive as that on topical finasteride, but a growing number of trials and case series shed light on its efficacy. Below, we summarize key findings across different concentrations and use cases:

Study	Concentration & Vehicle	Hair Growth-Outcomes	Systemic/Serum Findings
Nada et al, 2018, prospective randomized study, 30 men, 24 weeks.	Group 1: Minoxidil + topical dutasteride (0.02%). Group 2: Minoxidil only.	Group 1 showed a significant increase in hair density, width, and terminal/vellus ratio compared to Group 2. Patient assessment showed higher satisfaction in Group 1 than in Group 2.	Reduction in serum DHT observed.
Sanchez-Meta et al, 2022, double-blind RCT, 34 men, 16 weeks.	Group 1: Minoxidil and topical dutasteride (0.01%). Group 2: Minoxidil only.	Minoxidil and dutasteride produced a superior overall change in hair thickness and density compared to minoxidil alone.	Not evaluated.
Panuganti et al, 2025, phase II randomized, double-blind study, 135 men, 24 weeks.	Group 1: Dutasteride 0.01% w/v topical solution. Group 2: Dutasteride 0.02% w/v. Group 3: Dutasteride 0.05% w/v. Group 4: Oral finasteride 1 mg. Group 5: Placebo.	Dose-dependent increase in target area hair count (TAHC) vs placebo. Dutasteride 0.05% superior to finasteride at week 24. Mean TAHC increase: 0.01% (12.78), 0.02% (20.03), 0.05% (34.30) vs finasteride (12.57). More patients achieved investigator global photography assessment ≥+2 with 0.05% vs finasteride.	Dutasteride caused modest changes in serum testosterone/DHT, while finasteride caused moderate changes. 0.05% dutasteride showed a better pharmacokinetic profile with reduced systemic absorption compared to oral finasteride.

Overall, while there is a lack of peer-reviewed scientific literature, it does support the idea that topical dutasteride is an effective treatment for AGA. Where topical dutasteride does shine is in offering these benefits with reduced systemic involvement, making it a potential option for those who need dutasteride’s effects but are wary of its systemic effects.

Why Formulation and Dose Matter

Not all topical dutasteride products are created equal. Two main factors determine how well topical dutasteride works (and how “safe” it is systemically): formulation (the vehicle and additives) and dosage regimen (concentration and frequency).

• Vehicle and Penetration: Dutasteride is a large lipophilic molecule with poor water solubility.^[10]Kim, N.A., Choi, D.H., Kim, J.Y., Kim, K.H., Lim, D.G., Lee, E., Park, E-S., Jeong, S.H. (2014). Investigation of polymeric excipients for dutasteride solid dispersion and its physicochemical … Continue reading This makes formulation challenging; you need solvents or carriers that keep it stable and help it traverse the skin barrier. Newer vehicles like lipid carriers or cyclodextrin inclusion complexes might improve scalp targeting while limiting diffusion into blood.^[11]Kim, M-S., Ha, E-S., Choo, G-H., Baek, I-H. (2015). Preparation and in vivo evaluation of a dutasteride-loaded solid-supersaturable self-microemulsifying drug delivery system. International Journal … Continue reading,^[12]Min, M-H., Park, J-H., Choi, M-R., Hur, J-H., Ahn, B-N., Kim, D-D. (2018). Formulation of a film-coated dutasteride tablet bioequivalent to a soft gelatin capsule (Avodart): Effect of γ-cyclodextrin … Continue reading 
• Applied Dose vs. Concentration: Users often focus on the percentage (e.g., 0.1% vs 0.02%), but the total amount of drug applied per session is just as important. For example, using 2 mL of a 0.1% solution (which contains 2 mg dutasteride) will deliver four times the dutasteride to your scalp as 1 mL of the same solution. For example, one study using a 0.25% topical used at 4 sprays (around 400 μL) caused a much larger drop in serum DHT than the same solution used at 1-2 sprays (100-200 μL).^[13]Ding, Y., Wang, C., Bi, L., Du, Y., Lu, C., Zhao, M., Fan, W. (2024). Dutasteride for the Treatment of Androgenetic Alopecia: An Updated Review. Dermatology. 240(5-6). 833-843. Available at: … Continue reading 
• Furthermore, volume matters: a seemingly “low” concentration could cause systemic effects if applied in large quantities. Conversely, high concentrations used sparingly might localize better. 
• Dosing Frequency: Dutasteride’s long half-life means you may not need daily application to maintain its effect on the scalp. Ultimately, the goal is to find a regimen that keeps follicles saturated with dutasteride whilst avoiding leakage into the bloodstream.

Minimizing Systemic Absorption

As we have mentioned above, one of the primary motivations for using topical dutasteride is to limit the risk of side effects that come with systemic DHT suppression. There are several strategies you can use to achieve this. 

Vehicle & Penetration Enhancers

As discussed, formulation plays a huge role. Nanoemulsion-based gels and nanoemulgels significantly increase skin permeation and deposition of dutasteride compared to conventional formulations, with optimized nanoemulsions showing up to 1.5-fold enhancement in permeation.^[14]Ali, M.S., Alam, M.S., Alam, N., Siddiqui, M.R. (2014). Preparation, Characterization and Stability Study of Dutasteride-Loaded Nanoemulsion for Treatment of Benign Prostatic Hypertrophy. Iranian … Continue reading If systemic absorption is a concern, you could opt for a slightly less efficient formulation. 

Time On Scalp

The longer the product stays on your scalp, the more the drug can penetrate, increasing efficacy (and potentially systemic absorption). Washing your hair too soon can rinse away some of the medication, potentially reducing efficacy. Many protocols recommend allowing at least 4 hours of contact time (and preferably 6-8 hours) before washing off a topical. 

Application Frequency

Frequency can be adjusted to manage systemic load. Because dutasteride binds 5ɑ-reductase for so long, daily application might not be necessary for full benefit. If you find that daily use lowers your serum DHT more than desired, you could try every other day or even twice-weekly dosing. 

Scalp Condition and Individual Variation

Your skin’s permeability is unique to you..Differences in skin thickness can affect drug permeability (and therefore efficacy).^[15]Noor, N.M., Abudl-Aziz, A., Sheikh, K., Somavarapu, S., Taylor, K.M.G. (2020). In vitro Performance of Dutasteride-Nanostructured Lipid Carriers Coated with Lauric Acid-Chitosan Oligomer for Dermal … Continue reading However, you should be mindful that if you have a scalp condition (like seborrheic dermatitis, etc), you should avoid using any topical hair loss treatments until it has resolved.

Application Area

The larger the area of scalp you treat, the more drug can be absorbed. Treating just the crown vs. the entire scalp could proportionally change systemic exposure. If you have diffuse thinning and apply broadly, you might consider using a lower concentration to compensate for the larger area.

To minimize systemic absorption without compromising results, a practical approach can be:

• Use the lowest effective concentration.
• Use the smallest effective volume.
• Use the least frequent schedule.

This will often require trial and error as you find out what works for you. If you notice side effects like decreased libido, brain fog, or breast tenderness, these could be signs of systemic absorption. In such cases, dial back the frequency or concentration.

How to Maximize Gains and Minimize Risk

If you decide to use topical dutasteride, here are strategies to get the best hair growth results while keeping your risk low:

• Establish a Baseline (Lab Tests): Before starting, it’s wise to get bloodwork for your hormone levels – especially serum DHT and testosterone. This baseline will tell you where you started. Some people also get a full hormone panel (if advised to do so by their doctor). You can then re-test after 4-6 weeks to monitor any significant changes.
• Standardize Your Application Routine: Consistency is key for results. Apply the treatment to a dry scalp. If using a dropper or spray, try to target thinning areas evenly and rub it in gently. Pick a time of day you can stick with. Many prefer nighttime so it can absorb overnight; just be cautious about transferring to pillows (and thereby to partners). If you apply it in the morning, ensure it dries before any activity that might cause sweat (sweating could increase absorption or cause the product). 
• Add Proven Adjuncts (like minoxidil or microneedling): To maximize regrowth, consider combining therapies. Minoxidil can synergize with dutasteride by stimulating follicles directly, while dutasteride tackles the hormonal aspect. As seen above, studies show that dutasteride and minoxidil yield better density than either alone. Microneedling is another option. Weekly or monthly sessions of dermarolling have been shown to boost topical drug delivery and induce growth factors.^[16]Ahmed, K.M.A., Kozaa, Y.A., Abuawwad, M.T., Al-Najdawi, A.I., Mahmoud, Y.W., Ahmed, A.M., Taha, M.J.J., Fadhli, T., Giannopoulou, A. (2025). Evaluating the efficacy and safety of combined … Continue reading 
• Be Patient and Track Progress: Hair growth is a slow process. Do not expect major changes in the first weeks. In fact, you might experience some shedding initially. This can happen with any effective treatment and usually subsides. Give the treatment at least 6 months to a year to judge its effect. To accurately gauge progress, use objective tracking, such as standardized photos, hair counting, or a dermascope. 
• Lifestyle and Supplements: While on treatment, avoid introducing supplements that might complicate treatment. For instance, creatine may increase DHT, and quercetin may decrease it.^[17]van der Merwe, J., Brooke, N.E., Myburgh, K.H. (2009). Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical … Continue reading,^[18]Ma, Z., Nguyen, T.H., Huynh, T.H., Do, P.T., Huynh, H. (2004). Reduction of rat prostate weight by combined quercetin-finasteride treatment is associated with cell cycle deregulation. Journal of … Continue reading 
• Monitor Side Effects: If you notice any difference, then keep a note and let your healthcare provider know. You may be able to adjust the dosage to maintain hair gains and reduce side effects.

Combination Therapies: Enhancing Outcomes

Combination therapy can amplify the benefits of topical dutasteride. We’ve summarized a few of these below:

Dutasteride and Fractional CO2 Laser

One study was conducted in which 30 male AGA patients were randomized to either fractional CO2  laser plus topical dutasteride (0.002%) applied after each session.^[19]Galal, S.A., Ali, M.S., HafizHala, H.S.A. (2025). Comparative study between fractional CO2 laser alone versus fractional CO2 laser combined with topical dutasteride in treatment of male androgenic … Continue reading Each group received 3 sessions, one month apart. The combination group had significantly superior increases in terminal hair count and reductions in vellus hair and hair diameter diversity versus laser alone. Higher patient satisfaction was also reported in the combination group.

Triple Topical Therapy: Dutasteride, Finasteride, and Minoxidil

Fifteen male AGA patients, including both atopic and non-atopic subjects, used a topical compound containing finasteride, dutasteride, and minoxidil (“NuH Hair”), with optional additions of oral finasteride, topical minoxidil foam, and ketoconazole shampoo.^[21]Rafi, A.W., Katz, R.M. (2011). Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN Dermatology. 2011(241953). Available at: … Continue reading

All patients experienced significant new hair growth. Among those using all four components, significant regrowth was seen as early as 30 days, with “major” growth in three patients by day 30 and in all by day 60.  In those using only the triple topical, significant regrowth was observed in all by 3 months, despite some using it less frequently than recommended.  No systemic or local adverse effects were reported.

Topical Dutasteride + Microneedling

A 20-week, randomized, double-blind, placebo-controlled trial of microneedling plus topical 0.01% dutasteride solution (MNSD) vs. microneedling plus saline. The combination group demonstrated significant improvement in hair growth and density compared to the control. No systemic androgen suppression was detected, indicating a favorable safety profile.^[22]Sanchez-Meza, E., Ocampo-Candiani, J., Gomez-Flores, M., Herz-Ruelas, M.E., Ocampo-Garza, J., Orizaga-y-Quiroga, T.L., Martinez-Moreno, A., Ocampo-Garza, S.S. (2022). Microneedling plus topical … Continue reading 

The overarching theme of combinations like the above is synergy. By attacking hair loss from multiple angles, you often get faster, fuller, and more sustained regrowth.

Who Should (or Shouldn’t) Use Topical Dutasteride

Good Candidates

• Men with AGA who need a stronger option.
• Those who experienced side effects from oral finasteride/dutasteride.

Bad Candidates

• Anyone trying to conceive, or with infants, toddlers, or pregnant partners.
• People with non-AGA hair loss.
• Those with severe persistent side effects from 5ɑ-reductase inhibitors.
• People who aren’t able to commit to a consistent routine.

Final Verdict

So, does topical dutasteride work? In short, yes. Clinical trials and real-world use show that topical dutasteride can significantly improve hair growth and reduce shedding in men with androgenetic alopecia. When formulated correctly, it offers comparable scalp DHT suppression and regrowth potential to oral finasteride, and in some cases, it even approaches the efficacy of oral dutasteride, but with lower systemic exposure and fewer side effects.

The key is proper use. Results depend heavily on the right concentration, vehicle, dosage, and frequency. A well-balanced regimen, often guided by a medical provider, offers the best chance of success.

Topical finasteride is gaining traction as a lower-risk alternative to oral finasteride, especially for those concerned about systemic side effects. In the U.S., providers like Ulo and Strut stand out for customization and lab-tested purity. Canadian options include Xyon Health and Essential Clinic, while the UK and EU offer licensed sprays and private compounding through clinics like Hair Repair and Sons. No matter your location, choose sources with strong medical oversight and clear quality standards to ensure you’re getting a safe, effective treatment.

Top Places to Buy Topical Finasteride

• #1 Choice for Quality and Growth: Ulo
• Top Runner-Up in the USA: HappyHead
• Top Pick in Canada: Xyon Health 
• Top Runner-Up in Canada: Jupiter
• Top Pick in the UK: Hair Repair Clinic
• Top Runner-Up in the UK: UsMen

Topical finasteride is a well-known 5ɑ-reductase inhibitor used off-label as a localized treatment for androgenic alopecia (AGA). Finasteride in oral form is an FDA-approved medication for AGA, but its topical formulation is not officially approved in the US. However, compounding pharmacists and telehealth services do prepare it for off-label use.

The goal of using finasteride topically is to deliver the drug to hair follicles in the scalp while minimizing systemic absorption, thereby reducing the risk of side effects commonly associated with the oral pill. Below, we’ll discuss how topical finasteride works and why the source of your topical finasteride matters. Then we’ll explore where to buy topical finasteride in the US and around the world.

Interested in Topical Finasteride?

Low-dose & full-strength finasteride available, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

Click Here For 15% Off

*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Mechanism of action

Finasteride works by inhibiting the enzyme 5ɑ-reductase (specifically the type II isoenzyme) that converts testosterone into dihydrotestosterone (DHT). DHT is the androgen hormone that binds to hair follicles and causes them to miniaturize in genetically susceptible individuals, leading to thinning hair and eventual hair loss. By blocking DHT production, especially in the scalp, finasteride helps halt this miniaturization process, thereby maintaining or increasing hair density.

Oral finasteride (1 mg daily) is a proven treatment that significantly increases hair counts compared to placebo in men with AGA.^[1]Gupta, K.A., Venkataraman, M., Talukdar, M., Bamimore, M.A. (2021). Finasteride for hair loss: a review. Journal of Dermatological Treatment. 1938-1946. Available at: … Continue reading It’s this effect that topical formulations also aim to achieve, but with a more localized effect.

Advantages of Topical Finasteride

The hope of the topical finasteride formulation is localized delivery of the drug to the scalp, which can minimize systemic exposure. By applying finasteride directly to the balding areas, high drug concentrations can be achieved in the skin and hair follicles where it’s needed, while ideally limiting how much finasteride enters the bloodstream. This targeted approach means the scalp DHT can be lowered substantially (similar to oral finasteride’s effect on scalp DHT) without as large a reduction in blood DHT levels.^[2]Zhou, C., Bin, Y., Huiming, Z., Rushan, X., Ningning, D., Qinping, Y., Chunlei, Z., Guogiang, Z., Aihua, W., Wei, L., Shuxia, Y., Qingchun, D., Yangfeng, D., Liming, W., Lunfei, L., Danyang, J., … Continue reading In other words, topical finasteride can maintain the same inhibitory effect on scalp DHT with significantly less impact on systemic DHT levels. 

While research is ongoing, the suspected outcome of this is that at the right doses, topical finasteride usage will lead to lower side effects than oral. Oral finasteride is well-tolerated by most, but a minority of users experience side effects like reduced libido, erectile dysfunction, or other hormone-related issues. Research shows that these side effects are less common with topical finasteride.^[3]Gupta, A.K., Talukder, M. (2022). Topical finasteride for male and female pattern hair loss: Is it a safe and effective alternative? Journal of Cosmetic Dermatology. 21(5). 1841-1848. Available at: … Continue reading

Clinical trials of a 0.25% finasteride topical spray in men showed significant hair regrowth versus placebo, with good safety and tolerability; no serious adverse effects were reported, and only mild localized side effects (like slight scalp irritation) occurred.^[4]Piraccini, B.M., Blume-Peytavi, U., Scarci, F., Jansat, J.M., Falques, M., Otero, R., Tamarit, M.L., Galvan, J., Tebbs, V., Massana, E. (2021). Efficacy and safety of topical finasteride spray … Continue reading

Other studies similarly report that topical finasteride users experience far fewer sexual side effect reports than oral users, suggesting that keeping finasteride localized to the scalp can indeed mitigate many unwanted systemic effects.^[5]Gupta, A.K., Talukder, M., Keene, S.A., Bamimore, M.A. (2025). Is the Safety of Finasteride Correlated with Its Route of Administration: Topical Versus Oral? A Pharmacovigilance Study with Data from … Continue reading Moreover, by delivering the drug via the skin, it’s possible to use a small total dose of finasteride (since it isn’t undergoing first-phase metabolism in the liver), yet still achieve a therapeutic effect in the hair follicle.

Why Sourcing Matters

Since topical finasteride lacks FDA approval as a commercial hair loss treatment, it relies on compounding pharmacies and specialized telehealth providers for preparation. This creates substantial variation in formulation quality and standards across different sources.

The compounding process introduces multiple variables that can significantly impact the final product. Different providers may use varying preparation techniques, carrier systems, and active ingredient concentrations, resulting in inconsistent efficacy and safety profiles between products.^[6]American Hair Loss Association. (no date). Hair Loss Treatments Online: What to Know About Compounded Medications. Available at: … Continue reading Without the stringent regulatory framework that governs mass-produced pharmaceuticals, these compounded formulations face less oversight regarding quality control and manufacturing standards.

This regulatory gap creates particular concerns around dosing accuracy. Compounded topical finasteride products may contain active ingredient levels that differ from their labeled concentrations, potentially leading to subtherapeutic underdosing or potentially harmful overdosing. The lack of standardized manufacturing processes and quality assurance protocols means patients cannot be certain they are receiving the intended dose or purity level.

These factors underscore why careful selection of telehealth providers and compounding sources becomes essential when considering topical finasteride treatment, as the wide variation in preparation methods and quality standards can directly influence both treatment outcomes and patient safety.

Price and Purity Considerations

The cost of topical finasteride can vary depending on where you get it and what’s included. In general, because these are custom prescriptions, they tend to be more expensive than generic oral finasteride. Prices can fluctuate based on local pharmacy compounding costs, the inclusion of additional active ingredients, and how the product is sold (subscription model vs. one-time purchase).

Ingredient purity represents another consideration, as the quality of raw finasteride used in compounding can fluctuate significantly based on the supplier and sourcing practices. This introduces concerns about both therapeutic effectiveness and the risk of contamination or impurities in the final product. The inconsistency in raw material quality means that patients may receive formulations with compromised potency or unknown adulterants that could affect safety profiles. 

These quality variations highlight the importance of thoroughly evaluating both the provider and their compounding standards when selecting a topical finasteride treatment. Patients and healthcare providers should prioritize sources that demonstrate transparency in their sourcing practices, manufacturing processes, and quality control measures to ensure they receive a safe and effective compounded topical finasteride product.

Now, let’s explore where you can get topical finasteride in various regions (US, Canada, UK/EU, and elsewhere).

Where To Buy Topical Finasteride

United States Providers

In the US, there is no FDA-approved topical finasteride product on the market. Therefore, all topical finasteride is obtained via prescription compounding. The US has a thriving telehealth industry for hair loss, so many patients get topical finasteride by consulting an online healthcare provider who can prescribe a compounded solution shipped to them. 

Ulo – #1 Choice for Quality & Growth

Ulo stands out in the US telehealth market for its high degree of flexibility and rigorous standards:

• Evidence-First Formulations:
  • Offered in both low-dose (0.005%) and full-strength (0.2%) topical finasteride, accurately compounded to mirror the proven effects of oral finasteride on scalp DHT.
  • Every batch undergoes independent GC/MS and HPLC testing with lab reports published online so you know exactly what’s in your bottle.

You can read more about our product lab testing results here.

• Unrivaled Personalization:
  • Add up to five enhancers: 7% minoxidil, 0.01% tretinoin, 0.2% caffeine, 0.01% melatonin, and 1% cetirizine, to tailor your regimen. 
  • Partner physicians collaborate with you to adjust concentrations and ingredients over time, based on your response and tolerance.
  • Treatment regimens can be tailored for once- or twice-daily application, with thoughtfully designed dropper-marked bottles to facilitate accurate dosing.

• Consumer Safety Built-In:
  • No propylene glycol, no corticosteroids, and no ”trending” additives that lack robust safety data (e.g., no latanoprost or copper peptides).
  • Proprietary, low-irritation vehicle ensures deep follicle penetration without the need to mask side effects with steroids.

• Transparent Quality & Pricing:
  • Third-party lab reports accompany every shipment for total transparency.
  • Ulo’s pricing starts at $0.82 per ml (or $0.61 per ml with the discount) for the low-dose finasteride-only formulation, increasing with dose and other ingredients.

• Ongoing Medical Support:
  • Unlimited access to Ulo’s network of licensed physicians via a secure portal, ask questions, report progress, and get real-time guidance anytime.
  • Clear timelines set “possibility vs. probability”, so you know when to expect regrowth, when it might plateau, and how to safely escalate your protocol. 

Ulo was built by advocates who have spent over a decade exposing the hair loss industry’s worst practices and decided to solve them. 

Pros

• Connects patients directly with licensed providers, offering discreet prescriptions and continuous support throughout their hair restoration journey. 
• The customized topical treatments blend finasteride and minoxidil, addressing the underlying drivers of hair loss to deliver more noticeable regrowth.
• Additional ingredients, such as cetirizine, melatonin, caffeine, and retinoic acid, are included to further improve regrowth outcomes.

Cons

• Twice daily usage can be inconvenient.

HappyHead – #1 Runner Up in the USA

HappyHead is a US-based telehealth company specializing in hair growth solutions with a strong focus on medical-grade, customizable topical treatments. HappyHead offers prescription Topical Finasteride, either as monotherapy or in combination with minoxidil and/or retinoic acid, compounded for each patient after an online consultation with a licensed physician. 

Some versions include minoxidil (up to 8%) and tretinoin, aiming to optimize results based on patient needs and tolerance. HappyHead’s platform emphasizes medical guidance, ongoing support, and flexible subscriptions, shipping directly to consumers in most US states. 

Pros

• Offers personalized prescriptions through its telehealth platform, ensuring patients receive discreet access to treatment from licensed providers.
• Its compounded topical solution has the option to combine finasteride with minoxidil and retinoic acid.
• Flexible formulation strengths enable tailoring to patient needs, which can be particularly beneficial for individuals sensitive to the side effects of oral finasteride.

Cons

• Twice-daily application is the standard recommendation, which may feel less convenient compared to simpler once-daily regimens.
• Higher concentrations of finasteride may lead to an increased risk of systemic side effects.
• No dosing flexibility.

Strut Health

Strut Health is an online compounding pharmacy that provides custom formulas for hair loss. Strut allows some customization: their Finasteride Hair Loss Formula can include finasteride 0.25%, minoxidil 0-7.5%, tretinoin 0-0.0125%, fluocinolone 0.01%, and biotin. Corticosteroids are often used to offset the potential irritation that comes with topical use; however, this comes at the risk of long-term skin thinning for customers.

We conducted third-party testing on their custom formula and found that it met the required levels of finasteride, minoxidil, and tretinoin.

Pros

• Strut Health offers tailored hair loss treatments and ongoing support from licensed providers.
• The compounded topical formula combines finasteride with proven agents like minoxidil and tretinoin, both targeting DHT and promoting follicular activity. 
• Custom blends may also include additional ingredients that can strengthen hair, reduce inflammation, and further adapt the treatment to specific requirements.

Cons

• Strut Health includes corticosteroids in its formulation to help with the potential irritation of topical use. However, this comes at the risk of long-term skin thinning for customers.
• Not the cheapest option, costing $1.97 per serving.

Hims

Hims & Hers is a large digital health platform focused on men’s and women’s health. They offer a Topical Finasteride & Minoxidil Spray for hair loss, featuring finasteride 0.1% and minoxidil 6%. A dual-action, pill-free formula is available by prescription after an online consultation. The spray is designed to minimize systemic absorption and side effects compared to oral finasteride, and it’s marketed for its convenient application and personalized telehealth experience.

While we haven’t done third-party testing on their topical formulation, we did on their oral finasteride counterpart – and it met the claimed level of finasteride.

Pros

• Combines finasteride and minoxidil into a single, easy-to-use topical spray, offering a convenient alternative to oral pills.
• Once daily usage is recommended, making the regimen less time-consuming than some alternatives requiring multiple applications daily.

Cons 

• Some users may find sprays less suitable than dropper or foam-based applications, especially if precise targeting of thinning areas is preferred.
• The formulation’s alcohol base could lead to scalp dryness or irritation for sensitive individuals.

Ro (formerly Roman)

Ro is a well-known direct-to-consumer telehealth provider. Their Roman Hair Solution Rx is a 3-in-1 prescription topical spray: finasteride 0.3%, minoxidil 6%, and tretinoin 0.025%. Ro emphasizes convenience with free follow-ups and no required video visits. Customization is not as extensive as with some compounding pharmacies.

Similar to Hims, we haven’t done third-party testing on their topical formulation, but we did on their oral finasteride product – and it met the claimed level of finasteride.

Pros

• Roman Hair Solution Rx blends finasteride, minoxidil, and tretinoin into one topical formula. 
• The solution offers a once-daily, convenient spray application. 

Cons

• No customization offered
• No dosing flexibility
• Some users may experience mild scalp irritation, redness, or dryness due to alcohol-based solutions

Keeps

Keeps is a telehealth brand specializing exclusively in men’s hair loss treatments. Their Topical Finasteride & Minoxidil Gel delivers 0.25% finasteride and 5% minoxidil in a single application. Keeps focuses on ease of use, competitive pricing, and online medical evaluations, shipping treatments directly to most US states. 

As with the above, we haven’t done third-party testing on their topical formulation, but we did on their oral finasteride product – and it met the claimed level of finasteride.

Pros

• Offers a topical gel combining finasteride and minoxidil to target two AGA routes. 
• Gel formula designed to minimize systemic absorption.

Cons

• No customization available.
• No dosing flexibility available.
• Most expensive option (price per serving)

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/Serving	Purity Testing
Ulo	Yes	Minoxidil 7%, Cetirizine 1%, Tretinoin 0.01%, Melatonin 0.01%, and Caffeine 0.2%	Yes, 0.005% or 0.2% finasteride	$0.61	3rd-party lab reports.
HappyHead	No, the doctor customizes the product for you	Finasteride (0.3%), Minoxidil (8%), Retinoic Acid (0.001%), Hydrocortisone (1%)	No	$1.98	3rd-party lab reports of another product were mixed, with some ingredients not meeting the claimed dose.
Strut	Yes	Finasteride 0.25%, Minoxidil 0-7.5%, Tretinoin 0-0.0125%, Fluocinolone 0.01%, and Biotin.	Yes	$1.97	3rd-party lab reports of topical finasteride were good.
Hims	No	Finasteride and Minoxidil	No	$0.65	No 3rd party testing for their topical product, but their oral finasteride product passed lab testing.
Ro	No	Finasteride 0.3%, Minoxidil 6%, and Tretinoin 0.025%	No	$0.65	No 3rd party testing done for topical finasteride
Keeps	No	Finasteride and Minoxidil	No	$2	No 3rd party testing for their topical product, but their oral finasteride product passed lab testing.

Canada Providers

Xyon Health – Top Pick in Canada

Xyon Health is a telehealth brand offering topical hair treatments, including dutasteride and finasteride. For their finasteride options, you can either buy finasteride alone or combined with minoxidil. The platform requires online consultations with specialist physicians and delivers medications in discreet packaging across Canada.

Pros

• Xyon Health uses its patented SiloxysSystem gel technology to deliver its treatment directly to the scalp.
• Offers 92% less systemic absorption than oral finasteride.
• Alcohol-free formula.
• Have a choice of finasteride alone or in combination with minoxidil.
• Convenient once-daily administration.

Cons

• Not the cheapest option ($327 per order for a 3-month supply).

Jupiter – Top Runner-Up in the USA

Jupiter is a telehealth platform offering personalized topical hair loss treatments. Through Jupiter, customers can access a compounded topical that may include finasteride as well as up to four other active ingredients, depending on their needs, including minoxidil, tretinoin, panthenol, and caffeine. 

Unfortunately, they don’t advertise their concentrations or prices, mentioning that you can only view specific medication pricing and options after completing an online assessment. Jupiter provides free shipping Canada-wide, however. 

Pros

• Personalized hair loss treatment, which includes finasteride, minoxidil, tretinoin, panthenol, or caffeine. 
• Convenient once-daily treatments.

Cons

• A lack of freely available data, including whether dosing flexibility is possible and the price per serving.

Essential Clinic

Essential Clinic is a Canadian telehealth platform that specializes in men’s health issues like hair loss and erectile dysfunction. They offer Topical Finasteride + Minoxidil Liposomal Gel that combines finasteride with minoxidil in a liposomal delivery system designed to enhance scalp penetration while minimizing systemic absorption. The platform provides online consultations with licensed Canadian doctors and nurse practitioners. 

Pros

• Treatment is paired with ongoing access to licensed Canadian physicians for follow-up and dose adjustments, plus fast, confidential home delivery of medications.
• The topical finasteride treatment is combined with minoxidil for greater efficacy.

Cons

• The most expensive option that we are able to see prices for.
• No customization. 
• No dosing flexibility.

Beyoung Health

Beyoung Health is another Canadian telehealth clinic (based in Ontario) that offers treatments for men’s health, including hair loss. They prescribe compounded topical finasteride as part of their hair loss program. Beyoung offers finasteride alone or in combination with minoxidil for hair loss therapy. 

Beyoung’s approach is relatively patient-tailored. The doses that they offer are 0.25% finasteride + 5% minoxidil, 0.1% finasteride + 7% minoxidil foam, or finasteride 0.1% + minoxidil 10%.

Pros

• Offers customizable finasteride doses combined with minoxidil. 
• Dosing flexibility.

Cons

• A lack of freely available data, including the price per serving.

Jack Health

Jack Health is a prominent Canadian telehealth platform that offers personalized hair loss treatments, including topical finasteride formulations. Their hair loss program features a product called “Hello Hair”. This program provides custom topical ingredients that may include topical finasteride to assist with hair regrowth.

Pros

• Dosing flexibility offered.

Cons

• A lack of freely available data, including the price per serving.
• No available customization on the site – it is conducted after consultation.

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/Serving	Purity Testing
Xyon Health	Yes	Minoxidil 6%	Yes, Finasteride 0.25% (with 5% minoxidil) or 2.5% (finasteride alone)	$1.21	No
Essential Clinic	No	Finasteride 2.5% and Minoxidil 5%	No	$1.61	No
Jupiter	Yes	Minoxidil, Tretinoin, Panthenol, and Caffeine.	Unknown	Unknown	None
Beyoung Health	Yes	Minoxidil (different strengths)	Yes Finasteride 0.25% (+5% minoxidil) or 0.1% (+7/10% minoxidil)	Unknown	None
Jack Health	No	N/A	Yes	Unknown	None

If you don’t want to buy topical finasteride from a telehealth company, a few dermatology clinics can also prescribe and compound topical finasteride. If you prefer an in-person route, you could ask your dermatologist about a topical finasteride prescription to be made at a local compounding pharmacy. The downside is that compounding costs in Canada can be high, and many dermatologists are still more comfortable with oral finasteride. 

United Kingdom & Europe

In the UK and EU, the situation is a bit different because, unlike the US and Canada, there has been a topical finasteride formulation approved in some markets. In 2021, a finasteride 0.25% topical solution received approval in certain European countries.^[7]Zhou, C., Bin, Y., Huiming, Z., Rushan, X., Ningning, D., Qinping, Y., Chunlei, Z., Guogiang, Z., Aihua, W., Wei, L., Shuxia, Y., Qingchun, D., Yangfeng, D., Liming, W., Lunfei, L., Danyang, J., … Continue reading

Hair Repair Clinic – Top Pick in the UK

Hair Repair Clinic is a UK-based specialist compounding pharmacy offering Finasol, their custom-formulated topical finasteride solution. They use TrichoSol, a proprietary alcohol-light delivery system made from natural mineral salts that’s free of propylene glycol to minimize scalp irritation. Available in concentrations ranging from 0.025% to 0.1% finasteride, with custom strengths available upon request.

Pros

• Products custom-made in the UK by compounding pharmacies, with same-day approval for most orders.
• Uses the TrichoSol base for improved delivery and minimised local irritation.
• Offers customization and dosing flexibility.
• Doesn’t use propylene glycol.
• Convenient once-daily application.

Cons

• Prescription required and needs to be paid for privately; will not be reimbursed by the NHS.

UsMen – Top Runner-Up in the UK

UsMen is a UK telehealth platform specializing in men’s health that offers Topical Finasteride 0.1% and Minoxidil 5% spray. They emphasize competitive pricing and do not require subscriptions. To purchase their prescription products, you must complete a consultation.

Pros

• Cheapest UK offering that we found ($0.51 per serving).
• Topical finasteride is offered combined with minoxidil. 
• Users report easy ordering, low costs, flexible purchase options, and rapid home delivery.

Cons

• No customization or dosing flexibility available. 

Dr Fox

Dr Fox is an established UK online pharmacy that offers Dr. Fox Hair Growth Spray containing finasteride 0.3% and minoxidil 5%. They provide a dual-action topical spray designed to combine the DHT-blocking effects of finasteride with the growth-stimulating properties of minoxidil. 

Pros

• Good pricing: $0.58 per serving.
• Same day approval and discreet UK home delivery.
• The product contains finasteride, minoxidil, and tretinoin for comprehensive treatment.

Cons

• No customization options.
• No dosing flexibility.

Sons

Sons is a major UK telehealth platform offering a Topical Finasteride & Minoxidil Spray, combining finasteride with minoxidil and tretinoin. They claim to be the only UK licence holder for both finasteride and minoxidil treatments. 

Pros

• Convenient, once daily usage.
• Their finasteride product is combined with minoxidil. 

Cons

• A lack of freely available data, including whether dosing flexibility is possible and the price per serving.
• No add-ons available.

Manual

Manual is another leading UK men’s health platform offering an all-in-one spray containing topical finasteride, 10% minoxidil, and 5% azelaic acid. This triple-therapy approach is designed to address multiple aspects of hair loss. Manual provides comprehensive medical support throughout treatment.

Pros

• The “All-in-One Spray” combines prescription-strength topical finasteride, high-dose minoxidil, and azelaic acid into a single formula for male AGA.
• Convenient once-daily application.
• Base formulation designed for efficient absorption.

Cons

• Women and those with non-androgenic hair loss are excluded, with use restricted to adult men who pass clinical screening.
• No customization and no dosing flexibility available.
• A lack of freely available data, including the price per serving.

Hims UK 

Hims UK operates as the British arm of the US company, offering topical finasteride and minoxidil combinations. They provide subscription-based services with online consultations and ongoing medical support. Unfortunately, without going through the consultation, we cannot find out the dosage and price options.

Pros

• Convenient once-daily treatment
• Combination of finasteride and minoxidil. 
• Ongoing medical support available.

Cons

• A lack of freely available data, including customization, dosing flexibility, and price per serving.

Hair Medics UK

This London-based hair clinic also offers compounded topical formulas for sale. They advertise a topical finasteride (0.1%) and dutasteride (0.1%) combination solution (for men only) for £69.99 ($94.72). They also offer a minoxidil (5%) and finasteride (0.25%) combination solution for the same price.

Pros

• Offer a customizable topical finasteride solution that can be combined with either dutasteride or minoxidil.
• Dosing flexibility from 0.1-0.25%.

Cons

• The most expensive option that we have found per serving. 

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/Serving	Purity Testing
Hair Repair Clinic	Yes	Minoxidil	0.025%,0.05%, and 0.1%	$0.81	No
Dr Fox	No	None	No	$0.58	No
UsMen	No	None	No	$0.51	No
Sons	No	None	No	Unknown	No
Manual	No	None	No	Unknown	No
Hims UK	Unknown	Unknown	Unknown	Unknown	No
Hair Medics UK	Yes	Minoxidil, and Dutasteride	0.1% and 0.25%	$2.71	None

If you choose this path, keep in mind that you’re essentially experimenting on yourself with a product of unknown quality. Whenever possible, opt for a reputable telehealth provider or licensed pharmacy. This way, you’ll have professional medical supervision and a much greater assurance that your medication actually contains the right amount of finasteride.

Final Thoughts

Topical finasteride offers a compelling alternative to oral finasteride for individuals seeking effective hair loss treatment with potentially fewer systemic side effects. While the medication is not FDA-approved in topical form in the US, reputable telehealth and compounding options are available throughout the US, Canada, and parts of Europe. Providers like Ulo, Strut, Happy Head, Xyon, and others have stepped in to fill this gap by offering prescription-based, customized topical finasteride, often with additional active ingredients like minoxidil or tretinoin to enhance results.

When choosing a provider, look beyond marketing claims. Consider customization options, pricing transparency, dosing flexibility, and, crucially, whether third-party testing verifies what’s actually in the bottle. A cheap, poorly compounded product may do more harm than good, and skipping medical oversight could leave you exposed to unnecessary risks.

If you’re serious about topical finasteride, make sure you’re sourcing it from a trusted telehealth platform or compounding pharmacy that provides medical consultation and prioritizes formulation quality. Your treatment’s success and your peace of mind depend on it.

When it comes to hair loss treatments, oral dutasteride often emerges as the most powerful option, consistently outperforming FDA-approved alternatives like finasteride in clinical studies. Across the internet, personal stories echo this sentiment: discussion boards and Reddit threads feature dramatic recoveries, with some users claiming transformations from advanced thinning to a full, healthy head of hair.

(You can read more about this one below.)

However, online spaces tend to spotlight the extremes, either remarkable success stories or reports of failure, creating a distorted picture of what typical results look like. 

So, where does dutasteride truly stand? How do we distinguish between what’s possible and what’s probable? How can you weigh anecdotal experiences against the outcomes you’re most likely to see? And importantly, what might your pattern of regrowth look like after 1, 2, 3, or even 10 years of therapy?

This article addresses these questions directly. We’ll set clear expectations for oral dutasteride, explore how to interpret results shared online, highlight some of the most dramatic dutasteride before and after photos, and offer guidance on what an average treatment journey may look like. 

Finally, we’ll introduce a framework you can use to evaluate and compare all hair loss therapies, helping you see dutasteride ranks in terms of regrowth potential, evidence quality, and long-term safety.

Interested in Oral Dutasteride?

Oral Dutasteride Hair gains bigger than finasteride? Dutasteride makes this possible, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

Click Here For 15% Off

*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Quick Refresher on Androgenic Alopecia (AGA)

Androgenic alopecia (AGA) is the most common form of hair loss affecting both men and women, marked by progressive thinning and miniaturization of hair follicles. This is primarily thought to be a result of genetic predisposition and the influence of androgens, especially dihydrotestosterone (DHT).^[1]Chen, S., Xie, X., Zhang, G., Zhang, Y. (2022). Comorbidities in Androgenetic Alopecia: A Comprehensive Review. Dermatology and Therapy. 12(10). 2233-2247. Available at: … Continue reading 

There is a huge choice of treatment options for AGA, with FDA-approved therapies such as topical minoxidil and oral finasteride. Many other options are either used off-label or under investigation, including low-level laser therapy, platelet-rich plasma injections, hair transplant surgery, herbal compounds, and emerging agents like prostaglandin analogs and caffeine-based solutions.^[2]Bajoria, P.S., Dave, P.A., Rohit, R.K., Tibrewal, C., Modi, N.S., Gandhi, S.K., Patel, P. (2023). Comparing Current Therapeutic Modalities of Androgenic Alopecia: A Literature Review of Clinical … Continue reading This diversity reflects both the complexity of the disease and a significant unmet need in achieving consistent, satisfactory results for patients.

Despite existing for decades, oral dutasteride has recently surged in popularity as an off-label AGA treatment. Like finasteride, it inhibits the conversion of testosterone to DHT. But it blocks both type I and II 5-alpha-reductase enzymes more effectively, potentially offering a more potent effect. 

Dutasteride 101

Dutasteride blocks both type I and type II isoforms of the 5ɑ-reductase enzyme. This enzyme converts testosterone to DHT, a key hormone driving male pattern hair loss and prostate growth. By inhibiting both isoforms, dutasteride causes a near-complete suppression of DHT, reducing its levels in blood by up to 98%, which is higher than finasteride’s reduction of around 65-70%.^[3]Clark, R.V., Hermann, D.J., Cunningham, G.R., Wilson, T.H., Morrill, B.B., Hobbs, S. (2004). Marked Suppression of Dihydrotestosterone in Men with Benign Prostatic Hyperplasia by Dutasteride, a Dual … Continue reading,^[4]Nickel, J.C. (2004). Comparison of Clinical Trials with Finasteride and Dutasteride. Reviews in Urology. 6(Suppl 9). S31-S39. Available at: PMID: 16985923

The standard and most studied dose is 0.5 mg daily. This is the FDA-approved dose for benign prostatic hyperplasia and the most common dose used off-label for hair loss. Lower doses like 0.2 mg daily have been used in one clinical trial, though 0.5 mg remains the norm.^[5]Escamilla-Cruz, M., Magana, M., Escandon-Perez, Bello-Chavolla, O.Y. (2023). Use of 5-Alpha Reductase Inhibitors in Dermatology: A Narrative Review. Dermatology and Therapy. 13(8). 1721-1731. … Continue reading,^[6]Lee, S., Kim, J.E., Lew, B-L., Huh, C.H., Kim, J., Kwon, O., Kim, B.M., Lee, Y.W., Lee, Y., Park, J., Kim, S., Kim, D.Y., Choi, G.S., Kang, S. (2025). Efficacy and Safety of Low-Dose 0.2 mg … Continue reading 

Why “Expectation Setting” Matters

Realistic expectation setting is fundamentally important for anyone starting their AGA treatment journey, particularly with treatments that do not have a large amount of evidence.

Some people may expect dramatic hair regrowth, often influenced by online testimonials or dutasteride before and after photos showing “hyper responders”.

Others may experience disappointment, frustration, and a decline in self-esteem when their own results are modest or average.

On the other hand, those with overly low expectations may forgo potentially beneficial treatments altogether, missing out on improvements that could positively impact their quality of life.

Online before-and after photos and personal anecdotes present another challenge. They are not standardized, can be misleading, and often feature individuals who have responded exceptionally well to a product, rather than the majority who see more moderate effects. These images rarely account for factors like lighting, hair styling, photo angles, or even digital enhancement, all of which can distort perceived efficacy.

To help guide your treatment selections & expectations, here are two key principles that, once understood, will make all the difference in how you approach your hair growth journey.

Principle #1: What’s Possible ≠ What’s Probable

Consider the following chart.

Note the individual datapoints and how scattered they appear. Also note the trendline, which represents the average of all individual datapoints shown in the chart.

The individual datapoints represent what’s possible for any one individual. The trendline represents what’s probable.

 

Resultantly, people see these dutasteride before and after success stories, and think, “This is all I see. And so I’ll probably get the same regrowth, too.” This shifts their expectations for the drug far above the trendline:

Then they try dutasteride and either quit too early to see regrowth (more on that soon)… or they don’t get the same results, and determine (often erroneously) that the drug just isn’t working for them.

The solution: don’t set expectations by what’s possible. Set expectations by what’s probable. Understand the trendlines for oral dutasteride: when results will typically first start to show, when results will peak and/or plateau, and what results will look like 5+ years into the future.

You can do this by using a standardized rubric we created called Regrowth Potential.

Regrowth Potential

As mentioned above, Principle 1 shows us that results tend to scatter across a spectrum: some datapoints high, some low, with a trendline running through the middle. The problem is that online anecdotes usually highlight only the high datapoints, while clinical trial data can feel abstract and hard to translate into lived experience. 

Regrowth Potential is our way of standardizing this landscape. It’s designed to cut through anecdotal extremes and align patients with the trendline, what most people can realistically expect.

So what does the average look like?

Most people see stabilization first, regrowth second, and a slowing of hair loss, with partial reversal layered on top. 

Gains usually peak within 6-12 months, then plateau.^[8]Nestor, S, M., Ablon, G., Gade, A., Han, H., Fischer, D.L. (2021). Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of … Continue reading

Typical regrowth brings hair back to where it was 1-3 years earlier, not to pre-hair-loss density. 

And what influences where you fall on that spectrum?

1. How long you’ve been losing hair: Earlier intervention = higher trendline. Long-standing bald spots rarely respond.^[9]Feldman, P.R., Gentile, P., Piwko, C., Motswaledi, H.M., Gorun, S., Pesachov, J., Markel, M., Silver, M., Brenkel, M., Feldman, O.J., Kamen, C.L., Uleryk, E., Guevara-Aguirre, J., Fiebig, K.M. … Continue reading 
2. Which therapy you use: Some are more effective at certain stages or patterns.
3. How consistent you are: Skipped doses or stopping early push results below the trendline.

Most patients should expect stabilization and modest regrowth. A small minority will experience “hyper-responsiveness,” but these rare outcomes should not set the benchmark. 

Principle #2: Poorly-Studied Treatments = More Variability In Results

When fewer studies exist on a treatment, expectations for hair regrowth become harder to pin down. With limited data, some patients may get spectacular results, while others see very little. But, without enough trials, it’s nearly impossible to know how common each outcome really is.

Take finasteride and oral dutasteride as examples. Finasteride has been tested in dozens of randomized controlled trials, which means we can say with high confidence what the average regrowth looks like and where most patients will land. Oral dutasteride, by contrast, has fewer high-quality studies. 

That doesn’t mean dutasteride is ineffective. In fact, the regrowth gains by dutasteride have often outperformed finasteride users. But it does mean the range of possible outcomes is wider, with more unpredictability between “great responders” and “minimal responders”. 

When it comes to understanding expectations for androgenic alopecia treatments, the normal distribution model helps clarify why individual results can be so different, even when clinical averages sound reassuring. Treatment outcomes typically form a bell-shaped curve rather than a single value, meaning people experience a range of responses. 

• Clinical averages, which are often cited in studies, represent the peak of this curve, not the experience of every patient. Most individuals see results somewhere near this average, but plenty fall above or below it.

• Wide curve (high variability, low evidence): When evidence for a treatment is limited or inconsistent, like with newer therapies, the curve is broad. Some may see fantastic regrowth, others very little, and outcomes are harder to predict. 
• Narrow curve (predictable outcomes, high evidence): For well-researched medications, the curve is tight. Most people’s results cluster close to the average, giving new patients more confidence in knowing what to expect.

Importantly, average never means “everyone”. Treatment outcomes often show a spread, so while clinical trials help set realistic expectations, individual journeys may differ depending on genetics, age, stage of hair loss, and treatment adherence. 

This variability also explains why anecdotes online can feel so misleading. When people share their results in forums, they’re often the outliers, the best or worst cases. On a scatterplot of individual datapoints, these stories sit at the edges. With dutasteride, the scatter is typically above the trendline, meaning a Reddit “success story” may be far removed from what most users should expect.

The rubric we can use to get a sense of whether our results will be predictable or variable is Evidence Quality.

Evidence Quality

Evidence quality answers the question “How reliable is the evidence that this intervention will actually help regrow my hair?” The strength of this evidence is determined not only by the number of studies available but also by their design, especially RCTs, which typically provide the most trustworthy evidence.

The concept of confidence in treatment outcomes can be likened to a game show in which money is hidden behind two doors. Behind door number 1, the amount of money behind it could be anywhere between $0 and $100. You might walk away with nothing, a little, or a lot, and there’s no way to know for sure, because there just isn’t enough evidence to narrow down the possibilities. 

With door number 2, the money behind it ranges tightly between $49 and $51. Because so many high-quality studies exist, you can be confident that your outcome will almost certainly fall within this narrow window, making it much easier to know what to expect.

More evidence means a smaller range and greater predictability; less evidence means more uncertainty and a wider range of possible outcomes.

Relating this back to oral dutasteride, the treatment has fewer published randomized controlled trials compared to finasteride. This means less outcome certainty, so patients considering dutasteride face a wider bell curve of potential results (as shown above), from exceptional regrowth to only minor improvement.

To summarize: 

• More and better studies = tighter confidence around the true average results
• Fewer studies = more uncertainty, a wider range of possible outcomes, and less ability to predict what will happen for any individual. 

Understanding the evidence quality of a treatment empowers patients to interpret clinical claims and anecdotal stories with a critical eye, helping them choose interventions with the best established track record and manage expectations where data is still emerging.  

Anecdotal Successes

In the world of hair loss drugs, Redditors and hair loss forums tend to overshare the best of what’s “possible”. 

Let’s have a look at 10 real-life anecdotal reports shared by Reddit users. 

It goes without saying that the experiences related below, including any before-and-after photos, are anonymously submitted by users and strictly represent their personal experiences. They are not considered medical evidence, nor should they be relied upon as medical advice. 

It should also be noted that some of these individuals used other treatments alongside dutasteride to assist in their hair regrowth journey. With combination treatments, it is not easy to see what’s causing the hair growth, so we need to be even more cautious about the success seen.

Case 1: 14-month course of oral dutasteride 0.5 mg daily

This 25-year-old male reported aggressive hair thinning between ages 19–21, which he reportedly stabilized with dutasteride monotherapy at 0.5mg/day. He had previously tried finasteride for about a year but did not report any visible regrowth. The patient described significant regrowth of previously thin hairs, with increased hair density compared to treatment start. He noted that there were no side effects throughout treatment. Notably, he mentioned that finasteride provided stabilization only, while dutasteride produced visible regrowth after one year of use. Other users also highlighted the greater potency and longer half-life of dutasteride compared to finasteride.

Case 2: 10-month course on dutasteride 0.5 mg and oral minoxidil 0.625 mg daily

A female individual (age unspecified) with diffuse thinning, especially around the parting, reported on her experience using dutasteride 0.5mg/day, along with oral minoxidil 0.625mg/day (which was scaled back from an initial dose of 1.25mg). Further into the treatment, she added topical minoxidil to her treatment stack. At the 10-month mark, she reported a significant increase in hair density compared to baseline, with notable thickening at the part line, as confirmed by the user-submitted photos. The user was delighted with her results and intends to decrease her dutasteride use to a maintenance dose eventually. 

Case 3: 10-month course on dutasteride 0.5 mg and oral minoxidil 5 mg daily

This report was from a 26-year-old male with clearly noticeable balding by age 20 and a family history of male pattern baldness, including his father and both grandfathers. The user’s protocol included oral dutasteride 0.5mg and oral minoxidil 5mg daily. The user noted heavy shedding in the first two months of treatment, with the first noticeable signs of improvement appearing at months 2-3, before achieving a successful outcome by month 10, when they reported marked hair thickening and a renewed sense of confidence and self-esteem. The user did not report any side effects from dutasteride, but linked minoxidil use to a mild increase in arm hair. It’s worth noting that the user’s physician had recommended he switch from his initial finasteride therapy to dutasteride due to their “aggressive” alopecia.

Case 4: 3.5 months on oral dutasteride 0.5 mg and minoxidil 5 mg daily

A 22-year-old male shared his experience using oral dutasteride (0.5mg/daily), oral minoxidil (5mg/daily), plus dermarolling (1.5mm/weekly) for 3.5 months. The user achieved significant increases in hair density and regrowth, a self-reported improvement in self-esteem, and no reported side effects, namely as to his libido and sexual function. He noted his consistent use and starting relatively early in the hair loss process as reasons for his favorable outcome. Additionally, he highlighted that he did not titrate up to his final doses but started the full protocol from day one.

Case 5: 6 months on dutasteride 0.5 mg (ed 1st month – 3x/wk) + microneedling 1.0 mm weekly

This male (23 y/o) used dutasteride at the dose of 0.5mg daily for the first month, then reduced to 0.5mg thrice weekly, along with microneedling 1.0mm once weekly, over the course of six months. The apparent results include hairline and temple regrowth, with the hair improving in thickness and health overall. The user did not report any side effects beyond bleeding associated with microneedling, noting that he began to notice changes within a month. In explaining his results, he also believed himself to be highly responsive to the treatment. 

Case 6: 2+ years on dutasteride 0.5 mg daily and sublingual minoxidil 0.9 mg – 2.7 mg daily

In this report, a 31-year-old male shared his results on a protocol of oral dutasteride (0.5mg daily) and sublingual minoxidil (gradually increased from 0.9mg to 2.7mg daily). While he started treatment with oral finasteride, he switched to dutasteride and sublingual minoxidil at the advice of his dermatologist. The users reported significant improvement after 3–4 months, with darker hair color and thickening of hair at the crown and mid-scalp. He added that most improvements came within 12 months, noting that he did experience any shedding with minimal side effects.

Case 7: 2 months on dutasteride 0.5 mg daily and oral minoxidil 2.5 mg daily

A 31-year-old male detailed his experience taking dutasteride 0.5mg daily alongside oral minoxidil following a series of unsuccessful treatments. He initially began with finasteride 1mg, which slowed hair loss but did not affect major regrowth. He then tried minoxidil and microneedling, before restarting finasteride and topical minoxidil alongside dermarolling. Upon switching to dutasteride, he noted major improvement in just two months, including achieving thicker hair and the disappearance of bald spots. The user reported no major side effects and noted supplementing his protocol with a daily multivitamin (Becadexamin) and a collagen supplement to support skin and hair.

Case 8: 3.5 months on dutasteride 0.5 mg daily and topical minoxidil 2x daily

A 24-year-old male reported significant improvement in hair density and coverage following 3.5 months of oral dutasteride 0.5mg/day and topical minoxidil (Rogaine) applied twice daily. The Redditor reported hair shedding, especially around the hairline, at month one. In the second half of the treatment period (months 2-3.5), however, he experienced accelerated hair regrowth with the appearance of a full head of hair. He was prescribed dutasteride directly (no prior finasteride use) and reported no major side effects as of the 3.5-month mark. 

Case 9: 1 year on dutasteride 0.5 mg daily and 10 years on topical minoxidil

This user (age 31) used daily dutasteride (Avodart 0.5mg) for one year in addition to ten years of consistent topical minoxidil use. He had previously used finasteride for two years with satisfactory results, stating that he could have achieved more regrowth by combining minoxidil with a DHT blocker. Following his switch from finasteride to dutasteride, he noted improvements in hair strength, libido increase, and clearer thinking. Months 3-8 were marked by shedding and brittle, weaker hair, with the patient considering switching back to finasteride. But after month 8, he saw thicker strands and mild regrowth. He also noted longer hair cycles, which now allow him to better maintain hair length. The user planned to continue with treatment and reevaluate at the two-year mark.

Case 10: 8 months on dutasteride 0.5 mg and 10 months on oral minoxidil 2.5 mg

This male user (29 y/o) undertook a protocol of oral dutasteride 0.5mg/day and oral minoxidil 0.5mg/day concurrently for eight months, with strong improvements in hair regrowth and thickness. He reported shedding at months 1-3 followed by regrowth starting at the 3-month mark. He observed increased hair density in the crown and temples from months 3 to 8, and noted major progress by month 10, with the crown nearly full, despite a persistent “M-shaped” hairline. The user reported no major side effects and plans to undergo a hair transplant, notwithstanding the favorable outcome. 

But these anecdotes are often far above the trendline, over “average” expectations.

Probable Regrowth Timeline for Oral Dutasteride

We have laid out a likely timeline for oral dutasteride treatment. However, this is based on four studies that we could find using oral dutasteride for hair loss, including one where it was used for frontal fibrosing alopecia.^[10]Tsunemi, Y., Irisawa, R., Yoshiie, H., Brotherton, B., Ito, H., Tsuboi, R., Kawashima, M., Manyak, M. (2016). Long-term safety and efficacy of dutasteride in the treatment of male patients with … Continue reading,^[11]Pindado-Ortega, C., Saceda-Corralo, D., Moreno-Arrones, O., Rodrigues-Barata, A.R., Hermosa-Gelbard, A., Jaen-Olasolo, P., Vano-Galvan, S. (2020). Effectiveness of Dutasteride in a Large Series of … Continue reading,^[12]Vano Galvan, S., Saceda-Corralo, D., Morena-Arrones, O.M., Rodrigues-Barata, R., Morales, C., Gil-Redondo, R., Bernardez-Guerra. C., Hermosa-Gelbard, A., Jaen-Olasolo, P. (2019). Effectiveness and … Continue reading,^[13]Harcha, W.G., Martinez, J.B., Tsai, T-F., Katsuoka, K., Kawashima, M., Tsuboi, R., Barnes, A., Ferron-Brady, G., Chetty, D. (2014). A randomized, active and placebo-controlled study of the efficacy … Continue reading

Month 0-3: No visible changes:

• Most studies note minimal to no observable regrowth in the first 3 months as dutasteride begins to reduce DHT levels, but hair follicles have not yet responded morphologically. 

Month 3-6: Early results seen:

• Clinical improvements in hair thickness and reduced shedding are often first noted from around month 3 onward.
• Quantitative hair count changes become statistically significant compared with placebo after 12 weeks; global photographic assessments begin to reflect mild positive change (~22-31% of subjects with slight/moderate increase at week 12).

Month 6-9: First cosmetic improvements:

• By 6-9 months, most patients exhibit visible improvement in hair density and coverage, with the peak initial response typically building upon earlier thickening. 
  • In a Japanese study, mean hair count increased significantly at 26 weeks and continued to improve at 52 weeks (68-87 hairs in a 2.54cm area).
  • Panel assessments at month 6 indicated ~75-85% of patients had some improvement in global photographs.

Months 9-15: Peak response period:

• Maximum regrowth and cosmetic benefits are typically observed within the first 12-15 months, based on clinical results.
  • “Marked improvement” rates ranged from 23-25% at 12 months with daily dosing in large cohorts. Median improvement in photographic rating scores and increases in terminal hair count continue through this period.
  • Sustained effects shown to persist up to 1 year in an open-label extension study.

Months 15-24: Maintenance phase: 

• Most patients maintain results with continued therapy, improvements plateau or slightly decline, but remain superior to baseline and other treatments.
  • Longer-term users (mean follow-up up to 17 months) show stabilization and ongoing maintenance with only rare further large gains.
  • Clinical improvement was seen in studies where doses ranged 3-7 capsules/week, with higher doses correlating to better maintenance and slightly higher efficacy.

Months 24-26: Possible plateau, limited data:

• Efficacy plateaus; possible mild regression or fluctuation, but proper adherence maintains gains for most patients. 
  • Real-world data of up to at least 24 months confirm sustainability in appropriately selected patients, especially at higher doses.
  • No long-term studies exceed 36 months, so late-stage trends remain speculative.

But what about all the success stories we see online, users on Reddit or other forums who have experienced dramatic hair regrowth?

Well, this difference usually stems from a phenomenon called survivorship bias. 

What is Survivorship Bias?

• Survivorship bias happens when the accounts you see are not representative of all experiences but are disproportionately skewed toward the most remarkable, positive cases.^[14]Rao, T. (2024). Understanding Survivorship Bias: Implications for Research and Decision-Making. Journal of Emerging Technologies and Innovative Research, 11(6). JETIR2406276
• People with extreme positive results are much more likely to post about their experiences, eager to share their success.
• In contrast, those who experience average or mediocre outcomes (which is the majority) rarely feel motivated to post.
• As a result, the outcomes you typically see online are samples from the tails of the bell curve: exceptional or very poor cases, not the “center” or average results.

Clinical Trial vs. Online Reports

• Clinical trials measure average results across a large, diverse population, using objective metrics.
• Online reports are anecdotal and self-selected. Because impressive transformations are inspiring, these are far more likely to be posted and shared.
• This dynamic can mislead readers into believing that dramatic regrowth is almost guaranteed, when in reality it is just one possibility among many, and not the most probable outcome.

Combining Treatments: Narrowing the Curve

While oral dutasteride is one of the most effective monotherapies for AGA, if you want to increase your odds of good results, combining it with additional therapies can have a dramatic impact. 

Studies have shown that adding minoxidil to dutasteride can further improve regrowth outcomes, leveraging the vasodilatory and follicle-activating effects of minoxidil, alongside DHT suppression from dutasteride.^[15]Obeid, M.N.A., Fattah, N.S. A., Elfangary, M.M., Al Husseni, R.M. (2024). Comparison between topical minoxidil 5% alone versus combined with dutasteride (topical 0.02% through microneedling or oral … Continue reading

Furthermore, adding low-dose dutasteride to ongoing finasteride therapy in patients with suboptimal response resulted in a dramatic increase in hair density, suggesting that combined therapy can be beneficial for those not fully responding to finasteride alone.^[16]Boyapati, A., Sinclair, R. (2013). Combination therapy with finasteride and low-dose dutasteride in the treatment of androgenetic alopecia. Australasian Journal of Dermatology. 54(1). 49-51. … Continue reading 

Going back to the bell curves, more modalities = less variability. By targeting different mechanisms (like minoxidil) or by targeting more types of 5-alpha-reductase (like in the finasteride study), outcomes become less dependent on any single pathway. This leads to more predictable, less variable results across a wider patient group.^[17]Mysore, V., Kumaresan, M., Dashore, S., Venkatram, A. (2023). Combination and rotational therapy in androgenetic alopecia. Journal of Cutaneous and Aesthetic Surgery. 16(2). 71-80. Available at: … Continue reading 

How Can I Maintain “Realistic Expectations”?

To keep realistic expectations on oral dutasteride for hair regrowth, it’s critical to understand both the typical timelines and the nature of outcome variability:

What does “realistic” mean?

• Realistic does not mean pessimistic: Most users will benefit, but responses vary between individuals. A realistic expectation is based on clinical averages, not the best or worst case.
• Don’t expect to be “cured” of your hair regrowth. Most treatments “rewind the clock” a certain amount. Oral dutasteride may reverse hair loss by 6-24 months on average. However, dramatic multi-year regrowth is much less common, possible but not probable for most users.
• Your most probable result is noticeable improvement and stabilization, rather than full reversal of all past hair loss. 

Practical Takeaways

• Be patient: Oral dutasteride takes time – most users don’t see meaningful change until at least 6 months in, with optimal results often peaking around 12-15 months. 

• Track your own progress: Use consistent photos or, ideally, hair counts in a fixed area to monitor changes. Comparing to internet success stories often skews expectations and reflects outliers rather than the norm.

• Define success on your own terms: For some, success means stopping hair loss. For others, it’s regaining density. Know what you’re aiming for and adjust expectations accordingly. 

• Consider combination treatments: Pairing dutasteride with therapies like minoxidil or microneedling may improve outcomes and reduce variability, especially if you’re not seeing early improvements. 

• Use clinical data to ground your expectations: Clinical trials give you an average expectation, not a guarantee. Use online anecdotes as inspiration, not prediction.

Final Thoughts

Your expectations for any hair loss treatment, even oral dutasteride, should rest on two key pillars:  regrowth potential x evidence quality.

Together, they shape your position on the “bell curve” of likely outcomes.

• If you’re early in your hair loss journey, consistently take the medication, and possibly combine it with other therapies, you’re more likely to end up closer to the favorable side of the curve.
• If your hair loss is advanced or you’ve tried many options before, you might fall closer to the average or lower end.

Either way, understanding that most people land somewhere near the middle of the curve, not at the extremes, helps you avoid frustration and stay committed.

Setting expectations isn’t about limiting hope or being overly pessimistic; it’s about anchoring your treatment outcomes to reality, so you can make better, more sustainable decisions about your treatment journey.

Top Places to Buy Topical Dutasteride

• #1 Choice for Quality and Growth: Ulo
• Top Runner-Up in the USA: Happy Head
• Top Pick in Canada: Xyon Health
• Top Runner-Up in Canada: Jupiter
• Top Pick in the UK: Hair Repair Clinic
• Top Runner-Up in the UK: Hair Medics UK

Topical dutasteride is a potent 5ɑ-reductase inhibitor, and while dutasteride is normally taken orally to treat benign prostatic hyperplasia, its off-label topical use is being explored for localised hair regrowth therapies.^[1]Andrade, J.F.M., Verbinnen, A., Bakst, A., Cunha-Filho, M., Gelfuso, G.M., Tais Gratieri. (2024). Topical dutasteride for androgenic alopecia: current state and prospects. Therapeutic Delivery. … Continue reading

Interested in Topical Dutasteride?

Hair gains bigger than finasteride? Dutasteride makes this possible, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

Click Here For 15% Off

*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Mechanism of Action: 5ɑ-Reductase Inhibition

• Dutasteride inhibits both type I and type II isoenzymes of 5ɑ-reductase, the enzyme responsible for converting testosterone into dihydrotestosterone (DHT).
• DHT is a key driver of hair follicle miniaturization in AGA.
• By blocking this conversion, dutasteride effectively reduces scalp and systemic DHT levels, which can help maintain or restore hair density. 
• Dutasteride is significantly more potent than finasteride, another 5ɑ-reductase inhibitor, in reducing DHT and has shown superior efficacy in clinical studies on hair loss.^[2]Gupta, A.K., Venkataraman, M., Talukder, M., Bamimore, M.A. (2022). Relative Efficacy of Minoxidil and the 5-ɑ-reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients A Network … Continue reading 

Advantages of Topical Formulations

Topical application of dutasteride is being explored as a way to localize treatment to the scalp and potentially reduce systemic exposure. The hope is that by delivering the medication directly to hair follicles, topicals may achieve meaningful concentrations where they are needed while lowering the risk of systemic side effects sometimes reported with oral therapy. However, while early studies suggest this may be the case, large-scale clinical trials directly comparing topical and oral dutasteride are still lacking.

By delivering the medication directly to the hair follicles, topical dutasteride achieves high local drug concentrations where it is needed most, potentially improving effectiveness with a lower overall dose.^[3]Alam, M., Mishra, A., Yadav, K.S., Pradhan, D., Kar, B., Ghosh, G., Rath, G., Rai, V.K. (2024). Development and Evaluation of Dutasteride Nanoemulgel for the Topical Delivery Against Androgenic … Continue reading  Importantly, emerging data support a lower incidence of adverse systemic reactions in patients using topical formulations, all while delivering meaningful improvements in hair regrowth.^[4]Sanchez-Meza, E., Ocampo-Candiani, J., Gomez-Flores, M., Hertz-Ruelas, M.E., Ocampo-Garza, J., Orizaga-y-Quiroga, T.L., Martinez-Moreno, A., Ocampo-Garza, S.S. (2022). Microneedling plus topical … Continue reading

Why Sourcing Matters

When it comes to topical dutasteride, sourcing is crucial due to the significant variability in compounding and formulation standards. Since topical dutasteride is not commercially available as an approved product for hair loss, it is typically prepared by compounding pharmacies or specialty providers.

This means that compounding methods, choice of solvents, and the concentration of the active ingredient can differ widely, leading to variability in both efficacy and safety.^[5]American Hair Loss Association. (no date). Hair Loss Treatments Online: What to Know About Compounded Medications. Available at: … Continue reading Moreover, without the regulatory oversight afforded to mass-manufactured drugs, compounded topical dutasteride products are more prone to inaccuracies in labeled potency, which could result in under- or overdosing. 

Price and Purity

The cost and purity of compounded topical dutasteride are also highly variable. Pricing can fluctuate based on local regulations, pharmacy standards, inclusion of additional actives, and the source of individual ingredients.

Purity is also a significant concern; the quality of the active pharmaceutical ingredient used in compounding may vary depending on the source, raising uncertainty about both efficacy and the potential presence of contaminants. This variability makes it essential for patients and healthcare providers to carefully consider the source and standards behind any compounded topical dutasteride product.

So, let’s take a look at where you can get topical dutasteride in the US and around the world, and what the benefits (and potential drawbacks) of each one are.

Where To Buy Topical Dutasteride

United States Providers

When considering topical dutasteride in the US, your choice of provider can impact the quality, customization, and transparency you receive. With no FDA-approved commercial topical dutasteride products, most options are compounded by specialized pharmacies or telehealth companies.  These providers differ in terms of formula customization, purity verification, dosing flexibility, and pricing, making it essential to understand your options before starting therapy.

Ulo

Ulo stands out in the US telehealth market for its high degree of flexibility and rigorous standards:

• Evidence-First Formulations:

• • Every product’s ingredient concentrations are based on published studies relative to a user’s goals: localization, max hair gains, and more.
  • Independent Laboratory Testing. Third-party reports for GC/MS and HPLC testing are publicly posted, verifying that what’s on the label is what’s in the bottle.

You can read more about our product lab testing results here.

• Ulo offers both low-dose and full-strength topical dutasteride (0.02% & 0.2%), enabling a range of options for localization and results.

• Unrivaled Personalization:

• • • Customize your formula by adding 7% minoxidil 0.01% tretinoin, 0.2% caffeine, 0.01% melatonin, and 1% cetirizine.
    • Treatment regimens can be tailored for once- or twice-daily application, with thoughtfully designed dropper-marked bottles to facilitate accurate dosing.
    • Partner physicians work with you one-on-one, making real-time adjustments to dosing and ingredients based on your response and tolerability.

• Consumer Safety Built-In

• • • No propylene glycol, no corticosteroids, and no “trending” off-label additives (e.g., latanoprost, copper peptides) that carry unproven risks.
    • Formulations are crafted to maximize follicle prevention while minimizing scalp irritation, so there’s no need to mask side effects with steroids.

• Transparent Quality & Pricing

• • • Third-party lab reports accompany every batch.
    • Ulo’s pricing starts at $1.15 per ml (or $0.86 per ml with the discount) for the low-dose dutasteride-only formulation, increasing with dose and other ingredients.

• Ongoing Medical Support

• • Unlimited access to Ulo’s network of licensed physicians via a secure portal, ask questions, report progress, and get tailored advice anytime.
  • Realistic timelines and expectation setting: know when to expect regrowth, potential plateaus, and strategies to boost results.

Ulo represents a true evolution in telehealth haircare, built by advocates who’ve spent over a decade exposing industry-wide bad practices. At Ulo, you get formulations that have been vetted inside and out, with the power to tweak every detail to your needs, backed by experts who prioritize your safety and success.

Pros

• Cheaper per ml than other options.
• Highly customizable formulas with options for minoxidil, tretinoin, caffeine, melatonin, and cetirizine.
• Dosing adjustments available.
• No unnecessary additions (no corticosteroids, propylene glycol, or trending unproven ingredients.
• Direct access to licensed physicians for real-time support.

Cons

• If prescribed to use twice daily, it may be inconvenient.

Only a few other online US telehealth providers provide topical dutasteride:

Happy Head

Happy Head is a teledermatology service offering personalized prescription solutions for hair loss. They offer topical formulas that may include dutasteride, which can be combined with minoxidil or finasteride, depending on the specific product chosen. Happy Head’s standard plans are typically ~$89 per month, depending on the complexity of ingredients.

They also emphasize potency (advertising a 10-in-1 custom mix that includes 0.25% dutasteride) and convenience, though such “mega” formulations may increase the risk of side effects. 

Pros

• Flexible custom formulas available, with high minoxidil concentrations (up to 8%), with the option to include a large number of additional ingredients.
• Fast shipping and responsive customer service.

Cons

• Twice-daily application can be less convenient.
• The most expensive option.
• Formulated with propylene glycol, which can cause skin dryness.

Strut Health

Strut Health is an online compounding pharmacy that provides custom dutasteride formulas. Strut allows some customization: their “Strut 5-in-1” topical can include 0.1% dutasteride, minoxidil (up to 7.5%), tretinoin (up to 0.0125%), fluocinolone 0.01% (a corticosteroid), and biotin in either a solution or gel base. Unfortunately, the addition of corticosteroids to offset potential irritation comes at the risk of long-term skin thinning for customers.

Pros

• Fully compounded formulas with strong customization can adjust dutasteride strength, add/remove ingredients, and choose a base (no alcohol or propylene glycol)
• Option to combine dutasteride and minoxidil.
• Streamlined telehealth process

Cons

• Additions of corticosteroids come with the risk of long-term skin thinning.

Below is an overview table of these providers

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/mL	Purity Testing
Ulo	Yes	Minoxidil, Tretinoin, Cetirizine, Melatonin, and Caffeine	Yes (can choose 0.02 – 0.2%)	Starts at $1.15 per mL	3rd-party lab reports.
Strut	Yes	Minoxidil 0-7.5%, Tretinoin 0-0.0125%, Fluocinolone 0.01%, Biotin	No 0.1% offered only	$2.30 per mL	3rd-party lab reports of topical finasteride were good.
HappyHead	No, the doctor customizes the product for you	Minoxidil 8%, Cetirizine 1%, Latanoprost 0.005%, Dutasteride 0.25%, Finasteride 0.25%, Melatonin 1%, Caffeine 0.2%, Tretinoin 0.001%, Vitamin D3 1,000 IU/mL Biotin 0.2%	No 0.25% offered only	$2.97 per mL	3rd-party lab reports of another product were mixed, with some ingredients not meeting the claimed dose.

Note: Mainstream men’s telehealth brands, such as Hims and Keeps, do not currently offer topical dutasteride; instead, they typically focus on finasteride. 

When choosing a provider, consider that formulation differences can impact both efficacy and safety. Ulo’s approach of using lower concentrations for localized effect contrasts with some competitors selling “mega-dosed” topicals (e.g., extremely high finasteride or dutasteride percentages) that may “leak” systemically and negate the benefit of a topical.

Also, be aware of whether a product includes corticosteroids to reduce scalp irritation. While this can make usage more comfortable, chronic steroid use on the scalp can lead to skin thinning over time.^[6]Mir-Bonage, J.F., Piquero-Casals, J., Prudkin, L., Delgado, J., Martinez, J.S., Briones, V.G-P. (2024). Use of Topical Corticosteroids in the Treatment of Noninfectious Inflammatory Dermatoses of the … Continue reading  

Canada Providers

In Canada, dutasteride (oral or topical) is a prescription medication; however, telehealth and pharmacy services are available, similar to those found in the US. 

Xyon Health

Xyon Health is a telehealth brand based in Canada (although it is also available in the US). It contains the highest concentration of dutasteride yet – 2% – alongside its proprietary SiloxysSystem slow-release gel base, which is claimed to reduce systemic absorption. 

Xyon does not offer any customization options, focusing solely on monotherapy dutasteride treatments (although their finasteride treatment can be combined with minoxidil). The product is typically shipped in a 3-month supply for about $387 per shipment. 

Pros

• Proprietary slow-release gel base is stated to reduce systemic absorption.
• Highest known dutasteride concentration (2%) for those seeking potent therapy
• Simple no-additive formulas.

Cons

• No customization beyond the base solution.
• Expensive cost.

Jupiter 

Jupiter is a telehealth platform offering personalized topical hair loss treatments. Through Jupitor, customers can access a compounded topical that may include dutasteride as well as up to four other active ingredients, depending on their needs, including minoxidil, tretinoin, panthenol, and caffeine. 

Unfortunately, they don’t advertise their concentrations or prices, mentioning that you can only view specific medication pricing and options after completing an online assessment. Jupiter provides free shipping Canada-wide, however. 

Pros

• Personalized compound formulas with multiple additive options (minoxidil, tretinoin, panthenol, caffeine).
• Free Canada-wide shipping and online physician consultation.

Cons

• Lack of transparency on formula concentrations and price until after assessment.
• Dosing flexibility unclear.

Beyoung Health

Beyoung Health is another Canadian telehealth clinic (based in Ontario) that offers treatments for men’s health, including hair loss. They prescribe compounded topical dutasteride as part of their hair loss program. Beyoung offers finasteride or dutasteride, along with minoxidil, either alone or in combination, for hair loss therapy. In practice, this means a Beyoung patient can get a topical solution with dutasteride as the active ingredient, or a combination of dutasteride and minoxidil if appropriate. 

Beyoung’s approach is relatively patient-tailored. They don’t list fixed strengths, but they do mention that the price depends on formulation and concentration, typically ranging from $50 to $150 per month. Beyoung also charges a $25 fee for their online medical questionnaire consultation. 

Pros

• Can customize both dutasteride and minoxidil concentrations.
• Patient-centered pharmacy with tailored dosing and options.

Cons

• Pricing and product specifics are only revealed after a medical assessment.

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/mL	Purity Testing
Xyon Health	No	None	No 2%	$4.30	None
Jupiter	Yes	Minoxidil, Tretinoin, Panthenol, and Caffeine.	Unknown	Unknown	None
Beyoung Health	Yes	Minoxidil	Yes, but unknown	Unknown	None

Overall, Canadian residents have growing access to topical dutasteride through these services. Just ensure any provider is operating legally with Canadian-licensed healthcare professionals. As dutasteride is not officially approved for hair loss in Canada (similar to the US, it is used off-label), you won’t find it at regular pharmacies without a prescription and through the compounding route.

United Kingdom

In the UK, dutasteride is prescription-only and is not officially authorized for hair loss (oral dutasteride isn’t licensed for AGA in the UK). Nevertheless, if you are looking for where to buy topical dutasteride, doctors can prescribe it off-label, and a few online compounding services and clinics offer topical dutasteride for patients. 

Many online providers, such as Manual, Numan, and Sons – all well-known UK telehealth brands – typically do not list topical dutasteride among their available hair loss treatments. However, some online clinics do offer topical dutasteride compounding services.

Hair Repair Clinic

Via their compounding arm (Compounding Labs Ltd), Hair Repair Clinic offers Dutasol, topical dutasteride solutions in a proprietary low-alcohol vehicle called TrichoSol. Customers can choose a strength of 0.025%, 0.05%, or 0.1% dutasteride. You can also add minoxidil to this formula (called Dutasol-M), which combines dutasteride with 5% or higher minoxidil. 

A free online prescription (assessment) is included with the purchase, and the product is made fresh to order in the UK. Pricing is £70 ($94.81) for a 3-month supply of dutasteride-only treatment. This price increases if you add extras, such as high-strength minoxidil. Shipping within the UK costs £5.50, and they also ship to some EU countries.

Pros

• Multiple vehicle and dosing choices with the option to add minoxidil for further regrowth.
• Transparent formulation, made to order in the UK.
• Free online prescription.

Cons

• Not covered by the NHS

Hair Medics UK

This London-based hair clinic also offers compounded topical formulas for sale. They advertise a topical finasteride (0.1%) and dutasteride (0.1%) combination solution (for men only) for £69.99 ($94.72). They also offer a dutasteride-alone solution (0.1%) for £59.99 ($81.19).

Pros

• Offers dutasteride only and dutasteride-finasteride combination solutions.

Cons

• Limited customization compared to options in other regions.

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/mL	Purity Testing
Hair Repair Clinic	Yes	Minoxidil	Yes 0.025%, 0.05%, 0.01%	£1.40 ($1.90)	None
Hair Medics UK	Yes	Finasteride	No 0.1%	£2.00 ($2.71)	None

Topical dutasteride is available in the UK, but primarily through private telehealth/clinic channels. Expect to pay out of pocket, as these are private prescriptions. 

International Options

A few companies openly market topical dutasteride worldwide without a prescription, operating in a gray area of enforcement. They are able to do this by exploiting international legal ambiguities, inconsistent enforcement, and gaps between national regulatory systems, which enable the global shipping of their products that might otherwise be restricted in the customer’s country. These practices largely persist due to a lack of harmonized global enforcement and prioritization of more serious pharmaceutical offenses.^[7]Feder, J. (2004). Legal Issues Related to Prescription Drug Sales on the Internet. CRS Report for Congress. Available at: … Continue reading

MinoxidilMax

MinoxidilMax offers a product called Duderma, which is a 0.1% dutasteride topical (1 mg/mL) in a 60 mL dropper bottle. It’s available with or without propylene glycol, and they also sell combinations with minoxidil or finasteride. Notably, MinoxidilMax requires no prescription; you can simply add it to your cart and purchase it directly from their site.

The cost is also relatively low compared to other options (approximately $40 for one bottle). It is essential to note that these are unregulated products, and you are essentially relying on the vendor’s word regarding the contents of the bottle. At PHH, we have tested Duderma and it has passed laboratory testing. However, we have found issues with other MinoxidilMax products, like the Dualgen-15 No PG Plus.

Pros

• Wide variety of compounded products (dutasteride alone or with minoxidil/finasteride).
• Low cost per milliliter.

Cons

• No prescription required raises regulatory/legal concerns.
• Quality control consistency is variable; some products tested below label potency

HemiaCosmetics

HemiaCosmetics is a Europe-based company that claims to operate out of Serbia. They sell Dutagen, a topical dutasteride solution at 0.1% (1 mg/mL) in 50 mL bottles. Like MinoxidilMax, no prescription is required to buy products from this company. Prices are also in a similar range (~$50). 

Users have reported mixed experiences with HemiaCosmetics products; some experienced increased shedding or no results, raising suspicions that the product may not contain the promised actives in the right concentration.^[8]u/motorcuadam (2023). Hemiacosmetics: Are they legit? Reddit. Available at: … Continue reading In short, there is a trust deficit with such grey-market sellers.

Pros

• Good inventory and pricing for topical dutasteride delivered to the EU/UK.
• Option to customize by enquiry.

Cons

• Mixed user feedback with concerns about formulation efficacy and potential shedding.

Provider	Customization	Add-Ons	Dosing Flexibility	Approx. Price/mL	Purity Testing
MinoxidilMax	Yes	Minoxidil, Finasteride	No 0.1%	$0.33	3rd-party lab reports.
Hemia Cosmetics	Yes (but only available upon enquiry)	No	No 0.1%	$1.01	None

Important: We do not endorse buying prescription-strength medications from unregulated sources. While it may be tempting due to lower costs or the absence of a doctor’s consultation, you are taking on risks in terms of product purity and legality. 

If you go this route, be aware that you’re essentially conducting an experiment on yourself with a substance of uncertain quality. Whenever possible, use a legitimate telehealth service or pharmacy; you’ll have medical oversight and a far better assurance that the bottle contains real dutasteride in the correct dosage.

Final Thoughts

Topical dutasteride presents a promising option for individuals who have not achieved sufficient success with topical finasteride or who wish to maximize DHT reduction at the scalp while potentially minimizing systemic effects. Several telehealth options are available if you are looking for where to buy topical dutasteride, but it’s crucial to choose a reputable source. In the U.S. and Canada, specialized telehealth companies like Ulo, Happy Head, Xyon, Strut, and others can prescribe and deliver custom-compounded solutions to your home. 

In the UK and Europe, a few compounding pharmacies (often linked with hair clinics) will work with you via online consultations to provide topical dutasteride legally. When comparing options, pay attention to factors like formula customization (do you want minoxidil or other growth boosters included?), convenience, and proven quality. Providers such as Ulo have set a high bar by offering third-party testing and personalized care, whereas some others might prioritize a one-size-fits-all high-dose approach or include unnecessary additives. 

Lastly, be wary of any vendor that seems too good to be true (for instance, selling dutasteride without a prescription or at suspiciously cheap prices). Saving a bit of money is not worth the risk of applying a mystery substance to your scalp. Whenever possible, stick with licensed telehealth and pharmacy services; you’ll ensure you’re getting authentic dutasteride in the proper concentration, and you’ll have medical guidance on how to use it safely and effectively. Your hair (and health) will be better off for it!

Oral finasteride has established itself as a highly effective treatment for androgenic alopecia (AGA) and is widely prescribed around the globe. Its success can be largely attributed to its proven ability to slow hair loss and stimulate regrowth by inhibiting the conversion of testosterone to DHT, the hormone chiefly responsible for follicular miniaturization. 

However, despite its well-documented efficacy, oral finasteride has become equally notorious for its potentially systemic side effects. Some men experience adverse effects such as decreased libido, erectile dysfunction, mood changes, and even persistent symptoms after discontinuation, a phenomenon called post-finasteride syndrome.^[1]Diviccaro, S., Melcangi, R.C., Giatti, S. (2019). Post-finasteride syndrome: an emerging clinical problem. Neurobiology of Stress. 12. 100209. Available at: https://doi.org/10.1016/j.ynstr.2019.100209 This reputation has prompted many to seek alternatives that are both effective and safer for long-term use.

Recently, topical finasteride formulations have garnered attention as a promising alternative. By delivering the medication directly to the scalp, topical finasteride aims to minimize systemic absorption and thereby reduce the likelihood of side effects while still providing the benefits of DHT inhibition where it matters most. This alternative approach has piqued the interest of both patients wary of systemic issues and clinicians seeking tailored treatments.

In this article, we will examine whether topical finasteride can serve as a viable alternative to its oral counterpart. The main focus will be on answering three questions:

1. Can topical finasteride effectively regrow hair in those affected by AGA?
2. Does it match the efficacy results seen with oral finasteride?
3. Can it reduce hair loss while offering a more favorable side effect profile?

Ulo offers finasteride options that range from low to high dose finasteride – allowing you to be flexible in your treatment choices.

Interested in Topical Finasteride?

Low-dose & full-strength finasteride available, if prescribed*

Take the next step in your hair regrowth journey. Get started today with a provider who can prescribe a topical solution tailored for you.

Click Here For 15% Off

*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

Oral vs. Topical Finasteride

Some research directly compares oral finasteride (1 mg daily) with various concentrations of topical finasteride, aiming to match hair regrowth efficacy while minimizing systemic side effects. Let’s take a look at a couple of examples:

Study 1 – Piraccini et al., 2022 (Phase III RCT, 24 weeks)

• Compared topical finasteride (0.25% spray) to oral finasteride (1 mg/day) and placebo in men with AGA.^[2]Piraccini, B.M., Blume-Peytavi, U., Scarci, F., Jansat, J.M., Falques, M., Otero, R., Tamarit, M.L., Galvan, J., Tebbs, V., Massana, E., Topical Finasteride Study Group. Efficacy and safety of … Continue reading
• The increase in hair count on a defined scalp area was similar for topical and oral finasteride, both outperforming the placebo, suggesting comparable clinical benefit.
• Systemic finasteride (oral) reduced mean serum DHT by 55.6%,  whereas topical finasteride reduced it by 34.5%. Plasma finasteride exposure from topical application was over 100 times lower than from oral administration. 
• Both had similar low rates of mild side effects, but sexual side effects, but sexual side effects were more associated with oral treatment. 
• Caveats: The “target area” measured may not represent the full scalp effects; although systemic absorption, albeit at a much lower level with topical application, still occurred and varied by formulation. 

Study 2 – Bhura, 2013 (RCT, 8 months)

• Parallel-group comparison in male AGA, tracking hair density and systemic DHT.^[3]Bhura, M. (2013). Comparative Analysis of Topical and Oral Finasteride in Androgenetic Alopecia: Impact on Hair Growth, Systemic Absorption, and Adverse Effects. Indian Journal of Basic and Applied … Continue reading 
• Oral finasteride resulted in slightly superior increases in hair number and thickness, although the difference was not statistically significant.
• Oral finasteride significantly reduced systemic DHT and caused more sexual side effects; topical finasteride led to minimal serum DHT changes and almost no systemic side effects, with most reactions being local (e.g., irritation).
• Those worried about long-term systemic effects preferred topical use, despite slightly less pronounced gains.

Study 3 – Hajheydari, 2009 (RCT, 6 months)

• Compared a 1% topical gel + placebo tablet with oral finasteride 1 mg/day + placebo gel.^[4]Hajheydari, Z., Akbari, J., Saeedi, M., Shokoohi, L. (2009). Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian Journal of Dermatology, … Continue reading 
• Both the gel and tablet produced statistically significant increases in total hair count and terminal hair count.
• There were no significant differences in hair thickness, hair count, or size of the bald area between the two groups. 

Mechanism of Action

Finasteride Pharmacodynamics

Finasteride is a competitive inhibitor of 5α-reductase, primarily targeting the type II isoenzyme at therapeutic doses, which predominates in the hair follicles and prostate. As mentioned above, this enzyme catalyzes the conversion of testosterone to DHT. 

At higher tissue concentrations, finasteride can also inhibit type I 5α-reductase, which is primarily found in the skin and sebaceous glands; however, its clinical significance for hair loss at standard doses is limited. By selectively inhibiting the type II enzyme, finasteride effectively lowers local and systemic DHT levels.^[5]Finn, D.A., Beadles-Bohling, A., Beckley, E.H., Ford, M.M., Gililland, K.R., Gorin-Meyer, R.E., Wiren, K.M. (2006). 12(1). 53-76. A New Look at the 5α-reductase Inhibitor Finasteride. CNS Drug … Continue reading 

What is Finasteride’s Effect on DHT Suppression?

Finasteride’s effect on DHT suppression is characterized by a logarithmic dose-response curve, meaning that even very low systemic levels can produce a marked reduction in both serum and scalp DHT. Most of the drug’s inhibitory action is achieved at low doses, with additional dosing yielding only marginal further effect.

As a result, even minimal “leakage” of topically applied finasteride into the bloodstream can decrease DHT levels elsewhere in the body.

Pharmacokinetic studies show that inhibition of type-II 5ɑ-reductase reaches saturation at typical clinical dosage, while type-1 enzyme inhibition requires much higher concentrations. This nonlinear pharmacodynamic profile explains both the strong efficacy and the wide safety margin of topical finasteride: a small amount achieves most of the desired effect, so careful formulation is crucial to maximize scalp delivery while minimizing unwanted systemic exposure.^[6]Suzuki, R., Satoh, H., Ohtani, H., Hori, S., Sawada, Y. (2010). Saturable Binding of Finasteride to Steroid 5ɑ-reductase as Determinant of Nonlinear Pharmacokinetics. Drug Metabolism and … Continue reading 

What the Science Says

Topical finasteride has been studied across a 200-fold concentration range, from 0.005% solutions to 1% gels. Collectively, these trials demonstrate meaningful reductions in shedding and measurable regrowth; however, systemic exposure increases with dose and vehicle potency.

Study	Concentration & Vehicle	Hair Growth-Outcomes	Systemic/Serum Findings
Mazzarella 1997, single-blind, 52 men/women, 16 months.	0.005% hydro-alcoholic solution	73% reported “high effectiveness”; wash-test hair counts improved; slowed shedding by month 6	No significant change in plasma DHT or testosterone; absorption was negligible.
Tanglertsampan 2012 RCT, 33 men, 24 weeks.	0.1% lotion + 3% minoxidil	The combination arm gained more hairs/cm2 and thicker shafts than minoxidil alone.	Local irritation mild; systemic parameters not monitored.
Datta 2021 double-blind trial, 35 participants completed, 6 months.	0.1% lotion +5% minoxidil vs oral 1 mg.	The topical combination was non-inferior to oral minoxidil for reducing the Hamilton-Norwood stage.	Sexual adverse events only occurred in the oral group; topical was well-tolerated.
Caserini 2016 OK study, 50 men, 1 week; Piraccini 2022 phase III, 323 completers, 24 weeks.	0.25% solution.	-70% scalp DHT after once-daily 1 mL; +20.2 hairs in 1 cm2 target area at 24 weeks – numerically equal to oral 1 mg.	100-200 μL doses reduced serum DHT by only 24-26%; 400 μL treatment reduced levels by 44-48%; Cmax was more than 100 times lower than oral.
Rossi 2020 retrospective, 69 women, 12-18 months.	0.5% lotion (postmenopausal women)	The Finasteride + minoxidil group scored higher on a 7-point global scale compared to the 17ɑ-estradiol + minoxidil group.	No androgenic side effects reported.
Hajheydari 2009 DB-RCT, 45 men, 6 months.	1% gel	Increases in total and terminal hair counts matched those of oral 1 mg; the bald area remained unchanged.	Serum DHT not assayed; clinical side-effects minimal.

Low-Dose Takeaways

Even a micro-dose of 0.005% twice daily (~0.1 mg/day) curbed shedding and improved density without measurable systemic suppression, making it an attractive option for highly risk-averse users.^[7]Mazzarella, F., Loconsole, F., Cammisa, A., Mastrolonardo, M., Vena, G.A. (1997). Topical finasteride in the treatment of androgenic alopecia. Preliminary evaluations after a 16-month therapy course. … Continue reading

Mid-Range (0.1-0.25%)

Adding 0.1% finasteride to minoxidil amplifies regrowth compared to minoxidil alone, while standalone 0.25% sprays deliver oral-level scalp DHT blockade, maintaining serum exposure roughly one-tenth that of tablets. Dose and volume are critical.^[8]Caserini, M., Radicioni, M., Leuratti, C., Terragni, E., Iorizzo, M., Palmieri, R. (2016). Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men … Continue reading

High-Dose (0.5-1%)

Topical finasteride options at 0.5% have been shown to extend benefits to female pattern hair loss with good tolerability.^[9]Rossi, A., Magri, F., D’Arino, A., Pigliacelli, F., Muscianese, M., Leoncini, P., Caro, G., Federico, A., Fortuna, M.C., Carlesimo, M. (2020). Efficacy of Topical Finasteride 0.5% vs 17ɑ-Estradiol … Continue reading

Why Formulation and Dose Matter

1. The vehicle drives absorption: according to the studies, hydro-alcoholic sprays penetrate faster than gels or liposomes, explaining divergent serum DHT curves at equal nominal strengths. 
2. Daily drug load, not percentage alone, predicts systemic spill over; 0.025% at 400 μL approaches the systemic impact of oral dosing, whereas 100 μL does not.
3. Combination therapy often allows for a lower finasteride concentration to achieve equal cosmetic benefits, thereby minimizing exposure.

Minimizing Systemic Absorption

While topical finasteride offers an option for minimizing systemic exposure, several key variables influence the amount that enters the bloodstream, and this can occur surprisingly quickly.

Key Factors Affecting Systemic Absorption

• Carrier Agent: The vehicle used to deliver finasteride dramatically alters absorption. Alcohol-based (ethosomal) carriers enhance drug penetration through the skin and into deeper layers like the dermis much more than conventional liposomes, which tend to remain more superficial. One study found that ethosomes resulted in approximately six times greater dermal accumulation than liposomes, highlighting the direct impact of carrier choice on systemic exposure.^[10]Rao, Y., Zheng, F., Zhang, X., Gao, J., Liang, W. (2008). In Vitro Percutaneous Permeation and Skin Accumulation of Finasteride Using Vesicular Ethosomal Carriers. AAPS PharmSciTech. 9(3). 860-865. … Continue reading
• Time on Scalp Before Washing: The longer finasteride remains on the scalp before washing, the greater the chance for absorption through the skin. Washing off too soon reduces drug uptake, but leaving it for extended periods increases both local efficacy and systemic exposure. Guidelines often recommend allowing at least 4-6 hours on the scalp, though this can vary by formulation. 
• Frequency of Use: If you can keep topical finasteride on your scalp for at least 10-12 hours, once-daily applications of low-dose topical finasteride might be beneficial. For those who can only tolerate finasteride for 4-6 hours, twice-daily applications may be better. You can read more about how often topical finasteride should be applied here.
• Individual Skin Permeability: Personal factors, including skin thickness, barrier integrity, genetics, and even scalp conditions, can strongly influence how much finasteride penetrates the scalp. Individuals with more permeable skin may absorb a greater amount of the drug systemically, increasing the risk of side effects.^[11]Brito, S., Baek, M., Bin, B-H. (2024). Skin Structure, Physiology, and Pathology in Topical and Transdermal Drug Delivery. Pharmaceutics. 16(11). 1403. Available at: … Continue reading 

How To Maximize Gains and Minimize Risk

To achieve the best results and reduce the likelihood of side effects, there are several strategies you can employ:

• Establish a Baseline with Serum DHT Testing

Before starting topical finasteride, get a baseline measurement of your serum DHT levels through a blood test. This serves as a reference to assess the extent to which systemic DHT is affected by your treatment. 

• Retest After 30 Days

After one month of consistent topical use, repeat the serum DHT test under the same conditions (preferably in the morning, fasted, and at a similar time of day). This helps you gauge systemic absorption and adjust your regimen if your serum DHT levels drop excessively. Hormone levels fluctuate based on daily rhythms, food intake, and stress, so always test under similar circumstances: morning, fasted, and ideally before applying the day’s finasteride.

• Avoid Confounding Supplements

Avoid supplements that may directly affect DHT, such as those that increase DHT (e.g., creatine) or quercetin (which may lower it). This ensures your test results and progress are a direct reflection of the topical finasteride.^[12]van der Merwe, J., Brooke, N.E., Myburgh, K.H. (2009). Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players. Clinical … Continue reading,^[13]Ma, Z., Nguyen, T.H., Huynh, T.H., Do, P.T., Huynh, H. (2004). Reduction of rat prostate weight by combined quercetin-finasteride treatment is associated with cell cycle deregulation. Journal of … Continue reading 

• Be Patient – It Takes Time

Visible improvements often require 12-24 months. Don’t make hasty adjustments if you don’t see immediate changes; hair cycles are slow. 

• Track Your Progress Objectively

Use standardized, high-quality photo documentation, same angle, lighting, and distance each time, to objectively monitor changes in hair density and coverage.

Combination Therapies

Robust evidence supports the use of combination therapies for AGA, with multi-modal approaches consistently outperforming monotherapy in terms of efficacy and speed of regrowth.

Finasteride + Minoxidil: Studies show that pairing topical finasteride with 5% minoxidil yields superior hair density and patient satisfaction compared to either agent alone, particularly after 24 weeks of treatment.^[14]Apoorva, V.B., Vibhu, M., Singh, R.H., Smita, T. (2023). Comparative Efficacy of Topical Finasteride (0.25%) in Combination with Minoxidil (5%) Against 5% Minoxidil or 0.25% Finasteride Alone in Male … Continue reading,^[15]Rossi, A., Caro, G. (2023). Efficacy of the association of topical minoxidil and topical finasteride compared to their use in monotherapy in men with androgenetic alopecia: A prospective, randomized, … Continue reading,^[16]Abeck, F., Hansen, I., Kott, J., Schroder, F., Garrahy, E., Veneroso, J., Runger, A., Torster, L., Schneider, S.W., von Buren, J. (2024). Patient-reported outcomes of topical finasteride/minoxidil … Continue reading This combination is effective for both new users and those who have experienced shedding after discontinuing oral finasteride.

Finasteride + Microneedling: Adding microneedling to topical therapy can significantly enhance outcomes. Clinical trials demonstrated that combining microneedling with minoxidil and/or finasteride increased hair density and shaft diameter more than minoxidil alone, with effects noticeable within just 12 weeks.^[18]Chang, Y., Zhang, W., Zhou, J., Lv, L., He, Q., Chen, Y., Wang, P., Zhai, Q. (2025). Clinical efficacy of microneedle combined with 5% Minoxidil solution and finasteride in the treatment of … Continue reading,^[19]Adistri, K., Sirait, S.P., Rihatmadja, R., Legiawati, L., Indriatmi, W., Saldi, S.R.F. (2024). Effectiveness and safety of the combination therapy of micro-needling and minoxidil in androgenetic … Continue reading 

Triple Topical Therapy: Preliminary studies on formulations that combine finasteride, dutasteride, and minoxidil show promising results, with visible regrowth as early as three months in some cases.^[20]Rafi, A.W., Katz, R.M. (2011). Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN Dermatology. 241953. Available at: … Continue reading

So, combination therapy appears to be more effective than monotherapy. Therefore, leveraging two or more topical therapies or adding microneedling can support hair regrowth outcomes.

Who Should (or Shouldn’t) Use Topical Finasteride?

Good Candidates:

• Men diagnosed with AGA.
• Those who tolerate oral finasteride but seek to minimize systemic risks.

Not Ideal For: 

• People with hair loss from causes other than AGA (e.g., alopecia areata, telogen effluvium). 
• Those who have previously shown a poor response to finasteride.
• Anyone trying to conceive, or with infants, toddlers, or pregnant individuals in close contact.
• Users who are unable or unwilling to follow consistent application routines or medical monitoring. 

Final Verdict

Topical finasteride is a legitimate option for hair regrowth. When formulated and used properly, it can rival oral finasteride’s effectiveness with a lower risk of systemic side effects. Success hinges on the right delivery method, correct dilution, and consistent application. While not flawless, it excels as part of a comprehensive regimen, especially when paired with therapies like minoxidil or microneedling. 

For those hesitant about oral medication, topical finasteride offers a practical, lower-risk compromise, provided users carefully follow evidence-based protocols to optimize both safety and results. Used strategically, it is a potent addition to hair loss treatment plans.

Topical minoxidil is one of the most widely used treatments for hair loss, known for its accessibility, relatively low risk profile, and ability to slow or partially reverse androgenetic alopecia in both men and women. First developed as a blood pressure medication, it gained FDA approval in the 1980s after researchers observed its unexpected side effect, stimulating hair growth when applied to the scalp.

In this article, we examine the mechanisms of action, formulation differences, dosing strategies, long-term efficacy, side effects, and methods to enhance results through combination therapies, such as microneedling or retinoids. Whether you’re just starting your hair restoration journey or reassessing your regimen, this guide provides an evidence-based foundation to help you make informed decisions.

Key Takeaways

• What is it? Topical minoxidil is an over-the-counter, FDA-approved liquid or foam. It is usually supplied as 2% or 5% as standard (although it can be offered at higher concentrations). It acts locally and is converted to minoxidil sulfate by scalp SULT1A1.
• Clinical Data. Topical minoxidil has been demonstrated in multiple randomized controlled trials to increase hair count, prolong the anagen phase, and enhance patient satisfaction in the short term, particularly at a 5% concentration. However, long-term data reveal diminishing efficacy over time, with many users reporting waning results or plateauing benefits after 12–18 months, particularly when used without adjunctive therapies like microneedling or anti-androgens.
• Safety. Topical minoxidil is generally safe, with a low incidence of systemic side effects due to minimal absorption. The most common adverse reactions are local, including scalp irritation, itching, and flaking, which are primarily attributed to the presence of propylene glycol in liquid formulations. More severe side effects like hypertrichosis or cardiovascular symptoms are rare and typically linked to misuse or high-sensitivity individuals. It is highly toxic to cats and should be handled with care by pet owners.
• Evidence Quality. Topical minoxidil scored 97/100 for evidence quality by our metrics.
• Best Practices. Apply topical minoxidil to a dry scalp once or twice daily, using 1 mL of solution or half a capful of foam per session. Gently massage to enhance penetration and avoid washing the scalp for at least two hours after application. Foam formulations are often better tolerated due to their lack of propylene glycol. For enhanced results, consider combining this treatment with microneedling, topical retinoids to boost SULT1A1 activity, or anti-androgenic therapies to counteract ongoing miniaturization.

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What is Topical Minoxidil?

Topical minoxidil formulations were originally developed in the early 1980s after an interesting side effect was discovered when it was used as an oral hypertensive agent. This side effect was hypertrichosis, or increased hair growth. The U.S. FDA approved topical minoxidil for male pattern hair loss in 1988 and for female pattern hair loss in 1991.^[1]Suchonwanit, P., Thammarucha, S., Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. 13. 2777-2786. Available at: … Continue reading

Minoxidil is a pro-drug: it requires enzymatic activation to exert its pharmacological effect on hair follicles. The key enzyme involved in this is sulfotransferase SULT1A1, which is highly expressed in the outer root sheath (ORS) of hair follicles.^[2]Bacqueville, D., Jacques, C., Duprat, L., Jamin, E.L., Guiraud, B., Perdu, E., Bessou-Touya, S., Zalko, D., Duplan, H. (2017). Characterization of xenobiotic metabolizing enzymes of a reconstructed … Continue reading The level of SULT1A1 activity in the hair follicle correlates strongly with clinical response to topical minoxidil; individuals with low SULT1A1 activity are less likely to benefit from treatment.^[3]Pietrauszka, K., Bergler-Czop, B. (2020). Sulfotransferase SULT1A1 activity in hair follicle, a prognostic marker of response to the minoxidil treatment in patients with androgenetic alopecia: a … Continue reading

Topical minoxidil typically comes in two main formulations:

• Solution: The original and most widely used form. Some use carrier agents like propylene glycol to improve solubility and scalp penetration, but it is a common cause of local irritation (itching, redness, flaking).^[4]Epstein, G.K., Epstein, J., Cohen, J. (2019). Hair Loss in Men and Women: Medical and Surgical Therapies. 2(1). 161-176. Available at: https://doi.org/10.1016/j.yacs.2019.02.006 
• Foam: Developed to address PG sensitivity. The foam formulation is propylene glycol-free, reducing the risk of irritation and allergic reactions. It is easier to apply, dries quickly, and is FDA-approved at 5% strength.^[5]Lupatini, R., Sidhu, R., Patel, H., Bichar, K. (2021). Stability Evaluation of Minoxidil in FOAMIL Foam Base with Bracketing Study Design. International Journal of Pharmaceutical Compounding. 25(3) … Continue reading

Some options also offer propylene glycol-free solutions and gels. Some newer products use water-based or liposomal vehicles to cater to users with sensitive skin or allergies.

Why Might I Consider Topical Minoxidil Over Oral?

Many people opt for topical minoxidil over oral formulations due to key differences in safety, accessibility, and side effect profiles. 

Over-the-Counter Access & fewer Barriers

Topical minoxidil is available over the counter, making it easy to obtain and start treatment promptly. Oral minoxidil, however, requires a prescription and is typically used off-label for hair loss, which can delay access and introduce hurdles within the healthcare system.

Minimal Systemic Exposure

Applying minoxidil directly to the scalp results in minimal absorption into the bloodstream. This localized delivery reduces the risk of systemic side effects that are more common with oral minoxidil, which circulates throughout the body.^[6]Ashique, S., Sandhu, N.K., Haque, S.N., Koley, K. (2020). A Systemic Review on Topical Marketed Formulations, Natural Products, and Oral Supplements to Prevent Androgenic Alopecia: A Review. Natural … Continue reading

Lower Risk of Hypertrichosis, Edema, and Cardiac Events

Oral minoxidil demonstrates a high incidence of hypertrichosis, whereas in topical minoxidil, it is usually localized and linked to misuse.^[7]Jiminez-Cauhe, J., Sicco, K.I.L., Shapiro, J., Hermosa-Gelbard, A., Burgos-Blasco, P., Melian-Olivera, A., Ortega-Quijano, D., Pindado-Ortega, C., Buendia-Castano, D., Asz-Sigall, D., Vano-Galvan, S. … Continue reading

Similarly, edema (fluid retention/swelling) and cardiac side effects (such as tachycardia, pericardial effusion, and exacerbation of angina) are rare with topical use but do have the potential to cause issues for those with preexisting cardiovascular, renal, or hepatic conditions.^[8]do Nascimento, I.J.B., Harries, M., Rocha, V.B., Thompson, J.Y., Wong, C.H., Varkaneh, H.K., Guimaraes, N.S., Arantes, A. J. R., Marcolini, M.S. (2020). Effect of Oral Minoxidil for Alopecia: … Continue reading

How Does Topical Minoxidil Work?

Topical minoxidil stimulates hair growth through a variety of interconnected biological mechanisms, many of which have been elucidated in peer-reviewed research.

Local Vasodilation and VEGF Up-Regulation

Minoxidil acts as a potent vasodilator by opening potassium channels in vascular smooth muscle, leading to increased blood flow around hair follicles. This enhanced microcirculation delivers more oxygen and nutrients to the follicular environment, creating conditions favorable for hair growth.

Additionally, minoxidil upregulates the expression of vascular endothelial growth factor (VEGF) in dermal papilla cells. VEGF is a key mediator of angiogenesis, supporting the development and maintenance of the follicular blood supply necessary for robust hair growth.^[9]Zeltzer, A.A., Keren, A., Paus, R., Gilhar, A. (2024). Topical minoxidil rejuvenates hair follicles from men with androgenetic alopecia in vivo. Acta Dermato Venereologica. 104(24213). Available at: … Continue reading

Anagen Induction and Telogen Shortening

One of the hallmark effects of topical minoxidil is its ability to induce the anagen (growth) phase of the hair cycle and shorten the telogen (resting) phase.^[10]Van Neste, D. (2020). Placebo-controlled dose-effect studies with topical minoxidil 2% or 5% in male-patterned hair loss treated with oral finasteride employing an analytical and exhaustive study … Continue reading By prompting resting hair follicles to re-enter the growth phase more rapidly, minoxidil effectively “resets” the hair cycle, leading to increased hair density and thickness over time. This is a central reason for its clinical efficacy in treating AGA and other hair loss disorders.

Wnt/ꞵ-Catenin Activation in Dermal Papilla

Recent studies have shown that minoxidil activates the Wnt/ꞵ-catenin signaling pathway within dermal papilla cells. This pathway is essential for hair follicle development, regeneration, and maintenance. Activation of ꞵ-catenin dermal papilla cells prolongs the anagen phase and supports the proliferation and differentiation of follicular cells, further enhancing hair growth.^[11]Kwack, M.H., Kang, B.M., Kim, M.K., Kim, J.C., Sung, Y.K. (2011). Minoxidil activates ꞵ-catenin pathway in human dermal papilla cells: a possible explanation for its anagen prolongation effect. … Continue reading

Prostaglandin Modulation (PGE2)

Minoxidil has been found to increase the production of prostaglandin E2 (PGE2) by activating prostaglandin synthase-1 (PGHS-1) in dermal papilla fibroblasts. Elevated PGE2 levels are associated with hair growth promotion, possibly by providing cytoprotective effects and modulating local inflammation within the follicle environment.^[12]Michelet, J.F., Commo, S., Billoni, N., Mahe, Y.F., Bernard, B.A. (1997). Activation of cytoprotective prostaglandin synthase-1 by minoxidil as a possible explanation for its hair growth-stimulating … Continue reading This prostaglandin modulation may also counteract the inhibitory effects of certain nonsteroidal anti-inflammatory drugs (NSAIDs).

Penetration Factors: Vehicle, Skin Barrier, and Enzymes

The effectiveness of topical minoxidil depends significantly on its ability to penetrate the scalp and reach the hair follicle. Only about 1.4% of applied minoxidil is typically absorbed through intact skin.^[13]Gupta, A.K., Talukder, M., Venkataraman, M., Bamimore, M.A. (2022). Minoxidil: a comprehensive review. Journal of Dermatological Treatment. 33(4). 1896-1906. Available at: … Continue reading

The formulation’s vehicle (e.g., alcohol-based solution, foam, or novel delivery systems like cetosomes), the integrity of the skin barrier (stratum corneum), and the presence of activating enzymes (notably sulfotransferase SULT1A1 in the outer root sheath) all influence absorption and efficacy.^[14]Sattur, S. Talathi, A., Shetty, G., Arsiwala, S., Pereira, R., Dhoot, D. (2023). Comparative Clinical Study Evaluating the Efficacy and Safety of Topical 5% Cetosomal Minoxidil and Topical 5% … Continue reading

Dosing and Application Logistics

Once vs Twice Daily – What the Evidence Shows

Clinical studies have demonstrated that once-daily application of 5% topical minoxidil achieves hair count improvements comparable to twice-daily use of the 2% solution in men with AGA.^[15]Olsen, E.A., Dunlap, F.E., Funicella, T., Koperski, J.A., Swinehart, J.M., Tschen, E.H., Trancik, R.J. (2002). A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and … Continue reading In long-term studies, men who switched from twice daily to once-daily minoxidil maintained most of their hair gains, though there was a slightly greater mean loss in those on the once-daily regimen compared to those who remained on twice-daily dosing.^[16]Olsen, E.A., DeLong, E.R., Weiner, M.S. (1987). Long-term follow-up of men with male pattern baldness treated with topical minoxidil. Journal of the American Academy of Dermatology. 16(3 Pt 2). … Continue reading

Importantly, using 5% minoxidil twice daily can provide an incremental benefit, approximately 10-15% greater hair regrowth, over once-daily 5% application or twice-daily 2% solution, though this comes with a higher risk of local irritation.^[17]Olsen, E.A., Dunlap, F.E., Funicella, T., Koperski, J.A., Swinehart, J.M., Tschen, E.H., Trancik, R.J. (2002). A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and … Continue reading

For women with FPHL, randomized clinical trials have shown that once-daily application of 5% minoxidil foam is non-inferior to twice-daily use of the 2% minoxidil solution in terms of hair regrowth and target area hair counts.^[18]Blume-Peytavi, U., Hillmann, K., Dietz, E., Canfield, D., Bartels, N.G. (2011). A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the … Continue reading Both regimens lead to similar improvements, but the once-daily 5% foam offers a significant compliance advantage, as it is easier to incorporate into daily routines and is associated with fewer reports of scalp irritation.^[19]Ramos, P.M., Melo, D.F., Radwanski, H., de Almeida, R.F.C., Miot, H.A. (2023). Female-pattern hair loss: therapeutic update. Anais Brasileiros de Dermatologica. 98(4). 506-519. Available at: … Continue reading This practical benefit makes once-daily 5% foam a preferred initial therapy for many women.

Choosing a Topical Minoxidil Concentration

Selecting the right minoxidil concentration depends on your goals, tolerance, and clinical context. 

2% Minoxidil

• Profile: Traditionally labeled for women, especially those with sensitive scalps or mild hair loss.
• Efficacy: Offers modest improvement in hair counts and density; superior to the placebo but less effective than higher strengths.^[20]Olsen, E.A., Dunlap, F.E., Funicella, T., Koperski, J.A., Swinehart, J.M., Tschen, E.H., Trancik, R.J. (2002). A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and … Continue reading
• Tolerability: Minimal irritation and side effects; preferred for those prone to dermatitis or with a low threshold for adverse reactions.
• Best for: Mild AGA, sensitive skin, or those who prioritize safety over maximal regrowth.

5% Minoxidil

• Profile: The most widely studied and FDA-approved concentration for both men and women.
• Efficacy: Consistently outperforms 2% for both hair counts and patient satisfaction; considered the best balance between response rate and tolerability.^[21]Olsen, E.A., Dunlap, F.E., Funicella, T., Koperski, J.A., Swinehart, J.M., Tschen, E.H., Trancik, R.J. (2002). A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and … Continue reading
• Tolerability: Slightly higher risk of local irritation (itching, redness, flaking) than 2%, but generally well-tolerated, especially in foam (propylene glycol-free) formulations.
• Best for: Most patients with AGA seeking robust, evidence-based results.

7% Minoxidil

• Profile: Custom-compounded, not commercially available or FDA-approved; sometimes used for those with low follicular sulfotransferase activity (“enzyme low-responders”). 
• Efficacy: May offer incremental benefit for select non-responders to 5%, though supporting data are limited and mixed.^[22]Singh, S., Patil, A., Kianfar, N., Waskiel-Burnat, A., Rudnicka, L., Sinclair, R., Goldust, M. (2022). Does topical minoxidil at concentrations higher than 5% provide additional clinical benefit? … Continue reading 
• Tolerability: Higher risk of contact dermatitis due to increased propylene glycol and alcohol content; requires careful monitoring for irritation.
• Best for: Patients who do not respond to 5% and have confirmed low enzyme activity, under clinical supervision.

10-15% Minoxidil

• Profile: Compounded, not FDA-approved; considered a last-line topical option before transitioning to oral minoxidil.
• Efficacy: Evidence is conflicting; some studies suggest no added benefit over 5%, while others report modest gains in select cases. Side effects increase substantially with higher concentrations.^[23]Vasantha, K.L. (2025). Efficiency and Safety of 10% Minoxidil in the Treatment of Alopecia Areata: A Randomised Controlled Trial. Journal of Population Therapeutics and Clinical Pharmacology. 32(4). … Continue reading,^[24]Ghonemy, S., Alarawi, A., Bessar, H. (2021). Efficacy and safety of a new 10% topical minoxidil versus 5% topical minoxidil and placebo in the treatment of male androgenetic alopecia: a trichoscopic … Continue reading
• Risks: Marked increase in scalp irritation, dermatitis, and cost. Formulations typically require more propylene glycol and alcohol for solubility, compounding the risk of adverse reactions.
• Best for: Refractory cases under specialist care, when all lower strengths have failed, and before considering oral therapy.

Vehicle and Formulation Tweaks

There are a number of options you can take in terms of formulation or additional treatments to improve the efficacy of topical minoxidil. 

Foam vs. Liquid: Propylene Glycol, Irritation, and Drying Time

Liquid minoxidil formulations can contain propylene glycol, which improves drug solubility and skin penetration.^[25]Grice, J.E., Ciotti, S., Weiner, N., Lockwood, P., Cross, S.E., Roberts, M.S. (2010). Relative uptake of minoxidil into appendages and stratum corneum and permeation through human skin in vitro. … Continue reading However, propylene glycol is a frequent cause of scalp irritation; itching, redness, and flaking are common complaints, especially among users with sensitive skin.^[26]Patel, K., Palmer, A., Nixon, R. (2023). Allergic contact dermatitis from propylene glycol: A case series from Australia. Contact Dermatitis. 89(2). 79-84. Available at: … Continue reading

Foam minoxidil was specifically developed to avoid propylene glycol usage and minimize irritation. As a result, foam is generally much better tolerated, especially for individuals prone to dermatitis or scalp discomfort.^[27]Nestor, M.S., Ablon, G., Gade, A., Han, H., Fischer, D.L. (2021). Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of … Continue reading  Additionally, the foam dries faster than the traditional liquid, making it more convenient for daily use.

Efficacy: Most comparative studies and clinical experience suggest the 5% foam and 2% liquid are equivalent in hair regrowth when used appropriately; the choice often comes down to scalp tolerance and application preference.^[28]Blume-Peytavi, U., Hillmann, K., Dietz, E., Canfield, D., Bartels, N.G. (2011). A randomized, single-blind trial of 5% minoxidil foam once-daily versus 2% minoxidil solution twice daily in the … Continue reading

Propylene Glycol Free, Fast-Drying, Glycerin-Based Recipes.

For patients unable to tolerate propylene glycol or those seeking even less greasy, faster-drying options, newer propylene glycol-free formulations have been developed. These often use other solvents or humectants, with in vitro and clinical studies showing similar efficacy to products containing propylene glycol.^[29]Barbareschi, M., Vescovi, V., Starace, M., Piraccini, B.M., Milani, M. (2020). Propylene glycol free 5% minoxidil lotion formulation: cosmetic acceptability, local tolerability, clinical efficacy and … Continue reading

Addition of Retinol/Tretinoin (0.01%-0.025%) to Up-Regulate SULT1A1

As mentioned above, SULT1A1 is the key enzyme in the hair follicle that activates minoxidil by converting it to minoxidil sulfate, its effective form. Retinoids, notably tretinoin (0.01-0.025%), can be added to topical regimens to upregulate SULT1A1 in the outer root sheath, enhancing the local activation of minoxidil.^[30]Sharma, A., Goren, A., Dhurat, R., Agrawal, S., Sinclair, R., Trueb, R.M., Vano-Galvin, S., Chen, G., Tan, Y., Kovacevic, M., Situm, M., McCoy, J. (2019). Tretinoin enhances minoxidil response in … Continue reading

The mechanism appears to involve both increased skin permeability and direct modulation of SULT1A1 gene expression, making this combination particularly useful for patients with known or suspected low enzyme activity.

Topical Minoxidil Efficacy

When assessing the benefits of topical minoxidil, it’s critical to consider how response rates, regrowth rates, and especially months of use influence real-world outcomes for individuals with AGA. While many early studies highlight minoxidil’s promise, longer-term data reveal a more nuanced reality.

Short-Term Response

Within 3-6 months, minoxidil demonstrates high response rates. Surveys and clinical studies consistently show that roughly 60% of men perceive a meaningful response (slowing, stopping, or reversal of hair loss) in this window (as per self-assessment and investigator evaluations).^[31]Asilian, A., Farmani, A., Saber, M. (2023). Clinical efficacy and safety of low-dose oral minoxidil versus topical solution in the improvement of androgenetic alopecia: A randomized controlled trial. … Continue reading

Long-Term Response

After one year or longer, response rates drop dramatically. Multiple studies report rates below 30%, and even lower in five-year follow-up populations, with only about 20-30% of users satisfied with the results.^[32]Olsen, E.A., Weiner, M.S., Amara, I.A., DeLong, E.R. (1990). Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil. Journal of American Academy of Dermatology. 22(4). … Continue reading

Real-world data indicate discontinuation rates of 86–95% by the one-year mark. The leading reason cited by users for stopping? “Low effect,” or disappointment with the cosmetic improvement offered by the drug.^[33]Shadi, Z. (2023) Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia. Dermatology and Therapy. 13(5). 1157-1169. Available at: … Continue reading

Regrowth Rate: Short-Lived Gains

In one pivotal trial, men using 5% minoxidil twice daily saw a nearly 60% increase in hair “weight” (total mass of regrown/thickened hair) at 6 months. By 96 weeks, gains had diminished to just 25% above the baseline, a significant drop from the initial response.^[34]Van Neste, D. (2020). Placebo-controlled dose-effect studies with topical minoxidil 2% or 5% in male-patterned hair loss treated with oral finasteride employing an analytical and exhaustive study … Continue reading

Over 48 weeks, users displayed a 12% rise in hair count compared with 3% for placebo (statistically significant). Still, these increases in hair number did not always correspond to better visible scalp coverage when judged by experts, indicating that raw hair counts may overstate clinical benefit.

Why Does Efficacy Diminish With Time?

Lack of DHT Targeting and Ongoing Miniaturization

Minoxidil’s primary action is to stimulate hair follicles into a growth (anagen) phase; however, it does not block the effects of DHT, the androgen responsible for follicle miniaturization in genetic hair loss.^[35][Updated 2023 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482378/ Accessed: July 2025 Therefore, hair shafts may still become thinner despite greater numbers, diminishing real-world cosmetic impact.

Fibrosis: The Hidden Limitation

Emerging evidence points to fibrosis, the gradual formation of restrictive, scar-like tissue around miniaturizing follicles, as a rate-limiting factor in AGA.^[36]Trueb, R.M., Dias, M.F.R.G., Rezende, H.D. (2021). Comment on Follicular Inflammation and Fibrosis in Pattern Hair Loss. Skin Appendage Disorders. 7(2). 159-160. Available at: … Continue reading Minoxidil does not directly address this fibrotic process, so even if follicles are nudged back into growth, their ability to produce robust hair continues to decline as surrounding tissue stiffens and shrinks.

The Limits of Hair Count as a Metric

Statistical increases in hair count do not guarantee clinical satisfaction. Studies repeatedly show that even impressive numeric gains in hair counts (or surrogate measures, such as hair mass index) are not always matched by noticeable differences in scalp coverage or user satisfaction.^[37]Van Neste, D. (2020). Placebo-controlled dose-effect studies with topical minoxidil 2% or 5% in male-patterned hair loss treated with oral finasteride employing an analytical and exhaustive study … Continue reading Patient dissatisfaction and discontinuation remain high in the absence of true visual improvement, underscoring the practical limits of relying on surrogate endpoints.

Combining Minoxidil with Microneedling

Recent clinical trials have shown that adding microneedling to minoxidil treatment can significantly enhance both response and regrowth rates. One landmark study reported a nearly fourfold greater increase in hair count (approximately a 40% gain) compared to minoxidil alone at 12 weeks, with participants experiencing actual visible improvements in density.^[38]Ahmed, K.M.A., Kozaa, Y.A., Abuawwad, M.T., Al-Najdawi, A.I.A., Mahmoud, Y.W., Ahmed, A.M., Taha, M.J.J., Fadhli, T., Giannopoulou, A. (2025). Evaluating the efficacy and safety of combined … Continue reading

A six-month trial showed an 85% effective rate and a significant increase in hair count for the combination approach.^[39]Zhang, Y., Sheng, Y., Zeng, Y., Hu, R., Zhao, J., Wang, W., Yang, Q. (2022). Randomized trial of microneedling combined with 2% minoxidil topical solution for the treatment of female pattern hair … Continue reading

Why Does Microneedling Work So Well?

• Improved drug absorption: Microneedling transiently disrupts the scalp’s barrier, allowing minoxidil to penetrate more effectively.
• Enzyme upregulation: The procedure may increase the local activity of sulfotransferase enzymes needed for minoxidil activation, potentially overcoming a key bottleneck for some non-responders.^[41]Sharma, A., Surve, R., Dhurat, R., Sinclair, R., Tan, T., Zou, Y., Ramos, M.P., Wambier, C., Vernier, I., Kovacevic, M., Goren, A. (2020). Microneedling improves minoxidil response in androgenetic … Continue reading
• Counteracting fibrosis: Early research suggests that microneedling may help remodel fibrotic tissue, making the scalp environment more conducive to robust hair regrowth.

Non-Responder Pathway (SULT1A1-Guided)

For people who don’t respond adequately to topical minoxidil, several strategies can help overcome this resistance and optimize hair growth.

Increase Topical Minoxidil Concentration (7-10%)

Raising the concentration of topical minoxidil beyond 5%, to compounded strengths such as 7% or 10%, is a common clinical approach for patients identified as poor responders. The rationale is that higher drug levels may compensate, at least partially, for suboptimal enzymatic conversion of minoxidil to its active sulfate form in the outer root sheath.

Add Topical Retinoic Acid (0.01-0.05%)

Topical retinoic acid (such as tretinoin) can be combined with minoxidil to upregulate SULT1A1 activity, thereby enhancing the local activation of minoxidil in the hair follicle. Peer-reviewed research indicates that applying topical tretinoin upregulates follicle sulfotransferase enzymes, thereby enhancing the response to minoxidil.^[42]Sharma, A., Goren, A., Dhurat, R., Agrawal, S., Sinclair, R., Trueb, R.M., Vano-Galvan, S., Chen, G., Tan, Y., Kovacevic, M., Situm, M., McCoy, J. (2019). Tretinoin enhances minoxidil response in … Continue reading

Incorporate Weekly Microneedling (0.5-1.5 mm)

Microneedling is an increasingly popular adjunctive treatment for hair loss, particularly in individuals who do not respond to minoxidil. Weekly sessions using devices with needles 0.5–1.5 mm in length create controlled micro-injuries in the scalp, stimulating growth factors, activating dermal papilla cell signaling (such as Wnt/β-catenin), and boosting SULT1A1 enzyme expression.^[43]Dhurat, R., Sukesh, M.S., Avhad, G., Dandale, A., Pal, A., Pund, P. (2013). A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study. International … Continue reading,^[44]Kumar, K.M., Inamadar, A.C., Palit, A. (2018). A Randomized Controlled, Single-Observer Blinded Study to Determine the Efficacy of Topical Minoxidil plus Microneedling versus Topical Minoxidil Alone … Continue reading,^[45]Zhang, Y., Sheng, Y., Zeng, Y., Hu, R., Zhao, J., Wang, W., Yang, Q. (2022). Randomized trial of microneedling combined with 2% minoxidil topical solution for the treatment of female pattern hair … Continue reading

Switch to or Add Low-Dose Oral Minoxidil

Low-dose oral minoxidil, typically 0.25–5 mg daily, offers systemic activation, as minoxidil is converted to its active sulfate in the liver (where SULT1A1 levels are abundant).^[46]Ramirez-Marin, H.A., Tosti, A. (2022). Role of Oral Minoxidil in Patterned Hair Loss. Indian Dermatology Online Journal. 13(6). 729-733. Available at: https://doi.org/10.4103/idoj.idoj_246_22 For individuals whose follicular SULT1A1 is insufficient for topical efficacy, oral minoxidil can bypass the need for high local enzyme activity. Recent comprehensive reviews and clinical experience suggest that low-dose oral minoxidil is effective for hair regrowth in male and female pattern hair loss, with a favorable safety profile when started at low dosages.^[47]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. Available at: … Continue reading

Explore Compounded Minoxidil Sulfate (Direct Active Form)

Compounding pharmacies can prepare topical formulations containing minoxidil sulfate, the direct, active metabolite, bypassing the need for SULT1A1 conversion. Though theoretically attractive for SULT1A1 nonresponders, minoxidil sulfate is chemically less stable than parent minoxidil and is also more expensive.^[48]Chemical Book. (no date). Minoxidil Sulphate. ChemBook. Available at: https://www.chemicalbook.com/Price/Minoxidil-sulphate.htm Accessed: July 2025,^[49]Shan, Y., Xu, C., Guo, Y., Wen, L., Zhou, S., Fang, L., Xu, J., Zhen, H. (2025). Liposomes enhance the hair follicle delivery of minoxidil sulfate with improved treatment of androgenetic alopecia. … Continue reading Its shelf-life, risk of degradation, and limited availability currently constrain its widespread clinical use. Efficacy and safety data are lacking beyond case reports and experimental settings, and this approach remains investigational.

What To Expect Time-Line Wise

Understanding the typical milestones and changes during minoxidil treatment helps set realistic expectations, avoids premature discontinuation, and guides regimen adjustments for optimal hair regrowth. Here’s a week-by-week and month-by-month breakdown based on clinical evidence and peer-reviewed research.

Weeks 4-6: The Shedding Spike (“Telogen Synch”)

What happens: Many users notice an initial increase in hair shedding after starting minoxidil, usually peaking around weeks 4–6.

Why: This effect, known as telogen effluvium, occurs as minoxidil accelerates the transition of hair follicles from the resting (telogen) to the active (anagen) growth phase. Older, miniaturized hairs are shed to make way for new ones.

What to do: This shedding is temporary and generally indicates that the treatment is starting to take effect. Stopping minoxidil because of early shedding is unnecessary and may forfeit later gains.

Month 3: Early Vellus Thickening and the First Cosmetic Hints

What happens: Fine, soft “vellus” hairs begin to thicken. With combination treatments (such as minoxidil plus microneedling), these changes may be more pronounced and start to become cosmetically noticeable.

Why: Follicles kickstart new anagen cycles, and some can already be seen transitioning to more pigmented, visible hairs.^[50]Rafi, A.W., Katz, R.M. (2011). Pilot study of 15 patients receiving a new treatment regimen for androgenic alopecia: the effects of atopy on AGA. ISRN Dermatology. 11. 241953. Available at: … Continue reading

Expectations: While cosmetic gains are modest at this stage using monotherapy, up to 60–74% of users report improvement in density and coverage when asked at 3–4 months.^[51]Rundegren, J. (2004). Rapid onset of action of minoxidil 5% topical solution in a 4-month German observational study on both patients and physicians. Journal of the American Academy of Dermatology. … Continue reading

Months 6 – 8: Peak Visible Gains (Most Noticeable Results) and Plateau

What happens: The majority of the visible thickening and coverage improvements emerge by 6-8 months. Around this time, many people also see gains plateau and further visible regrowth slows considerably

Clinical evidence: At this point, studies show peak increases in terminal hair count and density (e.g., a 12–15% rise for standard 5% twice-daily solutions in men).^[52]Olsen, E.A., Dunlap, F.E., Funicella, T., Koperski, J.A., Swinehart, J.M., Tschen, E.H., Trancik, R.J. (2002). A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and … Continue reading

What to do: Regimen reevaluation is appropriate here; ensure ongoing compliance, assess satisfaction, and consider any adjuncts or boosters if progress is suboptimal.  If additional improvement is desired, this is the window to explore adjunctive approaches, such as adding microneedling, retinoids, or anti-androgen therapies, to enhance or sustain growth.

Month 9 +: Gradual Waning Without Additional Support

What happens: Many users see diminishing improvements after 9 months; some may even experience slow retreating benefits despite continued use.

Why: Minoxidil alone does not address the underlying drivers of androgenetic alopecia, namely, DHT-mediated follicle miniaturization and progressive perifollicular fibrosis. Without combining minoxidil with anti-DHT agents or regenerative wounding therapies, natural progression often limits sustained gains.

Long-term evidence: Only ~30% of users report being satisfied after several years; discontinuation is common, with the lack of a visible effect being the primary reason.^[53]Shadi, Z. (2023) Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia. Dermatology and Therapy. 13(5). 1157-1169. Available at: … Continue reading 

Safety and Side Effects

Dermatitis (2-6%): Mainly Propylene Glycol

• Incidence: Irritant or allergic contact dermatitis occurs in ~2-6% of users.
• Primary Cause: Most cases are induced by propylene glycol, a key solvent in liquid minoxidil solutions, rather than by minoxidil itself.^[54]Jadeed, H.B., Almudimeegh, A.M., Alomran, S.A., Alshathry, A.H. (2021). A Case of Contact Allergic Dermatitis to Topical Minoxidil. Cureus. 13(1). E12510. Available at: … Continue reading
• Symptoms: Itching, redness, scaling, and sometimes localized swelling.
• Management: Switching to propylene glycol-free foam formulations or compounded solutions using alternative solvents (like glycerol or butylene glycol) can resolve symptoms for sensitive users. Those with confirmed allergy to minoxidil itself should avoid all forms.

Scalp Dryness and Flaking

• Presentation: Dryness and flaking of the scalp are common, primarily due to the alcohol and propylene glycol content in the formulation.
• Management: 
  • Use gentle, sulfate-free shampoos.
  • Prefer shorter contact times and allow the product to dry completely.
  • Consider propylene glycol or alcohol-free versions when persistent dryness occurs.

Facial Hypertrichosis

• Incidence: Mild, reversible facial hair growth (hypertrichosis) may develop, especially with high doses or accidental application beyond the intended area, such as the scalp.
• Course: Usually appears within 2-5 months of starting minoxidil and typically resolves within one to five months after stopping or reducing use.
• Mechanism: Thought to result from inadvertent transfer or high follicular sensitivity, not systemic toxicity.^[55]Chellini, P.R., Pirmez, R., Raso, P., Sodre, C.T. (2015). Generalized hypertrichosis induced by topical minoxidil in an adult woman. International Journal of Trichology. 7(4). 182-183. Available at: … Continue reading

Toxicity to cats (prevalence: low if you’re careful; high if you’re reckless)

• Cats lack the enzyme required to metabolize minoxidil, much like dogs lack the enzymes required to quickly metabolize substances within chocolate. Resultantly, minoxidil is highly toxic to cats.^[56]DeClementi, C., Bailey, K.L., Goldstein, S.C., Orser, M.S. (2004). Suspected toxicosis after topical administration of minoxidil in 2 cats. Veterinary Emergency & Critical Care. 14(4). 287-292. … Continue reading From 2001 to 2014, there were four reported feline deaths from minoxidil exposure.
• This doesn’t mean that if you have cats, you can’t use minoxidil. It simply means that you need to take extra precautions during storage, application, and drying, and ensure your cats don’t come into contact with the drug (even through their fur).

Heart palpitations (prevalence: very low)

• There is some systemic absorption from the use of topical minoxidil. As such, a small percentage of users have reported blood pressure-related effects ranging from dizziness to heart palpitations.^[57]Leenen, F.H., Smith, D.L., Unger, W.P. (1988). Topical minoxidil: cardiac effects in bald man. British Journal of Clinical Pharmacology. 26(4). 481-485. Available at: … Continue reading

Stopping Topical Minoxidil

Discontinuing topical minoxidil is a significant decision, as virtually all clinical evidence and real-world experience indicate that hair gains made during treatment will be lost, usually within 3 to 12 months. This process is driven by the underlying physiology of follicles and the progressive nature of AGA.

The Physiology Behind Minoxidil Withdrawal

• Follicular Cycling: When minoxidil is stopped, hair follicles revert to their pre-treatment anagen (growth phase) timing within approximately three months. This leads to a synchronized shedding phase and a temporary drop in hair density, often falling below pre-treatment baseline before returning to the genetic trajectory over the subsequent months.
• Rebound Shedding: After ceasing minoxidil, the majority of users experience significant shedding, which can sometimes be more aggressive than before they began treatment. Typically, this shedding lasts for 3–6 months, but can persist for up to a year in some cases. The extent of the shed varies from person to person, but those who respond best to the drug are usually most affected, simply because they maintain or regrow more hair than they lose.

Evidence in Clinical Studies

One 96-week study on both 2% and 5% topical minoxidil found that after treatment was halted, hair counts and weight fell below both baseline and placebo levels within 3 months.^[58]Price, V.H., Menefee, E., Strauss, P.C. (1999). Changes in hair weight and hair count in men with androgenetic alopecia, after application of 5% and 2% topical minoxidil, placebo, or no treatment. … Continue reading By six months post-withdrawal, most subjects’ hair counts rebounded to baseline, indicating the temporary and reversible effects of minoxidil therapy in AGA.

Tapering Off: Protocol to Blunt Rebound Shedding

Abruptly ceasing minoxidil use (“cold turkey”) tends to induce more severe and acute shedding. To mitigate this shock to the hair cycle and scalp, expert opinion and clinical guidelines recommend a gradual taper, similar to protocols used for oral minoxidil or other hair loss medications.

A 6-month Tapering Schedule could look like this.

Weeks	Protocol Description
1-2	Alternate once-daily and twice-daily applications
3-4	Three days once-daily, one day twice-daily
5-6	Once daily, Monday-Friday, twice on weekends
7-9	Once daily
10-12	Once daily on weekdays, off weekends
13-15	Once daily, Monday-Thursday, off Friday-Sunday
16-18	Apply every other day
19	Every third day
20	Every fourth day
21	Every fifth day
22	Every sixth day
23	Once weekly, then discontinue

Bridging Strategies During the Transition

No protocol can eliminate post-minoxidil shedding, but supporting the scalp with additional therapies may enhance retention and cushion the transition.

• Microneedling: Weekly sessions (with or without ongoing minoxidil) can upregulate growth factors and SULT1A1, thereby enhancing follicle health, and have been shown to help some users retain density for several months after discontinuing minoxidil.
• Anti-Androgens: Initiating topical or oral anti-androgens (e.g., finasteride, spironolactone) before and during withdrawal can help offset DHT-driven miniaturization—a process that is not alleviated by minoxidil alone.
• Low-Level Laser Therapy (LLLT): LLLT devices supply scalp stimulation and may decrease shedding when minoxidil is reduced or stopped.
• Alternative Topicals: Some transitioners try diluted rosemary oil (2–5%) or similar topicals for additional support, though strong clinical evidence for these alternatives is limited.

You can read our article on what happens when you quit taking minoxidil here.

Best Practices

• Apply only to a dry scalp: Before treatment, ensure both hair and scalp are completely dry. This maximizes absorption and efficacy.
• Dosage: For solution, use exactly 1 mL (measure with the supplied dropper); for foam, use half a capful per application.
• Massage in: Gently massage the product into thinning areas for approximately 30 seconds to improve penetration.
• Wait before washing: Allow at least 2 hours after application before shampooing or rinsing your scalp. This ensures adequate drug absorption.

Who Is an Ideal Candidate for Topical Minoxidil?

You’re a good candidate if you are:

• An adult man or woman with AGA: This is the main, FDA-approved indication for topical minoxidil. It has the strongest evidence in these groups.
• Able to commit to at least 6 months of consistent use: Appreciable improvements are most common with twice-daily application and become noticeable after 3–6 months. Stopping before this period makes it hard to judge the benefit.
• Ready for ongoing, indefinite use: All gains from minoxidil are lost within 3–6 months of discontinuation, so lifelong adherence is necessary for persistent effects.
• Prepared for manageable, mostly mild side effects: Most users tolerate minoxidil well, but 2–6% experience skin irritation, mainly from propylene glycol in liquid formulas. Switching to propylene glycol-free foams or other vehicle-adjusted products usually solves these issues.
• Willing to pair with additional therapies (optional, but recommended): Combining minoxidil with weekly microneedling or oral/topical finasteride increases efficacy by two- to four-fold, with up to 70%+ response rates and greater visual gains. Microneedling notably enhances regrowth and can prolong the effectiveness of minoxidil.
• Financially able to sustain $15–$30/month long-term: Over the years of use, the accumulated cost is a practical consideration.
• Comfortable following a simple scalp-care routine: Best practices include applying the product to a dry scalp, massaging for at least 30 seconds, allowing it to absorb for 2 hours, and treating any scalp inflammation first with anti-inflammatory shampoos (like ketoconazole or zinc pyrithione).

Who May Want to Reconsider?

• Catowners unable to limit pet exposure: Cats are highly sensitive to minoxidil and can suffer fatal toxicity from even minute exposure. Strict precautions are required to keep pets safe.
• People with severe or persistent skin sensitivity/allergy: If unable to tolerate any formulation or if allergic to both minoxidil and carrier ingredients, other options may be preferable.
• Individuals seeking a permanent or “cure-all” solution: Minoxidil does not address androgenic miniaturization (DHT effect) or scalp fibrosis. On its own, efficacy usually plateaus or wanes, making it mostly a maintenance or adjunct therapy.
• Those seeking visible, dramatic regrowth from monotherapy alone: Statistical hair count increases may not always correspond to better scalp coverage or visually satisfying restoration.

FAQs

Will minoxidil lower my libido? No, minoxidil is not known to lower libido, as it does not affect hormones and has shown no significant link to sexual side effects in clinical studies or post-marketing data. For more information, refer to the following resources: Minoxidil: Getting Started (Interactive Guide).

Can I dilute topical minoxidil without losing its efficacy? You can dilute topical minoxidil or mix it with other topicals, but doing so may reduce its efficacy if it alters absorption, concentration, or stability, so it’s best to either separate applications (morning vs. evening) or use professionally compounded combinations to ensure reliable results. For more information, watch this video.

Can I use topical minoxidil alongside other topicals? Yes, you can use topical minoxidil alongside other topicals, but to avoid interference with absorption, it’s best to either apply them at different times of day (e.g., morning vs. evening) or combine them into a single formulation, ideally through a compounding pharmacy or by carefully preparing them at home following best practices.

How long should I leave minoxidil on my scalp? You should leave minoxidil on your scalp for at least one hour, but ideally for four hours or more, to ensure optimal absorption, especially if you’re applying it only once a day. Most of the drug is absorbed within the first few hours, so extending contact time helps maximize its effectiveness.

Does minoxidil accelerate skin aging? Minoxidil is unlikely to accelerate skin aging; reported changes in facial skin quality are more likely due to mild allergic reactions to propylene glycol or temporary water retention, both of which are typically reversible and manageable with formulation changes or improved application practices.

Final Thoughts

Topical minoxidil remains the cornerstone over‑the‑counter therapy for androgenetic alopecia, valued for its solid safety record, ease of access, and decades of clinical data supporting meaningful, if often modest, improvements in hair density and retention. For many men and women, especially those early in their hair-loss journey or those averse to systemic medications, it offers a practical first line of defense that can be further amplified with adjuncts such as microneedling, retinoids, or anti-androgens. 

Yet its benefits are not limitless: results plateau without complementary treatments, lifelong use is required to maintain gains, and irritation or simple user fatigue remain common reasons for discontinuation. Approached realistically, committing to at least six months of consistent, correctly dosed application, monitoring scalp health, and integrating synergistic therapies where appropriate, topical minoxidil can serve as a reliable, evidence‑based pillar in a comprehensive hair‑restoration plan.

Oral minoxidil is an increasingly popular off-label treatment for hair loss, offering a convenient alternative to topical solutions for both men and women. Originally developed as a blood pressure medication, it was discovered to promote hair growth, sometimes dramatically, by enhancing blood flow and stimulating key pathways involved in hair growth.

In this article, we break down what oral minoxidil is, how it works, what the research reveals across different types of hair loss, potential side effects, and best practices for safe and effective use.

Key Takeaways:

• What is it? Oral minoxidil is a prescription vasodilator originally used to treat high blood pressure. At lower doses (0.25–5 mg daily), it’s increasingly prescribed off-label to treat hair loss, especially in people who don’t respond well to topical minoxidil. It promotes regrowth by enhancing blood flow, shortening the hair’s resting phase, and activating key follicular growth pathways.
• Clinical Data. Studies have shown that oral minoxidil is effective for multiple types of hair loss, including androgenic alopecia (AGA), chronic telogen effluvium, and even permanent chemotherapy-induced alopecia. For AGA, it offers comparable or better results than 5% topical minoxidil, particularly at doses of 2.5–5 mg in men. In women, low-dose therapy (0.25–1.25 mg) is also effective, often combined with spironolactone for added benefit.
• Safety. At low doses, oral minoxidil is generally well-tolerated. The most common side effects include excess body hair, mild fluid retention, and lightheadedness. Rarely, serious cardiac issues like pericardial effusion may occur, especially in individuals with underlying health conditions. Most side effects are dose-dependent and reversible with adjustment or discontinuation.
• Evidence Quality. Oral minoxidil scored 63/100 for evidence quality by our metrics.
• Best Practices. Start with a low dose (2.5 mg for men, 0.25–1.25 mg for women) and titrate upward only if needed. Splitting doses between morning and night may improve tolerability. Sublingual minoxidil is a promising alternative to reduce systemic exposure. Combine with microneedling or topical agents if the results plateau. Always consult a healthcare provider, especially if you have concerns related to cardiovascular, renal, or hepatic health.

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*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

What is Oral Minoxidil?

Oral minoxidil is a medication originally developed in the 1970s as an oral hypertensive agent, designed to lower high blood pressure by acting as a potent vasodilator. During its use for hypertension, clinicians observed a notable side effect: increased hair growth, or hypertrichosis.^[1]Patel, P., Nessel, T.A., Kumar, D. (2023). Minoxidil. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/book/NBK482378/ Accessed: … Continue reading

This unexpected effect led to the development of topical minoxidil for hair loss, which was approved by the FDA in 1988 for male patients and in 1992 for female patients.^[2]Nestor, M.S., Ablon, G., Gade, A., Han, H., Fischer, D.L. (2021). Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of … Continue reading Oral minoxidil is also used as an off-label treatment for both men and women.

Why Might I Consider Oral Over Topical Minoxidil?

Many people consider oral minoxidil over topical due to fundamental differences in how each form is activated and delivered to hair follicles. Topical minoxidil is a pro-drug that requires conversion to its active form, minoxidil sulfate, by the sulfotransferase enzyme (specifically SULT1A1) located in the outer root sheath of scalp hair follicles.^[3]Pietrauszka, K., Bergler-Czop, B. (2020). Sulfotransferase SULT1A1 activity in hair follicle, a prognostic marker of response to the minoxidil treatment in patients with androgenetic alopecia: a … Continue reading

However, the activity of this enzyme varies significantly between individuals. For example, in one study on 120 patients, 40.8% exhibited low levels of sulfotransferase activity in the scalp.^[4]Chitalia, J., Dhurat, R., Goren, A., McCoy, J., Kovacevic, M., Situm, M., Naccarato, T., Lotti, T. (2018). Characterization of follicular minoxidil sulfotransferase activity in a cohort of pattern … Continue reading

Additionally, topical minoxidil faces a “penetration problem” where only about 1.4% of the drug applied is actually absorbed into the scalp skin under normal conditions.^[5]Suchonwanit, P., Thammarucha, S., Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. 13. 2777-2786. Available at: … Continue reading

Oral minoxidil largely bypasses these limitations. When taken by mouth, minoxidil is absorbed through the gastrointestinal tract and converted to its active form in the liver, where sulfotransferase activity is abundant. This ensures that nearly all ingested minoxidil is activated and delivered systemically, reaching hair follicles throughout the scalp and body, regardless of individual differences in scalp enzyme activity. As a result, oral minoxidil can be effective even for those who are non-responders to topical therapy due to low scalp sulfotransferase activity or poor drug penetration.^[6]Beach, R.A. (2018). Case series of oral minoxidil for androgenetic and traction alopecia: Tolerability & the five C’s of oral therapy. Dermatologic Therapy. 31(6). E12707. Available at: … Continue reading

How Does Oral Minoxidil Work?

Oral minoxidil promotes hair growth through several interrelated mechanisms at the cellular and molecular levels.

Potassium Channel Activation and Vasodilation

Minoxidil is converted in the liver to its active form, minoxidil sulfate (first phase metabolism), which opens adenosine triphosphate (ATP)-sensitive potassium channels in vascular smooth muscle and hair follicle cells.^[7]Gupta, A.K., Talukder, M., Shemar, A., Priaccini, B.A., Tosti, A. (2023). Low-Dose Oral Minoxidil for Alopecia: A Comprehensive Review. Skin Appendage Disorders. 9(6). 423-437. Available at: … Continue reading

This action triggers a process known as membrane hyperpolarization, resulting in vasodilation and increased blood flow to the scalp. This increased microcirculation delivers more oxygen, nutrients, and growth factors to hair follicles, creating a favorable environment for hair growth.

Stimulation of the Hair Growth Cycle

Minoxidil shortens the telogen (resting) phase and induces early entry of hair follicles into the anagen (growth) phase.^[8]Suchonwanit, P., Thammarucha, S., Leerunyakul, K. (2019). Minoxidil and its use in hair loss disorders. Drug Design, Development and Therapy. 13. 2777-2786. Available at: … Continue reading It also prolongs the duration of anagen, leading to longer and potentially thicker hair.

Activation of Wnt/ꞵ-Catenin Signaling

Minoxidil has been shown to activate the Wnt/ꞵ-Catenin pathway in dermal papilla cells. This pathway is a critical signaling route for hair follicle regeneration and maintenance of the anagen phase.^[9]Kwack, M.H., Kang, B.M., Kim, M.K., Kim, J.C., Sung, Y.K. (2011). Minoxidil activates ꞵ-catenin pathway in human dermal papilla cells: a possible explanation for its anagen prolongation effect. … Continue reading It also promotes the growth and specialization of hair follicle stem cells, supporting follicle growth.^[10]Wang, X., Liu, Y., He, J., Wang, J., Chen, X., Yang, R. (2022). Regulation of signaling pathways in hair follicle stem cells. Burns Trauma. 10. 1-19. Available at: … Continue reading

Direct Effects on Dermal Papilla Cells

Minoxidil stimulates the proliferation and survival of dermal papilla cells (DPCs), which are essential for hair follicle health.^[11]Kang, J-I., Choi, K.Y., Han, S-C., Nam, H., Lee, G., Kang, J-H., Koh, Y.S., Hyun, J.W., Yoo, E.S., Kang, H.K. (2022). 5-Bromo-3,4-dihydroxybenzaldehyde Promotes Hair Growth through Activation of … Continue reading

It also activates the extracellular signal-regulated kinase (ERK) and protein kinase B signaling pathways, increases the ratio of anti-apoptotic to pro-apoptotic proteins (Bcl-2/Bax), and prevents cell death, thereby prolonging the anagen phase.^[12]Jan, J.H., Kwon, O.S., Chung, J.H., Cho, K.H., Eun, H.C., Kim, K.H. (2004). Effect of minoxidil on proliferation and apoptosis in dermal papilla cells of human hair follicle. Journal of … Continue reading

Minoxidil also increases the expression of key growth factors, such as vascular endothelial growth factor (VEGF) and insulin-like growth factor 1 (IGF-1), which further support follicle nourishment and angiogenesis.^[13]Nagai, N., Iwai, Y., Sakamoto, A., Otake, H., Oaku, Y., Abe, A., Nagahama, T. (2019). Drug Delivery System Based on Minoxidil Nanoparticles Promotes Hair Growth in C57BL/6 Mice. International Journal … Continue reading

Anti-Inflammatory and Anti-Fibrotic Properties

Minoxidil exhibits anti-inflammatory effects by modulating the production of prostaglandins and other inflammatory mediators.^[14]Shin, D.W. (2022). The physiological and pharmacological roles of prostaglandins in hair growth. The Korean Journal of Physiology and Pharmacology. 26(6). 405-415. Available at: … Continue reading ^[15]Majewski, M., Gardas, K., Waskiel-Burnat, A., Ordak, M., Rudnicka, L. (2024). The Role of Minoxidil in Treatment of Alopecia Areata: A Systematic Review and Meta-Analysis. Journal of Clinical … Continue reading It also inhibits collagen synthesis, which could reduce fibrosis around hair follicles, maintaining a healthy microenvironment for hair growth.^[16]Fechine, C.O.C., Valente, N.Y.S., Romiti, R. (2022). Lichen planopilaris and frontal fibrosing alopecia: review and update of diagnostic and therapeutic features. Anais Brasileiros de Dermatologia. … Continue reading

How Effective Is Oral Minoxidil?

Let’s break this down into the types of hair loss that minoxidil can assist with.

Pattern Hair Loss/Androgenic Alopecia (Females)

Oral minoxidil has been found to be as effective as 5% topical minoxidil at treating female pattern hair loss. The study found no significant difference between topical and oral minoxidil 1 mg daily in terms of efficacy for female pattern hair loss (FPHL).^[17]Ramos, M.P., 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. Journal of the American Academy … Continue reading There were, however, differences in the occurrence of adverse events. While scalp itching occurred only in the topical group, only users of oral minoxidil experienced excess hair growth outside of the scalp.

Another study combined low-dose minoxidil (0.25 mg) and 25 mg spironolactone to treat FPHL.^[18]Sinclair, R.D. (2018). Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. International Journal of Dermatology. 57(1). 104-109. … Continue reading The results of the study demonstrated that the combined therapy:

• Decreased hair shedding as early as 3 months into the treatment.
• Increased hair density after 6 months.

However, the authors didn’t report any objective measurements of hair density, either at baseline or at the end of the study period. This makes it impossible to effectively compare the results of the previously mentioned study with those of this study.

So, we can’t effectively assess the difference in efficacy of spironolactone and low-dose oral minoxidil combination therapy or oral minoxidil monotherapy. However, the authors of this study do note that they believe the combination has an added benefit for FPHL.

Pattern Hair Loss/Androgenic Alopecia (Males)

Of all forms of hair loss, AGA may derive the most benefit from minoxidil (whether oral or topical). This is because one of the main mechanisms of action directly addresses one of the pathological facets of AGA: reduced blood flow.

This is evidence in one study on men with AGA.^[19]Lueangarun, S., Panchaprateep, R., Tempark, T., Noppakun, N. (2015). Efficacy and safety of oral minoxidil 5 mg daily during 24-week treatment in male androgenetic alopecia. Journal of the American … Continue reading In particular, it demonstrates a 100% response rate to a daily dose of 5 mg oral minoxidil. Even more impressively, subjects achieved an average 19% increase in hair count after 24 weeks.

The risk profile also appears to be favorable, with only 10% of participants reporting leg swelling. Ten percent of participants also reported a more significant side effect: an alteration in electrocardiogram (EKG) results.

These risks could theoretically be mitigated by lowering the dosage; however, one would need to consider the potential for reduced benefit. To better understand this, we’ll have to look at another study.

In line with the above results, this retrospective study showed a 90% response rate at 6-12 months for men taking 2.5-5.0 mg of oral minoxidil daily.^[20]Jiminiez-Couche, J., Saceda-Corralo, D., Rodrigues-Barata, R., Hermosa-Gelbard, A., Moreno-Arrones, O.M., Fernandez-Nieto, D., Vano-Galvan, S. (2019). Effectiveness and safety of low-dose oral … Continue reading Perhaps even more impressive is the fact that 60% of these men had tried other treatments for AGA, but had previously quit due to side effects or lack of efficacy.

In line with the trend of “decreasing dosage, decreasing efficacy”, one study using 0.25 mg of oral minoxidil found a 60% response rate in male AGA patients.^[22]Pirmez, R., Salas-Callo, C-I. (2020). Very-low-dose oral minoxidil in male androgenetic alopecia: A study with quantitative trichoscopic documentation. Journal of the American Academy of Dermatology. … Continue reading That’s on the low side for oral minoxidil overall, but on the high side when compared to topical minoxidil.

It’s also worth noting that there’s a key difference between this study and the one showing a 100% response rate at a 5mg daily dose. The 5mg study only included men with mild to moderate AGA; this study included both mild to moderate and severe AGA patients.

The mild to moderate group comprised 40% of study subjects, with the remaining 60% in the severe category. This suggests that low doses, such as 0.25mg, may be effective in severe AGA cases, at least in slowing and/or stopping their progression.

Notably, this study recorded leg swelling in only 4% of the group and found no difference in arterial pressure, suggesting that the risk of side effects reduces with decreasing dose. If these results were indeed confounded by the addition of severe AGA patients, these findings may indicate that 0.25 mg has a similar efficacy to 5 mg with a better risk profile.

All in all, it’s challenging to draw conclusions because the study designs differ significantly. In the future, it would be interesting to see how different groups with the same grade of AGA respond to 0.25 mg of minoxidil versus 5 mg of minoxidil. This could help us construct realistic treatment regimens that are both effective and minimize the risk of side effects.

Telogen Effluvium

Chronic telogen effluvium (CTE) is a common condition characterized by excessive hair shedding. Because one of minoxidil’s proposed mechanisms of action is its ability to shorten the “resting” telogen phase (where a lot of follicles stay in CTE, as opposed to the anagen growing phase), researchers have hypothesized that oral minoxidil may be a helpful treatment for the condition.

These hypothetical notions were explored in a recent 2017 study.^[24]Perera, E., Sinclair, R. (2017). Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study. F1000 Research. 6. 1650. Available at: … Continue reading This particular study was retrospective and looked at individuals with CTE who had been prescribed oral minoxidil (dosages ranging from 0.25 mg to 2.5 mg, with the most common being 1 mg) in-clinic.

They found that most patients experienced a decrease in hair loss after 6 months, with all patients showing an improvement either at the 6 or 12-month mark. This does not make minoxidil the be-all and end-all for CTE. The oral minoxidil treatment wasn’t compared against a placebo or any other potential treatments (including combination therapies) for the condition, so we can only conclude that topical minoxidil is one potential treatment for CTE.

We also need to acknowledge that most CTE cases may have an underlying cause that, when resolved, could improve hair shedding. In these cases, addressing the root cause of CTE, whenever possible, is far more effective.

Alopecia Areata

Upon investigation of topical minoxidil’s benefits for alopecia areata (AA), an autoimmune form of hair loss, researchers found that topical minoxidil, on its own, really doesn’t do much for alopecia areata (AA) patients.^[25]Suchonwanit, P., Thammarucha, S., Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. 13. 2777-2786. Available at: … Continue reading However, interestingly, oral minoxidil at a dose of 5 mg daily appears to be effective.

Although oral minoxidil for AA hasn’t been well-studied, one study reported that 18% of AA subjects taking oral minoxidil showed an improved cosmetic response after ~35 weeks of use.

Considering the side effects of oral minoxidil are increased at a dose of 5 mg, the 18% response rate doesn’t seem too promising. But there may be one combination therapy that proves to be more effective.

Another study found that adding oral minoxidil to a current alopecia areata treatment may enhance outcomes without increasing the current dosage.

Tofacitinib is an immunomodulator drug currently used to treat alopecia areata. Although the drug is usually effective for most individuals at a 10 mg daily dosage, some users may need to double the dose to see hair growth.^[26]Wambier, C.G., Craiglow, B.G., King, B.A. (2021). Combination tofacitinib and oral minoxidil treatment for severe alopecia areata.  Journal of the American Academy of Dermatology. 85(3). 743-745. … Continue reading

While this usually resolves treatment resistance, increasing the dose may also increase the risk associated with strong immunomodulatory effects, as well as the cost. So, there’s a real need for safe combination therapies to improve treatment outcomes without increasing the tofacitinib dose.

Oral minoxidil may be able to do just this. One study demonstrated that daily addition of oral minoxidil (2.5 mg for women and 5 mg, split into 2.5 mg doses, for men) to doses of tofacitinib ranging from 10 mg to 20 mg daily resulted in: 

• 67% of patients achieved 75% or greater hair regrowth, compared to another study’s results, which demonstrated that 20% of patients achieved cosmetically acceptable regrowth on oral minoxidil alone.
• The remaining 33% of patients experienced hair regrowth, with a range of 11% to 74%.

Chemotherapy-Induced Hair Loss

Permanent chemotherapy-induced alopecia (PCIA), a hair-shedding disorder in which hair lost to chemotherapy does not grow back 6 months after the end of chemotherapy, is considered to be generally irreversible.

One case study challenges this.^[27]Yang, X., Thai, K-E. (2016). Treatment of permanent chemotherapy-induced alopecia with low-dose oral minoxidil. The Australasian Journal of Dermatology. 57(4). E120-e132. Available at: … Continue reading After one year of 1 mg daily oral minoxidil treatment, a woman with PCIA achieved considerable growth. This is pretty amazing, considering no consistently effective treatment has been found for PCIA patients, yet. While future studies are still needed to confirm these findings, these results are certainly promising.

Ultra-Low and Ultra-High Doses of Minoxidil

Recent Brazilian studies have been published showing efficacy from both low and high doses of minoxidil.

Low-Dose

One 2025 Brazilian double-blind, randomized clinical trial was conducted on 100 men aged 25-55 years with Norwood-Hamilton stage 3V to 5V AGA. The participants were randomized 1:1 to receive either 2.5 mg or 5 mg oral minoxidil daily for 24 weeks.^[28]Varma, D. (2025). Oral Minoxidil 2.5 mg vs 5 mg: Similar Efficacy for Androgenetic Alopecia in Men. Medscape. Available at: … Continue reading,^[29]Fonseca, L.P.C., Miot, H.A., Chaves, C.R.P., Ramos, P.M. (2025). Oral minoxidil 2.5 mg versus 5 mg for male androgenetic alopecia: A double-blind randomized clinical trial. Journal of the American … Continue reading

The primary outcome was the change in non-vellus hair density at the vertex. Secondary outcomes were total hair density changes, global photographic assessment, and adverse events.

At 24 weeks, there was no significant difference in non‑vellus hair density between the 2.5‑mg and 5‑mg groups (mean difference = 0.9 hairs/cm²; P = .403). Total hair density was likewise comparable (mean difference = 3.6 hairs/cm²; P = .078). Dermatologists assessing photographs in a blinded manner reported similar clinical improvement rates (64% with 2.5 mg vs 62% with 5 mg; P = .386), although self‑reported improvement was higher with 5 mg (92% vs 84%; P = .009). Adverse events, notably pedal edema and dizziness, were more common in the 5‑mg group (P = .024), while heart rate and both systolic and diastolic blood pressure remained similar between groups.

The study authors concluded that oral minoxidil at 2.5 mg/day provided comparable efficacy to the 5 mg/day dose in treating male AGA, while offering a better safety profile. They further noted that these results support 2.5 mg/day as an appropriate starting dose in clinical settings.

High-Dose

A 2025 retrospective multicenter study in Brazil and Spain evaluated high-dose oral minoxidil (>5 mg/day) for AGA in 57 men. Most received 10 mg nightly, often alongside finasteride or dutasteride, after at least one year on low-dose minoxidil (≤5 mg/day).^[30]Moreno-Arrones, O.M., Hermosa-Gelbard, A., Saceda-Corralo, D., Jiminez-Cauhe, J., Ortega-Quijano, D., Pirmez, R., Galvan, S. (2025). High-dose Oral Minoxidil for the Treatment of Androgenetic … Continue reading

After 9-12 months, 45.6% improved hair density by 10-30%, 17.5% improved by >50%, and 17.5% improved by <10%, while 7% saw no change.

Adverse effects occurred in 24.6%, mainly hypertrichosis (17.5%) and tachycardia (3.5%), with hypertensive patients tolerating treatment well under blood-pressure monitoring.

The authors concluded that high-dose oral minoxidil may benefit selected men with AGA refractory to standard therapy, but variability in response and increased side effects highlight the need for gradual dose escalation and further research in larger, more diverse populations.

Based on this evidence, we think that starting off with a low dose can be effective (and potentially safer) than the standard oral minoxidil dose. However, if you are struggling to see benefits, there is efficacy data for high doses. It would be interesting for a study to compare how much more effective ultra-high doses of minoxidil are for hair regrowth than 5 mg (for example). This would help us to determine whether it is worth the potential increased side effects.

Furthermore, those who decide to go the low-dose oral minoxidil route may find it beneficial to add spironolactone to their routine.

Is Oral Minoxidil Safe?

Oral minoxidil has gained attention as an effective treatment for hair loss, but questions about its safety persist, particularly in comparison to the topical form. Here’s what the evidence shows.

Cardiovascular Risks: Myocardial and Pericardial Effusion

There are documented cases where people taking oral minoxidil developed pericardial effusion (fluid around the heart) and even pericarditis, sometimes at low doses used for hair loss.^[31]Dlova, N.C., Jacobs, T., Singh, S. (2022). Pericardial, pleural effusion and anasarca: A rare complication of low-dose oral minoxidil for hair loss. JAAD Case Reports. 11(28). 94-96. Available at: … Continue reading These events are rare but have prompted caution within the medical community.

Severe cardiovascular complications like pericardial effusion have been recorded the high doses (10-40 mg) used for hypertension, with rates around 3% in these populations.^[32]Bentivegna, K., Zhou, A.E., Adalsteinsson, J.A., Sloan, B. (2022). Letter in reply: Pericarditis and peripheral edema in a healthy man on low-dose oral minoxidil therapy. JAAD Case Reports. 20(29). … Continue reading However, it should be noted that this was reported in the 1980s in patients with severe hypertension, with no recent data available.

However, at the lower doses used for hair loss (0.25-5 mg), these complications are much less common and appear to be idiosyncratic (based on the individual response) rather than dose-dependent.^[33]Gupta, A.K., Bamimore, M.A., Abdel-Qadir, H., Williams, G., Tosti, A., Piguet, V., Talukder, M. (2024). Low-Dose Oral Minoxidil and Associated Adverse Events: Analyses of the FDA Adverse Event … Continue reading

Large observational studies and clinical experience with thousands of patients using low-dose oral minoxidil have not shown a significant increase in life-threatening cardiac events.^[34]Vano-Galvan, S., Pirmez, R., Hermosa-Gelbard, A., Moreno-Arrones, O.M., Saceda-Corralo, D., Rodrigues-Barata, R., Jiminez-Cauhe, J., Koh, W.L., Poa, J.E., Jerjen, R., de Carvalho, L.T., John, J.M., … Continue reading Most side effects are mild and reversible with dose adjustments or discontinuation of the medication.^[35]Bloch, D.L., Carlos, R.M.D. (2025). Side Effects’ Frequency Assessment of Low Dose Oral Minoxidil in Male Androgenetic Alopecia Patients. Skin Appendage Disorders. 11(1). 14-18. Available at: … Continue reading

Autopsy reports from patients who took extremely high doses (e.g., 60 mg) have not consistently shown pericardial or myocardial effusion, suggesting the risk is not universal or inevitable, even at high exposures.^[36]Sobota, J.T. (1989). Review of cardiovascular findings in humans treated with minoxidil. Toxicologic pathology. 17(1 Pt 2). 193-202. Available at: https://doi.org/10.1177/019262338901700115

Subclinical and EKG Changes

At high doses, minoxidil can cause changes in the heart’s electrical activity, and this has been observed in up to 60-90% of patients.^[37]Hall, D., Charocopos, F., Froer, K.L., Rudolph, W. (1979). ECG changes during long-term minoxidil therapy for severe hypertension. Archives of Internal Medicine. 139(70. 790-794. Available at: PMID: … Continue reading These changes are typically subclinical, meaning they do not cause symptoms or progress to life-threatening arrhythmias, and often resolve with continued use or a reduction in the dose.

In studies of low-dose minoxidil for hair loss, only minor, asymptomatic EKG changes have been observed, with no evidence of clinically significant heart rhythm disturbances in otherwise healthy individuals.^[38]Jiminiez-Cauhe, J., Pirmez, R., Muller-Ramos, P., Melo, D.F., Ortega-Quijano, D., Moreno-Arrones, O.M., Saceda-Corralo, D., Gil-Redondo, R., Hermosa-Gelbard, A., Dias-Sanabria, B., Restom, D., … Continue reading

Real-World Safety: Observational and Clinical Data

The most common side effects at hair loss doses are hypertrichosis, mild ankle swelling, lightheadedness, and occasional palpitations.^[39]Bloch, D.L., Carlos, R.M.D. (2025). Side Effects’ Frequency Assessment of Low Dose Oral Minoxidil in Male Androgenetic Alopecia Patients. Skin Appendage Disorders. 11(1). 14-18. Available at: … Continue reading Serious cardiac events are exceedingly rare. Most patients who experience side effects can continue treatment with dose adjustments. Only a small fraction discontinue due to adverse effects.

This favorable safety profile is not only a function of the lower dose but may also reflect the generally healthier status of this population compared to those prescribed high-dose minoxidil for hypertension. Most studies examining minoxidil for hair growth routinely exclude individuals with significant underlying disease.

Experts recommend that patients, especially those with pre-existing heart, kidney, or liver conditions, be monitored by a healthcare provider when starting oral minoxidil.^[41]Gupta, A.K., Bamimore, M.A., Haber, R., Williams, G., Piguet, V., Talukder, M. (2024). The Role of Patient- and Drug-Related Factors in Oral Minoxidil and Pericardial Effusion: Analyses of Data from … Continue reading

How Can I Make Oral Minoxidil Safer?

Here are a number of strategies you can use to help minimize side effects while maintaining results:

• Titrate Your Dose

Begin with the lowest effective dose and increase gradually if needed. This approach helps your body adjust and can reduce the risk of side effects, such as swelling, dizziness, or heart palpitations. 

Based on the published evidence, we believe that the best balance between efficacy and safety is 2.5 mg daily for men and 0.25-1.25 mg daily for women.

• Split the Dose: Morning & Evening

Oral minoxidil has a short half-life (about 3 hours). Taking your daily dose all at once can cause higher peak blood levels, increasing the risk of side effects. Taking half in the morning and half in the evening can help keep blood levels steadier and may reduce side effects.

• Consider Sublingual Administration

Taking minoxidil sublingually (letting it dissolve under your tongue) allows the drug to enter your bloodstream directly, bypassing the liver’s first-pass metabolism. Sublingual minoxidil becomes active when it reaches tissues with the right enzymes, such as those in the scalp, potentially enhancing its effectiveness. Studies suggest that sublingual minoxidil can lead to lower peak blood concentrations and fewer systemic side effects, while still promoting hair growth.^[42]Guo, R-X., Zhao, Y-K., Hu, K-J., Hia, K.M., Shi, W., Yi, Y-X., Gong, H-Y., Wang, J-B., Gao, Y. (2025). Research progress in the treatment of non-scarring alopecia: mechanism and treatment. Frontiers … Continue reading

• Switch To Topical Minoxidil

If oral minoxidil isn’t working for you because of the side effects, consider switching to the topical formulation. And, if you’re able to tolerate a 2% or 5% formulation well, you could consider adding microneedling or retinoic acid to boost your gains. 

To find out more information about the potential side effects and how to avoid them, watch our video: Oral Minoxidil: How to Eliminate Side Effects.

Is Oral Minoxidil Better Than Topical Minoxidil?

Deciding between oral and topical minoxidil involves weighing efficacy, convenience, safety, and individual response. 

Efficacy: Which Works Better?

At standard strengths, both 5% topical minoxidil and low-dose oral minoxidil (1-5 mg) show similar efficacy in clinical trials for total area hair count (TAHC).^[43]Fazal, F., Malik, B.H., Malik, H.M., Sabir, B., Mustafa, H., Ahmed, M., Abid, A., Adil, M.L., Shafi, U., Saad, M. (2025). Can oral minoxidil be the game changer in androgenetic alopecia? A … Continue reading However, oral minoxidil often leads to slightly thicker, more robust regrowth for some users, especially those with diffuse thinning.

When topical minoxidil is combined with enhancers, such as retinoic acid, at concentrations of 7-8% (or higher), the results can surpass those seen with oral minoxidil. Our members consistently report better outcomes with these combinations, even compared to 5 mg oral minoxidil.

Advantages of Oral Minoxidil

• More convenient: Oral minoxidil is taken as a pill once or twice daily, while topical minoxidil requires 1-2 daily applications, which can be inconvenient and affect adherence.
• No product residue: Oral minoxidil eliminates the sticky residue and styling issues associated with topical solutions.
• Cost-effective: Oral minoxidil is generally about half the price of topical formulations.
• Bypasses scalp enzyme variance: Oral minoxidil is activated in the liver, sidestepping the variability in scalp sulfotransferase enzyme activity that limits topical efficacy for some users.^[44]Goren, A., Shapiro, J., Roberts, J., McCoy, J., Desai, N., Zarrab, X., Pietrzak, A., Lotti, T. (2014). Clinical utility and validity of minoxidil response testing in androgenetic alopecia. … Continue reading
• Less scalp irritation: Oral minoxidil avoids the dryness, irritation, and brittleness sometimes caused by topical applications.
• May improve beard density: Some users report increased facial hair growth, which can be a benefit or drawback, depending on personal preference.^[45]Pirmez, R., Salas-Callo, C-I. (2020). Very-low-dose oral minoxidil in male androgenetic alopecia: a study with quantitative trichoscopic documentation. Journal of the American Academy of Dermatology. … Continue reading
• Better for brittle hair: Those with fragile or chemically treated hair may prefer oral minoxidil to avoid further brittleness.

Drawbacks of Oral Minoxidil

• Unwanted body hair: Oral minoxidil can cause hair growth on other parts of the body, which is especially concerning for women.
• Systemic side effects: Risks include fluid retention, rare cardiovascular effects, headaches, and skin rashes. These are uncommon at hair loss doses (0.25-5 mg), but still possible. 
• Prescription required: Unlike topical minoxidil, oral formulations require a prescription from a doctor.

Advantages of Topical Minoxidil

• Fewer systemic effects: Topical minoxidil acts locally, so there’s less risk of systemic side effects.
• Easier access: Available over-the-counter without a prescription.
• Customizable formulations: Various strengths and enhancers (like retinoic acid) can be tailored to individual needs.

Drawbacks of Topical Minoxidil

• Variable response:  Efficacy depends on scalp enzyme activity, which varies between individuals. 
• Scalp irritation: Some may experience irritation, dryness, or increased hair brittleness.^[46]Shadi, Z. (2023). Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia. Dermatological Therapy (Heidelb). 13(5). 1157-1169. Available at: … Continue reading
• Residue and Compliance: Daily application can be messy and inconvenient, which can impact adherence.

Special Considerations: Scalp Inflammation

Underlying scalp inflammation (like seborrheic dermatitis) can reduce the effectiveness of topical minoxidil.^[47]Mahe, Y.F., Cheniti, A., Tacheau, C., Antonelli, R., Planard-Luong, L., de Bernard, S., Buffat, L., Barbarat, P., Kanoun-Copy, L. (2021). Low-Level Light Therapy Downregulates Scalp Inflammatory … Continue reading Addressing inflammation is crucial before starting or modifying any hair loss treatment.

The bottom line: 

Oral minoxidil is more convenient, cost-effective, and bypasses scalp enzyme limitations, making it a strong option, especially for those who don’t respond to topical or want to avoid scalp irritation. 

High-strength topical minoxidil, when combined with treatments such as retinoic acid and microneedling, often delivers the best results but comes with more hassle, a higher cost, and a greater risk of scalp irritation.

Standard topical minoxidil remains a solid, accessible first-line option, especially for those who prefer to avoid systemic medications. 

Ultimately, the best choice depends on your hair loss pattern, your response to treatment, your tolerance for side effects, and your lifestyle. 

Can You Take Them Together?

Yes, it is possible to use oral and topical minoxidil together; however, this approach should only be considered under the supervision of a healthcare provider. Combining both forms may provide a more robust treatment for hair loss.

Some dermatologists suggest that using both can enhance efficacy, especially for individuals who have not achieved optimal results with one form alone. However, using both simultaneously increases the risk of side effects. Therefore, the decision to combine oral and topical minoxidil should be made with professional guidance to ensure proper dosing and monitoring for adverse effects.

Who are the Best Candidates for Oral Minoxidil?

According to the research we just outlined, you’re a good candidate for oral minoxidil if:

• You’re a male with AGA, TE, or permanent chemotherapy-induced alopecia who doesn’t respond to topical minoxidil and/or finds it difficult to comply with the treatment protocol.
• You’re a female with FPHL, TE, or permanent chemotherapy-induced alopecia who doesn’t respond to topical minoxidil and/or finds it difficult to comply with the treatment protocol, and you’re okay with a chance of increased hair growth in other places of the body.
• You have a healthy liver and normal to high blood pressure. If you are somewhat hypertensive, oral minoxidil may have the joint benefit of hair growth and antihypertensive effects.
• You’re a female who’s already taking spironolactone for FPHL and wants to see better results, or has seen a plateau with spironolactone alone.
• You’re an AA patient resistant to traditional immunomodulatory treatment.
• You suffer from a brittle hair disorder or hair loss and brittle hair and want to avoid exacerbating brittleness with topical minoxidil.
• You can obtain a prescription.

On the other hand, you’re not a good candidate for oral minoxidil if…

• You’re a female who’s not comfortable with the idea of increased hair growth outside of the scalp.
• You regularly drink alcohol, which can exacerbate the antihypertensive effects of minoxidil.
• You have or have had kidney, cardiovascular, or liver issues.
• You’re pregnant or planning on becoming pregnant.
• You’re currently taking another vasodilating/antihypertensive drug or a muscle relaxer like tizanidine. Taking two vasodilating drugs at once can increase the risk of side effects associated with low blood pressure.

What Are The Best Practices for Taking Oral Minoxidil?

When taking oral minoxidil for hair loss, it’s best to start with the lowest effective dose, typically 2.5 mg daily for men and 0.25–1.25 mg daily for women. The dose should be increased gradually only if needed, under the supervision of a healthcare provider. Splitting the total daily dose into morning and evening halves can help maintain steady blood levels and reduce the risk of side effects, such as palpitations, swelling, or dizziness. 

Sublingual administration (allowing the tablet to dissolve under your tongue) is an alternative that may further minimize systemic side effects by bypassing the liver’s first-pass metabolism, potentially making the medication more tolerable for individuals who are sensitive to it. Throughout treatment, monitor for common side effects, such as unwanted hair growth (hypertrichosis), ankle swelling, or lightheadedness, and promptly report any serious symptoms, including chest pain or significant changes in heart rate. 

Regular check-ins with your healthcare provider are essential, especially if you have underlying heart, kidney, or liver issues or take other medications that affect blood pressure. If side effects occur, consider reducing the dose, splitting it further, switching to a sublingual or topical minoxidil formulation, or discontinuing use as advised by your healthcare provider. 

Avoid combining oral minoxidil with other vasodilators or muscle relaxants without consulting a healthcare professional. Address any scalp inflammation before starting or adjusting therapy to maximize results and safety.

Final Thoughts

Oral minoxidil has emerged as a compelling option for individuals seeking effective hair loss treatment, offering robust regrowth potential and convenience for both men and women who may not respond to or tolerate topical formulations. While research supports its efficacy across a range of hair loss conditions, including androgenic alopecia and chronic telogen effluvium, it is not without risks, most notably rare but serious cardiovascular side effects, as well as more common issues such as unwanted hair growth and mild edema. For many, oral minoxidil represents a powerful, evidence-based tool in the fight against hair loss, but its use should always be informed, individualized, and guided by medical expertise to ensure both safety and satisfaction. If you are a good candidate and proceed thoughtfully, oral minoxidil can play a pivotal role in your hair restoration journey.

We’re thrilled to announce the arrival of Ulo: a haircare brand that offers best-in-class hair growth products and focuses on solving the biggest problems plaguing the hair loss industry.

Ulo’s core commitment to hair loss sufferers is its prioritization of evidence, personalization, and consumer safety. And there’s a reason we’re so confident in Ulo’s ability to deliver: we co founded the brand.

In fact, the Perfect Hair Health team was involved in every aspect of Ulo’s product development: its selection of manufacturers, ingredients, formulations, concentrations, & more. Now the product formulations for which we’ve been advocating for 10+ years are finally offered, all through a single provider.

Whether it’s over-the-counter serums or prescription products, Ulo represents the next evolution in telehealth haircare: one that puts the consumer first, sets realistic expectations, and supports customers at every step on their journey to better hair.

Below, we’ll detail our journey to launching Ulo, the problems Ulo solves, its core offerings, and why we currently consider Ulo to be a revolutionary step forward for consumers.

For those interested in this level of product personalization and support, Ulo is also offering 15% off all their products, forever. Any purchase made through the links in this article will result in a 15% discount applied to all product purchases, including all renewals. This is our thank you to you, and your opportunity to lock in a permanently discounted price on all products.

Why Ulo?

For 11 years, Perfect Hair Health has acted solely as a consumer advocacy resource for men and women fighting hair loss.

During this time, we never once endorsed a single hair growth product: no pill, supplement, topical, shampoo, or device. Instead, we focused entirely on educating hair loss sufferers on how to properly read studies, select treatments, and maximize their chances for hair regrowth.

For just a few examples of this commitment, see the following content pieces:

• What Causes Hair Loss? (Interactive Guide)
• Understanding Hair Loss Disorders (Interactive Guide)
• The Hair Loss Industry Is Broken: Evidence Quality Masterclass (Video)
• Nutrafol: The Problem With Their Clinical Studies (Company Investigation)
• Our Peer-Reviewed Studies (Publications)
• Independent Third-Party Lab Testing Results (Product Investigations)

But, as the hair loss industry continued to evolve, so too did its bad practices – particularly the sale of dangerous, improperly formulated products with ingredients that were “trending” on social media, but that lacked adequate efficacy and safety data.

For years, our organization called attention to these concerns – creating free evidence-based articles, videos, & interactive guides detailing these exact problems & how to protect yourself. And yet this entire time, as the hair loss industry expanded, we watched these problems only grow worse. We’ll detail several of them later in this article.

Two years ago, Perfect Hair Health was offered a once-in-a-lifetime opportunity to become more than just a voice of advocacy. We were approached with an offer to go beyond education and to start solving the very problems that have plagued this industry for years.

This meant an opportunity to create products that could finally serve as the antidote to every bad practice currently employed by other haircare brands at scale.

Initially, we were skeptical. We’ve seen firsthand how other brands deprioritize consumer safety in the name of “business decisions,” like with brands that include corticosteroids in their Rx topicals to offset irritation and increase recurring purchases… but at the expense of the risk of long-term, permanent skin thinning for their patients.

If we were going to become involved in a brand, we would need full control over the entire production process for hair loss. We wanted the sole ability to fire compounding pharmacies that failed to meet purity standards. We wanted final say in every aspect of product development: the ingredients, concentrations, formulations, & more. Without this level of control, we would never be able to prioritize what’s right for the consumer over what’s right for business.

We were pleasantly surprised to find 100% alignment with those offering a partnership. With just how easy it is to “cut corners” in the hair loss industry, we can’t describe how refreshing it was to connect with others who actually wanted to do right by the consumer.

After much reflection, we decided to step off the sidelines as critics and instead, start building a brand that walked the walk and started solving the hair loss industry’s biggest problems.

That brand is Ulo: a telehealth company dedicated exclusively to hair growth, and founded on three key pillars: evidence, personalization, and consumer safety.

What Problems Need Solving In The Hair Loss Industry?

Over the years, we’ve watched haircare brands adopt a set of bad practices that seemed uniquely targeted toward their bottom line, rather than consumer interests.

We’ll detail just a few of these below, along with how Ulo solves these problems and sets the bar higher.

Problem #1: Mega-Dosed Topicals

Other telehealth brands are selling mega-dose versions of topical finasteride & topical dutasteride – letting people think it’s staying on the scalp, when in reality, the dose is 60x too high, so it leaks into the blood & causes hormonal changes to the same extent as oral finasteride.

Videos here and here. FDA warning here.

Ulo’s Solution: Low-Dose Topical Finasteride & Low-Dose Topical Dutasteride

Ulo offers two kinds of topical finasteride & topical dutasteride: low-dose and full-strength.

For those truly interested in localization, the lower-dose topicals are far more appropriate than the mega-dosed topicals sold by other telehealth brands. And even more encouragingly, Ulo offers full customization of either topical – with the ability to add in ingredients like 7% minoxidil, 0.01% retinoic acid (tretinoin), 0.2% caffeine, 0.01% melatonin, and 1% cetirizine – so prospective users can ensure better control over every ingredient, pending a prescription:

Ulo’s Topical Finasteride

• Low-Dose Topical Finasteride (Optional: Add Enhancers)

• Full-Strength Topical Finasteride (Optional: Add Enhancers)

Ulo’s Topical Dutasteride

• Low-Dose Topical Dutasteride (Optional: Add Enhancers)

• Full-Strength Topical Dutasteride (Optional: Add Enhancers)

Problem #2: Corticosteroids In Rx Topicals (Permanent Skin Thinning)

Brands are adding dangerous ingredients to their Rx topicals –– like corticosteroids. They do this because their serums often contain propylene glycol, which helps with ingredient penetration but also causes skin irritation. Yet rather than fix their formulations, brands offset the irritation with corticosteroids (hydrocortisone, fluocinolone, etc.). This works in the short-term, and very likely, causes permanent, irreversible skin thinning after years of uninterrupted use. 

Article here. Video here. Study here.

Ulo’s Solution: No Corticosteroids, No Propylene Glycol, & Less-Irritating Formulations

Ulo doesn’t use propylene glycol in any of its topicals. Instead, its partner pharmacies have spent significant time developing & iterating base formulations containing water, alcohol, and glycol-like compounds – formulations that apply easily, dry quickly, allow for ample ingredient penetration into the hair follicles, and above all, are less irritating.

The end-result: Ulo’s topicals don’t need to add corticosteroids to mask irritation – because they were formulated properly from the start.

Note: some of Ulo’s optional ingredients – like retinoic acid (tretinoin) – can enhance the activation and penetration of minoxidil, but may also cause mild irritation in a subset of individuals. For those who discover they cannot tolerate retinoic acid (tretinoin), Ulo’s physician partners can easily remove this ingredient for them. This is a much better, much more sustainable alternative than simply masking irritation with a corticosteroid, especially given the long-term risks of skin irritation.

Ulo’s topicals can be found here, with a guide to help you select your offering here.

Problem #3: Selling Dangerous, “Trending” Ingredients

Other telehealth brands are offering “trending” drugs with long-term safety risks, like latanoprost. Originally developed to treat glaucoma, latanoprost is now widely added to Rx topicals for hair growth. The basis? Two small clinical studies, the longest of which ran for 9 months. The problem? The doses sold by telehealth brands are, at times, thousands of times higher than what was used to treat glaucoma. They absolutely go systemic. And there’s a permanent side effect that occurs in up to 20% of glaucoma patients using latanoprost – one that typically isn’t noticeable until after 12 months of use: the blackening of your irises, an effect that often persists even after quitting the medication. No studies exist evaluating this risk for topical latanoprost, and also, no telehealth brand seems to care.

Article here. Video here.

Ulo’s Solution: No “Trending” Ingredients That Risk Your Safety. Ever.

Unless an off-label ingredient offers notable hair gains through mechanisms distinct from other Ulo ingredients – and unless that ingredient has a respectable safety profile – Ulo will not include it as an offering to its product line.

That means no Carbon 60. No copper peptides. No latanoprost. No bimatoprost.

Ulo focuses on getting you results without compromising your safety. While the telehealth brand does offer off-label ingredients to certain users pending a prescription, such as dutasteride, spironolactone, melatonin, caffeine, and cetirizine, it only does so if safety & efficacy thresholds are met to justify their inclusion for added hair gains.

This is distinct from many other companies out there who simply attempt to capture your interest in ingredients “trending” on social media, but without enough data to determine whether these ingredients are safe, effective, and right for you.

You can see a sample of Ulo’s ingredient selections & concentrations here.

Problem #4: Compounding Dutasteride Without Emulsifiers

Other telehealth brands are compounding drugs that can’t be compounded, like dutasteride. To differentiate from the competition, telehealth brands often compound drugs like dutasteride & minoxidil into a single capsule, claiming bigger hair gains than finasteride and the convenience of a single daily pill.

The truth? When these companies “compound” dutasteride, they turn it from a soft gel into a powder, and inadvertently, they destroy its bioavailability, rendering dutasteride less effective than finasteride & causing major hair loss for customers who unknowingly switch to the 2-in-1 pills.

We have the lab tests to prove it. Post here. Video here.

Ulo’s Solution: No Compounded Dutasteride. Just The Real Thing.

Rather than offer compounded dutasteride, Ulo offers dutasteride as a soft gel – and in a formulation that has undergone bioequivalence testing, such that the efficacy should match that of the studies showing oral dutasteride outperformed oral finasteride for hair gains.

This is a distinction unrivaled by many other brands. Rather than sell you convenience in a 2-in-1 pill, Ulo sells you what works.

Better yet, Ulo still offers both oral dutasteride and oral minoxidil to those who want to multi-target their hair loss. They are just delivered as separate pills, in separate formulations, to maximize your potential for hair growth.

You can see Ulo’s oral Rx offerings here.

Beyond Ulo’s Products: Personal Support, Every Step Of The Way, Through Ulo’s Partner Physicians

As part of Ulo’s commitment to consumers, all subscriptions to their Rx product lines come with unlimited access to partner physicians – one of whom you’ll personally partner with to support your hair growth journey.

What does this look like? A completely different experience compared to other brands:

• • Real customization: dosing & ingredient adjustments made by our partner physicians depending on your goals & real-time experiences with the products.
  • Realistic expectations: separate “possibility” from “probability”. Our network physicians rely on clinical data to set realistic responses to your hair loss medications, including guides for when regrowth starts, when it might plateau, and what to do next to escalate your current protocol.
  • Unrivaled personal support: the ability to contact a doctor, any time, through Ulo’s portal. Someone in your corner who not only assumes care for you, but also wants to help you achieve the best possible outcomes.

We hope you feel the difference. This piece is something we see other brands “promise”, but rarely deliver. It’s time to change that.

15% Off All Ulo Orders, Forever

Ulo is a part of the Perfect Hair Health ecosystem, and as a thank you for being a part of our community, all orders made through this article will automatically receive 15% off the purchase price, forever. That includes all future renewals, so long as the orders are made through these links.

We hope you enjoy everything Ulo has to offer. We certainly love the product line and are thrilled that we finally have the chance to offer products in the exact formulations for which we’ve advocated over the past 10+ years.

We wish you the best with your hair health journey, and we look forward to supporting you every step of the way.

OS-01 is a topical scalp serum developed by OneSkin, a biotech company based in San Francisco. Marketed as both an anti-aging skin treatment and a hair regrowth product, OS-01 aims to address hair thinning by targeting cellular senescence in the scalp. The serum has gained attention through social media and interviews with the company’s CEO, Carolina Reis Oliveira. In this article, we will examine what OS-01 is, explore the science of cellular senescence and its role in hair loss, and assess the evidence behind OS-01’s claims as a potential treatment for androgenetic alopecia.

Key Takeaways:

• Branding. OS-01 has positioned itself as a biotech-backed anti-aging and hair regrowth serum from OneSkin, a company known for its focus on longevity science. The branding strongly emphasizes scientific credibility and a “rooted in science” approach.
• Unique Selling Point. OS-01 is a peptide that specifically targets cellular senescence in the scalp, aiming to rejuvenate the hair follicle microenvironment by modulating the senescence-associated secretory phenotype (SASP).
• Clinical Support. OneSkin reports a 6-month third-party clinical study showing improvements in hair density, thickness, and hair cycling when used with daily dermarolling. However, these results have not been published in peer-reviewed journals and rely on company-provided summaries.
• Concerns. Key concerns include the lack of independently published human data, reliance on dermarolling for efficacy, marketing claims that oversimplify complex skin and hair biology, and typical limitations seen in brand-led before-and-after photos.
• Evidence Quality. The OS-01 serum scored 31/100 for evidence quality by our metrics.
• Recommendations. We recommend that OS-01 consider publishing the results of their 6-month pilot study and, ideally, conduct a larger, registered, placebo-controlled clinical trial.

All-Natural Hair Topical

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*Only available in the U.S. Prescriptions not guaranteed. Restrictions apply. Off-label products are not endorsed by the FDA.

What Is OS-01?

OS-01 for hair is a topical scalp serum developed by OneSkin, a biotech company based in San Francisco, as both an anti-aging skin product and a hair regrowth product. The product is claimed to address hair thinning and loss by targeting the biological process of cellular senescence in the scalp.^[1]OneSkin. (no date). Rooted in Science: The Clinical Evidence Supporting OS-01 Hair. Available at:  … Continue reading

The product is sold in 1.7 fl oz bottles, available in 1-, 3-, or 6-month supplies, and comes with a dermaroller for $69, $207, or $424.

The product contains a number of ingredients, of which you can see the whole list here: 

“Water, Glycerin, 1,2-Hexanediol, Butylene Glycol, Hydroxyacetophenone, Panthenol, Inulin, Helianthus Annuus (Sunflower) Sprout Extract, Cellulose Gum, Alpha-Glucan Oligosaccharide, Tetrasodium Glutamate Diacetate, Propanediol, Morus Nigra Leaf Extract, Arginine, Acetyl Tyrosine, Rehmannia Chinensis Root Extract, Pentylene Glycol, Sodium PCA, Erythritol, Chondrus Crispus, PEG-12 Dimethicone, Oryza Sativa (Rice) Bran Water, Decapeptide-52*, Calcium Pantothenate, Zinc Gluconate, Sodium Benzoate, Niacinamide, Ornithine HCL, Caprylyl Glycol, Polyquaternium-11, Citrulline, Hydrolyzed Soy Protein, Xanthan Gum, Glucosamine HCL, Disodium Succinate, Fisetin, Raspberry Ketone, Sodium Benzoate, Citric Acid, Potassium Sorbate, Arctium Majus Root Extract, Panax Ginseng Root Extract, Biotin. *OS-01 Peptide.”

Several familiar ingredients are present here, including niacinamide, calcium pantothenate, zinc gluconate, raspberry ketone, ginseng, fisetin, and biotin.

• Niacinamide: Research shows that it may help protect hair follicle cells from oxidative stres, reduce the expression of DKK-1 (a protein that promotes hair follicle regression), and prolong the anagen (growth) phase of hair follicles.^[2]Choi, Y-H., Shin, J.Y., Kim, J., Kang, N-G., Lee, S. (2021). Niacinamide down-regulates the expression of DKK-1 and protects cells from oxidative stress in cultured human dermal papilla cells. … Continue reading Clinical studies have demonstrated increased hair fullness and thickness in some participants using niacinamide derivatives, though it is thought that it doesn’t actually increase hair density.^[3]Draelos, Z.D., Jacobson, E.L., Kim, H., Kim, M., Jacobson, M.K. (2005). A pilot study evaluating the efficacy of topically applied niacin derivatives for treatment of female pattern alopecia. Journal … Continue reading
• Calcium Pantothenate: This ingredient is commonly found in hair care products and supplements. Some studies suggest it may help improve hair thickness and reduce hair loss, especially when combined with zinc. For example, a clinical trial in women found that co-administration of zinc sulfate and calcium pantothenate alone was less pronounced, and more research is needed.^[4]Siavash, M., Tavakoli, F., Mokhtari, F. (2017). Comparing the effects of zinc sulfate, calcium pantothenate, their combination and minoxidil solution regimens on controlling hair loss in women: a … Continue reading
• Raspberry Ketone: This has been studied in small human trials and animal models. Topical application promoted hair growth in about 50% of humans with alopecia, possibly by increasing dermal IGF-1 production through sensory neuron activation.^[5]Harada, N., Okajima, K., Narimatsu, N., Kurihara, H., Nakagata, N. (2008). Effect of topical application of raspberry ketone on dermal production of insulin-like growth factor-I in mice and on hair … Continue reading However, the evidence base remains limited, and larger studies are necessary to confirm these effects.
• Fisetin: Fisetin is a polyphenol that has shown promise in preclinical studies. It may promote hair growth by increasing telomerase reverse transcriptase (TERT) expression, activating hair follicle stem cells, and facilitating the transition from a resting to a growth phase.^[6]Kubo, C., Ogawa, M., Uehara, N., Katakura, Y. (2020). Fisetin promotes hair growth by augmenting TERT expression. Frontiers in Cell and Developmental Biology. 8(566617). Available at … Continue reading Animal studies suggest that fisetin may induce hair growth; however, human data are currently lacking.
• Biotin: This ingredient is widely marketed for hair health, but strong evidence for its effectiveness in preventing hair loss or promoting hair growth in people without a deficiency is lacking. Biotin supplementation can help restore hair growth in cases of true biotin deficiency, but such deficiencies are rare. Most studies do not support its use for hair loss in otherwise healthy individuals, though it remains a popular ingredient.^[7]Yelich, A., Jenkins, H., Holt, S., Miller, R. (2024). Biotin for Hair Loss: Teasing Out the Evidence. Journal of Clinical and Aesthetic Dermatology. 17(8). 56-61. Available at: … Continue reading

However, the one we will be focusing on in this article is Decapeptide-52, also known as the OS-01 Peptide.

There has been a lot of hype on social media about this product, including a particularly interesting YouTube video featuring Dave Asprey, who talks with Carolina Reis Oliveira, the CEO and Co-founder of OneSkin.^[8]Asprey. D. (2025). Hair Growth Expert: Scientists Discover a Secret Peptide that Reverses Balding | Caroline Oliveria. YouTube. Available at: https://www.youtube.com/watch?v=FSY1x40N2ys Accessed: … Continue reading Carolina holds degrees in stem cell biology and tissue engineering, as well as a doctorate in immunology, which bodes well for the scientific integrity of the product.

However, in the first ~15 seconds of the above video, Carolina makes some interesting statements:

1. “The scalp of the skin basically has a similar structure of the skin in your face…”
2. “Your hair follicles are basically embedded in the epidermal layer…”
3. “…a lot of the things that we see happening in the skin of our face also happen in our scalp”

Now let’s break down what is wrong with these statements:

• “The scalp of the skin basically has a similar structure of the skin in your face…”

This statement is partially accurate. While the scalp and facial skin share the same basic layers (epidermis, dermis, etc.), there are significant structural and functional differences:

• When measuring total skin thickness in both men and women, scalp skin was found to be among the thickest.^[9]Oitulu, P., Tekecik, M., Taflioglu, T., Kilinc, F., Ince, B. (2022). Measurement of Epidermis, Dermis, and Total Skin Thicknesses from Six Different Face Regions. Selcuk Medical Journal. 38(4). … Continue reading
• The scalp contains a much higher density of hair follicles and sebaceous glands than facial skin.^[10]Gao, J., Liu, C., Zhang, S., Teacher, M.P., Bouabbache, S., Pouradier, F., Pangard. (2018). Revisiting, in vivo, the hair greasing process by the Sebuprint method. Skin Research and Technology. … Continue reading 
• The scalp is more prone to certain inflammatory and microbiome-related disorders due to its unique structure and physiology.^[11]Xu, Z., Wang, Z., Yuan, C., Liu, X., Yang, F., Wang, T., Wang, J., Manabe, K., Qin, O., Wang, X., Zhang, Y., Zhang, M. (2016). Dandruff is associated with the conjoined interactions between host and … Continue reading 

So, while the basic structure is similar, the differences are clinically and biologically significant.

• “Your hair follicles are basically embedded in the epidermal layer…”

This is factually incorrect. Hair follicles are not embedded in the epidermal layer; they are skin appendages that extend deep into the dermis, with the bulb even reaching the hypodermis (subcutaneous tissue).^[12]Oh, J.W., Kloepper, J., Langan, E.A., Kim, Y., Yeo, J., Kim, M.J., Hsi, T.C., Rose, C., Yoon, G.S., Lee, S.J., Seykora, J., Kim, J.C., Sung, Y.K., Kim, M., Paus, R., Plikus, M.V. (2016). A guide to … Continue reading 

• “…a lot of the things that we see happening in the skin of our face also happen in our scalp”

This is generally true, but it oversimplifies the differences. Many skin conditions (like psoriasis, eczema, and seborrheic dermatitis) can occur on both the scalp and face. However, the scalp’s unique anatomy, thicker skin, increased hair follicles, more sebaceous glands, and its coverage by hair, means it is prone to specific issues (like dandruff and increased oiliness) that are less common or present differently on facial skin. So, while there is overlap, the statement ignores important distinctions in disease prevalence and presentation.

These statements reinforce what we have been discussing in other articles – that you cannot blindly trust what people say. We should always adopt a scientific approach to the information we read online and attempt to find the scientific basis for their claims. 

With this in mind, we will explore the science of the product, examine what senescence is, and explore the data that suggests OS-01 can enhance hair growth.

What is Senescence and How is It Involved in Hair Cycling and Loss?

Before we get into how OS-01 works, it is essential to understand what senescence is, when it can be beneficial for hair growth, and when it can be detrimental.

Cellular senescence can be thought of as a “pause button for cells”. When cells are stressed or damaged due to factors such as DNA damage, aging, or excessive environmental stress, they cease to divide permanently. But instead of dying like in programmed cell death (apoptosis) they stay active, sending out signals to their neighboring cells, and beyond. 

Key features of these cells include:^[14]Nakanishi, M. (2025). Cellular senescence as a source of chronic microinflammation that promotes the aging process. Proceedings of the Japan Academy, Ser.B, Physical and Biological Sciences. 101(4). … Continue reading 

• A permanent stop in cell division: They’re kept in check by guardian pathways (p54/p2 and p16/Rb) that make sure they never divide again.
• Shape changes: They get bigger, flatter, and may look like “fried eggs” under the microscope.
• Special markers: Scientists detect them using a blue stain (called senescence-associated β-galactosidase (SA-β-gal)) that shows they have more lysosomes – cell “recycling bins”. 
• Secretory profile: They secrete a cocktail of chemicals, cytokines, growth factors, and enzymes, known as the senescence-associated secretory phenotype (SASP). This cocktail affects the surrounding tissue, sometimes beneficially, sometimes harmfully.

In recent years, senescence has become a trendy buzzword in the beauty and longevity industries, often used to market products as anti-aging breakthroughs. While genuine scientific research shows that senescent cells play a real role in aging and tissue decline, many companies oversimplify or exaggerate this science to promote creams, serums, or supplements with vague claims of “targeting senescence”. In reality, effectively targeting senescent cells is complex and context-dependent, and not every product touted as a senescence solution is supported by robust clinical evidence. As a result, the term is sometimes misappropriated more as a marketing hook than a rigorously validated mechanism.

Furthermore, while senescence was once thought of as a detrimental mechanism, it can actually be beneficial for both overall health and hair health.

Helpful Senescence: Encouraging Hair Growth

As mentioned above, some senescent cells can actually benefit hair growth:^[15]Wang, X., Ramos, R., Phan, A.Q., Yamaga, K., Flesher, J.L., Jiang, S., et al. (2023). Signalling by senescent melanocytes hyperactivates hair growth. Nature. 618(7966). 808-817. Available at: … Continue reading 

• Osteopontin signal: Senescent pigment cells (melanocytes) in skin moles produce a molecule called osteopontin. This acts like a motivational speaker for nearby hair cells by binding to CD44 receptors, waking them up.
• Stem cell activation: This process prompts hair follicles to exit their resting phase and re-enter growth mode, much like flipping the switch from winter to spring. 
• Proven boost: Injecting osteopontin or turning up its production in lab animals triggered hair growth; blocking it canceled the effect.

Harmful Senescence: Fueling Hair Loss

Recent studies show that accumulation of senescent cells can play a role in both androgenic alopecia (AGA) and age-related hair thinning.

As we age, more cells in the hair follicle’s support structures, like dermal papilla cells (DPCs) and hair follicle stem cells (HFSCs), become senescent.^[16]Shin, W., Rosin, N.L., Sparks, H., Sinha, S., Rahmani, W., Sharma, N., Workentine, M., Abbasi, S., Labit, E., Stratton, J.A., Biernaskie, J. (2020). Dysfunction of Hair Follicle Mesenchymal … Continue reading These cells lose their ability to renew themselves and support healthy hair growth, resulting in weaker follicles that gradually shrink over time. This process, known as hair follicle miniaturization, is why aging hair tends to become thinner and sparser.

Age-related hair thinning features a gradual loss of follicle stem/progenitor cell function, increased senescent cell burden, and mitochondrial dysfunction.^[17]Shin, W., Rosin, N.L., Sparks, H., Sinha, S., Rahmani, W., Sharma, N., Workentine, M., Abbasi, S., Labit, E., Stratton, J.A., Biernaskie, J. (2020). Dysfunction of Hair Follicle Mesenchymal … Continue reading This leads to both HFSC and DPC dysfunction.

Preclinical studies (studies done in cells or animals) have shown that antioxidants, senolytics, and interventions that reduce DPC/HFSC senescence or SASP can delay or ameliorate hair loss.^[18]Deng, Y., Wang, M., He, Y., Liu, F., Chen, L., Xiong, X. (2023). Cellular senescence: Ageing and Androgenetic Alopecia. Dermatology. 239(4). 533-541. Available at: https://doi.org/10.1159/000530681 However, clinical translation remains limited. Furthermore, some evidence suggests that senescence may be a consequence, rather than a sole cause, of follicle dysfunction, meaning that treating just the senescence aspect alone may not be beneficial for hair regrowth.^[19]Mirmirani, P., Karnik, P. (2010). Comparative Gene Expression Profiling of Senescent and Androgenetic Alopecia Using Microarray Analysis. Aging Hair. 67-76. Available at: … Continue reading

How Does the OS-01 Peptide Work?

According to OneSkin, OS-01 for hair targets senescent cells in the hair follicle to improve hair regrowth. One study frequently referenced on their website was conducted using human skin models.^[20]Zonari, A., Brace, L.E., Al-Katib, K., Porto, W.F., Foyt, D., Guiang, M., Cruz, E.A.O., Marshall, B., Gentz, M., Guimaraes, G.R., Franco, O.L., Oliveira, C.R., Boroni, M., Carvalho, J.L. (2023). … Continue reading In this study, OS-01 (referred to as pep14) was identified and characterized for its senomorphic activity. As a senomorphic, the OS-01 peptide reduces the burden of cellular senescence by suppressing the harmful secretions associated with the senescence-associated secretory phenotype (SASP) and by preventing pre-senescent cells from progressing to full senescence. Importantly, it does not kill or eliminate existing senescent cells.

OneSkin also seems to have conducted a laboratory study using outer root sheath keratinocytes (ORSKs).^[21]OneSkin. (no date). Discover the science behind every claim. Available at: https://www.oneskin.co/pages/claims?_ab=0&_fd=0&_sc=1 Accessed: June 2025

Interestingly, we had some difficulty determining the source of this information. It’s present on their shop page for OS-01 HAIR, but they cite 6 studies that don’t contain any information about this study. We then went to their Claims section and found the information below – again, however, there was no reference. 

We went to read some of the blogs where this information was also stated; the citation, however, led us back to the Claims section. The only conclusion we can draw is that OneSkin conducted an internal study that has not yet been published. Therefore, we should take all results with a pinch of salt.

OneSkin treated the cells with corticotropin-releasing hormone (CRH) (to induce senescence) alone or in combination with OS-01. According to the website, after 72 hours, cells treated with OS-01 + CRH showed significantly lower CDKN1A (p21) levels compared to those treated with CRH alone. 

Unfortunately, they don’t have any further data or information about this, so we can only go with what is written here.

Can OS-01 Benefit Patients with Androgenetic Alopecia?

OneSkin has also conducted a 6-month independent third-party clinical study in which 30 participants (23 women and 7 men) applied OS-01 HAIR twice daily and dermarolled their scalps once daily.^[22]OneSkin. (no date). Discover the science behind every claim. Available at: https://www.oneskin.co/pages/claims?_ab=0&_fd=0&_sc=1 Accessed: June 2025 Again, this data is unpublished in any peer-reviewed journal and so we are just having to go from what is on the site.

The overall results showed:

Category	Details
Hair Density	86.67% showed 39.62% avg increase after 6 months
Hair Density	70% showed 9.97% avg increase after 3 months
Hair Density	Double-blind, 30 participants, twice daily + dermarolling
Hair Density (Men)	85.71% men showed 34.86% avg increase after 6 months (7 men)
Hair Thickness	83.33% showed 42.58% avg increase after 6 months
Hair Thickness	Significant increase between 3 and 6 months
Hair Thickness (Men)	100% men showed 36.68% avg increase after 6 months; 85.71% men 28.42% after 3 months
Hair Cycle	73.33% showed 42.39% avg increase in anagen hairs after 6 months
Hair Cycle	Significant increase between 3 and 6 months
Hair Cycle (Men)	85.71% men showed 20.19% avg increase at 3 months, 35.42% at 6 months
Scalp Microbiome	Supported scalp microbiome: increased M. globosa, improved ratio, better bacterial diversity
Consumer Perception (Clinical) – 3 Months	80% saw hair improvement, 76.67% healthier hair, 70% faster growth, 73.33% fuller hair, 70% nourished scalp
Consumer Perception (Clinical) – 6 Months	70% faster growth, 76.67% healthier hair, 73.33% less shedding, 83.33% nourished hair, 70% thicker, 73.33% stronger, 70% better texture
Consumer Perception (Brand-led) – Immediate	89.47% could style hair, 85% lightweight
Consumer Perception (Brand-led) – 2 Months	80.95% more hydrated scalp
Consumer Perception (Brand-led) – 3 Months	81.82% new hair growth, 72.73% denser hair
Sensitive Skin	Dermatologically tested on 55 volunteers; no reactions
Lab Data – Senescence	OS-01 peptide reduces cellular senescence (lab data)
Lab Data – Senescence (Stress-induced)	Significant reduction in CRH-induced senescence (*p<0.05)
Lab Data – Inflammation	Significant reduction in IL-6 inflammation marker (*p<0.05)

We see some issues immediately jumping out about the clinical trial OneSkin has conducted:

• OneSkin do not explicitly mention whether the participants have any type of hair loss.
• The study included no placebo or treatment group – this means we can’t find out if hair cycle seasonality played any part in the participants’ hair growth.
• The treatment was combined with microneedling. Microneedling has been shown to potentially improve terminal hair counts by itself (we covered one here) so how can we separate out the effects of the peptide vs. the microneedling?
• In a similar vein, the product itself contains a number of other ingredients (with varying evidence showing improvement on hair regrowth) – so how can we separate out the effects of these compared to the peptide?
• While OneSkin do tell us how the hair counts were done, there was no disclosure of how terminal hairs were defined and starting hair zone parameters for the participants. For example in the niostem study, the researchers clearly outlined how they categorized terminal/vellus hair density (vellus (< 40 μm) and terminal (> 40 μm) hairs). A number of other studies however also don’t define terminal hairs (one that comes to mind is the CBD oil study) – so while it does happen, it is not good practice.
• Certain phrasings appear to be potentially misleading:
  • From the Claims section: “After 6 months, 83.33% of participants experienced a 42.58% average increase in hair thickness (sum of hair widths). (****p < 0.0001)”. The statistic refers only to the subset (83.33%) of participants who experienced an increase, not the entire study population. This means that 16.67% of participants did not experience an increase, but their results are not included in the average, potentially inflating the reported effect. The phrasing also raises the question of whether participants with no improvement or negative outcomes were excluded from the calculation. If so, and if those excluded participants had poor or negative results, the true average increase would be lower than reported.
    • This is not the only claim that does this and so we have to wonder what is happening with the other participants?
  • From the Claims section: “Participants saw a significant increase in hair thickness (sum of hair widths) between 3 and 6 months (**p < 0.01)”. Because we don’t have any graphs or data for this, we have to wonder…do we have a Niostem problem all over again? Niostem published their clinical data in February 2025 and claimed that “Terminal hair density improved significantly over time…” but this is not compared to the baseline – it’s compared to the three month time point, where there was actually a decrease in terminal hair density from the baseline. You can read our article about this here. Unfortunately we do not have any further information from OneSkin so we can’t know exactly what is happening.

You can read or watch some of our content that talk about these subjects here:

Deceptive But Legal: 3 Ways Marketers Cheat Hair Loss Studies

The Hair Loss Industry Is Broken | Evidence Quality Masterclass

Understanding Evidence Quality | How Hair Loss Companies Cheat Clinical Trials

Oneskin also has some before-and-after photos on their website, allowing us to see the progress people have experienced. However, they do fall for the usual pitfalls that we have mentioned in other articles, including different lighting, angles, and manipulating the hair so that it appears different in the before-and-after images (see below).

According to OneSkin, several positive results have been observed in their clinical trial; however, like many of these companies, the information has only been published on their website, and we have no way of verifying the data.

Let’s break down the biological plausibility of OS-01 HAIR, based on the mechanism OneSkin claims it has and current scientific understanding:

• Targeting Cellular Senescence

There is solid evidence that senescent cells accumulate in the hair follicle microenvironment with age and stress, disrupting the stem cell niche and impairing normal cycling. Studies show that hair follicle cells lose inductive capacity partly due to senescence and SASP-driven inflammation.^[23]Pappalardo, A., Kim, J.Y., Abaci, H.E., Christiano, A.M. (2024). Restoration of hair follicle inductive properties by depletion of senescent cells. Aging Cell. 24(1). E14353. Available at: … Continue reading So, reducing senescence or its effects could, in theory, rejuvenate follicle activity.

• OS-01 Peptide Mechanism

As mentioned above, OS-01 has been shown to reduce markers of cellular senescence in skin cells in vitro (and has been claimed to do the same in ORSKs). While these are promising cell culture results, translating that to sustained, clinically meaningful effects in human follicles in vivo is the critical step. 

• Delivery and Context

Topical peptides face challenges: skin penetration, stability, and reaching target cells in viable concentrations.^[24]Pintea, A., Manea, A., Pintea, C., Vlad, R.A., Birsan, M., Antonoaea, P., Redai, E.M., Ciurba, A. (2025). Peptides: Emerging Candidates for the Prevention and Treatment of Skin Senescence: A Review. … Continue reading Dermarolling (used in the clinical study) does enhance delivery through microchannels, aligning with other evidence that microneedling can improve topical drug uptake for hair growth.^[25]Zhang, S., Qiu, Y., Gao, Y. (2014). Enhanced delivery of hydrophilic peptides in vitro by transdermal microneedle pretreatment. Acta Pharmaceutica Sinica B. 4(1). 100-104. Available at: … Continue reading 

• Supporting Evidence

The company’s small clinical trial shows statistically significant improvements in hair density, thickness, and anagen hairs, aligning with the proposed mechanism. However, the studies are short-term, small, and unpublished in peer-reviewed journals. Larger, independent trials would strengthen credibility.

How Does OS-01 Compare to Rapamycin?

Rapamycin is a well-studied compound that has garnered significant attention in aging research due to its ability to slow cellular senescence, promote autophagy, and extend lifespan in multiple animal models. Rapamycin’s unique mechanism, which targets the mechanistic target of rapamycin (mTOR pathway), a central regulator of cell growth and aging, makes it a gold standard for interventions aimed at reducing age-related cellular dysfunction and tissue decline. So, let’s see how OS-01 stands up to it.

Both OS-01 and rapamycin aim to mitigate cellular senescence but use distinct mechanisms and applications.

Aspect	OS-01	Rapamycin
Primary target	Senescence-associated secretory phenotype (SASP).	mTOR pathway.
Senotherapeutic Class	Senomorphic (modulates SASP, prevents progression of pre-senescent cells).	Dual senomorphic/senolytic- inhibits mTOR and promotes autophagy (a process where a cell breaks down and recycles its own components).
Key Action	Reduces SASP markers, including IL-6, CXCL1, and CXCL8, in skin cells.	Inhibits mTORC1, enhances autophagy, and clears senescent cells.[26]Selvarani, R., Mohammed, S., Richardson, A. (2020). Effect of rapamycin on aging and age-related diseases – past and future. GeroScience. 43(3). 1135-1158. Available at: … Continue reading
Delivery	Topical serum applied with dermarolling for enhanced penetration.	Systemic (oral/injected) or localized formulations.

Efficacy in Hair and Senescence

OS-01

• Lab Studies: Reduced CRH-induced senescence in outer root sheath keratinocytes (ORSKs) by lowering p21 levels.
• Clinical Claims: In a 6-month trial (30 participants), reported 39.6% average hair density and 42.6% thickness improvement with dermarolling.
• Limitations: Small sample size, unpublished peer-reviewed data, and reliance on self-reported metrics.

Rapamycin

• Preclinical Evidence: Reduces senescence in cardiac progenitor cells and hair follicles by suppressing mTOR and promoting autophagy.
• Hair Growth: Extends the anagen phase and increases follicle size and density in animal models.^[27]Suzuki, T., Cheret, J., Scala, F.D., Akhundlu, A., Gherardini, J., Demetrius, D.L., O’Sullivan, J.D.B., Epstein, G.K., Bauman, A.J., Demetriades, C., Paus, R. (2023). mTORC1 activity negatively … Continue reading 
• Human Data: Limited direct hair studies, but show systemic anti-aging benefits (e.g., improved vascular function, cognitive decline reversal).

Safety and Practical Considerations

Factor	OS-01	Rapamycin
Side Effects	Minimal (skin dryness and irritation).[28]Zonari, A., Brace, L.E., Harder, N.H.O., Harker, C., Oliveira, C.R., Boroni, M., Carvalho, J.L. (2024). Double-blind, vehicle-controlled clinical investigation of peptide OS-01 for skin rejuvenation. … Continue reading	Immunosuppression and metabolic disruptions.
Application	Twice daily topical use and dermarolling.	Requires systemic dosing or specialized delivery.
Evidence Strength	Early-stage, company-led studies.	Robust preclinical and some clinical data.

Key Differences

• Approach: OS-01 focuses on localized SASP modulation, while rapamycin systemically targets mTOR to influence multiple aging pathways.
• Accessibility: OS-01 is available as a consumer product, whereas rapamycin is primarily used off-label or in research settings.
• Scope: Rapamycin has broader anti-aging applications beyond hair (e.g., cardiovascular, cognitive), while OS-01 targets scalp senescence and hair metrics.

In summary, OS-01 may offer a targeted, low-risk option for hair senescence; however, the data is preliminary and unpublished. Rapamycin, however, offers systemic or targeted action to provide broader anti-aging benefits but may have higher complexity and a more severe risk profile.

Is OS-01 Safe?

As mentioned above, in the clinical trial in which OS-01 was used for skin aging, skin dryness and irritation was observed in two participants. 

Beyond this, OneSkin mentioned that the peptide has been tested in in vitro toxicity and irritation tests, genotoxicity testing, and a repeated insult patch test (RIPT), and its effect on cancer cells has also been evaluated, with no negative effects observed.^[29]OneSkin. (no date). How Do We Know the OS-01 Peptide is Safe? Available at: https://www.oneskin.co/blogs/reference-lab/how-os-01-peptide-safety Accessed: June 2025,^[30]Zonari, A., Brace, L.E., Alencar-Silva, T., Porto, W.F., Foyt, D., Guiang, M., Cruz, E.A.O., Franco, O.L., Oliveira, C.R., Boroni, M., Carvalho, J.L. (2022). In vitro and in vivo toxicity assessment … Continue reading

However, it is worth noting that there have been no long-term human studies to evaluate any other potential effects.

Is OS-01 for Me?

OS-01 for hair may be worth a try for you:

• You want to add another product to your routine (it can be used alongside topical minoxidil, etc.)
• You do not suffer from inflammatory scalp conditions, which might mean you can’t use a dermaroller.
• Are happy using a dermaroller every day to facilitate penetration of the peptide into the scalp.

Final Thoughts

While OS-01 shows promise as an innovative approach to addressing hair thinning through targeting cellular senescence, the current evidence is still early and largely company-reported. Laboratory and small-scale clinical data suggest that it may help improve hair density and thickness, particularly when combined with dermarolling; however, these results need to be confirmed by larger, independent studies. There is no definitive proof yet that OS-01 can effectively reverse androgenic alopecia in the long term. If you are interested in trying OS-01, it may be reasonable to use it in conjunction with established treatments like minoxidil; however, it’s best to manage expectations and continue to follow emerging research as more data becomes available.

In dermatology, clear and accurate reporting of research findings isn’t just important; it’s essential. Yet, data misinterpretation and misrepresentation remain a persistent issue, often slipping through in abstracts, press releases, and articles from otherwise trusted sources. These distortions can have real consequences, affecting how products are marketed, how clinicians make decisions, and the public’s understanding of the science.

In this article, we break down recent examples from hair growth research to illustrate exactly how scientific data can be misinterpreted, why it matters more than ever in our 24-hour news cycle culture, and what that means for companies that prefer to share their data rather than relying on press releases.

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Thermos Thermophilus Extract (TTFE) and Hair Density

A striking example of data misinterpretation appeared in a recent Dermatology Times article, which claimed that Thermus Thermophilus Ferment Extract (TTFE) increased hair density by 96.88%.^[1]Bosslett, M. (2025). Thermos Thermophilus Fermentation Extract Can Treat Androgenic Alopecia. Dermatology Times. Available at: … Continue reading  At first glance, this figure suggests a near doubling of hair density, an extraordinary claim that would be making waves in cosmetic dermatology.

However, a closer examination of the original peer-reviewed study reveals a critical nuance: the figure refers not to the magnitude of increase in hair density, but to the proportion of participants who experienced any increase in hair density. In other words, nearly all subjects showed some improvement, but the actual percentage increase in hair density was much smaller.

This distinction is vital. Reporting the statistic as a 96.88% increase in hair density grossly inflates the effect size and misleads readers about the product’s efficacy. Read more about what we thought about this here.

Niostem Device Pilot Study

Another recent example involves the Niostem device. The device’s pilot study, published in the Journal of Cosmetic Dermatology, reported increases in total hair density (12% at 3 months, 19.3% at 6 months) and hair shaft thickness (8.8% over 6 months).^[2]Jellard, S., Moore, S., Chacon-Martinez, C.A. (2025). Novel Electrotrichogenic Device Promotes Hair Growth in Men with Androgenetic Alopecia: A Pilot Study. Journal of Cosmetic Dermatology. 24. … Continue reading

While these results are promising, the study’s abstract contains a potentially misleading statement, claiming: “terminal hair density improved significantly over time”.

However, the data showed that terminal hair density initially decreased at 3 months compared to baseline before increasing at 6 months. The significant increase is relative to the 3-month point, not the baseline, which would be the more relevant comparison for assessing treatment efficacy (and for which there was no statistically significant change).

This subtle but important spin in the abstract can create an overly optimistic impression of the device’s performance. You can read more in our article here.

CB-03-01 Phase II Study and Press Release Limitations

The second Phase II study of CB-03-01, a topical antiandrogen for female pattern hair loss, illustrates the pitfalls of relying on press releases rather than peer-reviewed publications. The press release summarized the main findings from a 293-participant study, but omitted critical details such as how CB-03-01 compared to the 2% minoxidil group.^[4]Cassiopea Spa, (2021). Cassiopea SpA Announces Topline Results of Phase II Proof of Concept Trial of Clascoterone Solution for the Treatment of Androgenetic Alopecia in Females. Available at: … Continue reading

Without all the data, readers can’t fully assess the study’s methodology, statistical analysis, or properly contextualize the results.

Should we trust the Kintor Pharma Press Releases?

When you see mistakes, misrepresentations, or only partial displays of results like these, it casts a shadow across companies like Kintor Pharmaceuticals, which have disseminated their efficacy and safety data primarily through press releases, investor announcements, and conference abstracts, rather than peer-reviewed journal articles. This lack of transparency makes it difficult for independent experts to critically appraise the robustness and clinical relevance of the findings.

For instance, Kintor’s Phase II trials report increases in target area hair count of approximately 10 to 22 hairs per cm2 compared to baseline or placebo after 24 weeks.^[6]Kintor Pharma. (2023). Kintor Pharma Announces Successful Completion of Phase II Clinical Trial of KX-826 for Treatment of Androgenetic Alopecia in the US. Available at: … Continue reading While these numbers appear promising, without full access to raw data, confidence intervals, or responder analyses, it is impossible to determine how consistent or meaningful these improvements are across the treated population. Moreover, the clinical significance of such hair count increases, whether they translate into visibly noticeable hair regrowth or improved patient satisfaction, is unclear without detailed patient-reported outcomes or photographic evidence.

Kintor’s decision to market KX-826-containing products as cosmetics rather than drugs in some regions further complicates trust in their claims. Cosmetics do not require FDA approval or demonstration of efficacy, and safety requirements are less stringent. This positioning allows products to be sold despite incomplete evidence of clinical benefit, potentially exposing consumers to unproven treatments.

Why Misrepresentation Happens and Its Consequences

Misrepresentation or “spin” in scientific communication can be intentional or unintentional. Authors and publishers may emphasize positive findings to attract attention, secure funding, or support marketing goals. Press releases often simplify complex results to appeal to broader audiences, sometimes glossing over limitations or nuances.^[7]PR Newswire. (no date). How Healthcare Companies are Using Press Releases. Available at: https://www.prnewswire.com/resources/articles/healthcare-company-press-releases/ (Accessed: June 2025) 

Done wrong, data can be misrepresented or misinterpreted, leading to:

• Mislead clinicians and potential consumers
• Dissemination of misinformation through social media and other internet sources
• Confusion and skepticism in scientific and medical fields
• Loss of trust from the consumer

The Role of Peer Review and Scientific Literacy

Peer review serves as a critical quality control mechanism, ensuring that research is rigorously evaluated by experts before it is published.^[8]Taylor & Francis. (no date). Understanding the peer review process. Available at: https://authorservices.taylorandfrancis.com/publishing-your-research/peer-review/ (Accessed: June 2025) It helps prevent unwarranted claims and promotes transparent reporting of methods and results. However, peer review is not foolproof, and errors or spin can still appear in abstracts or articles.

Peer review is only one part of the equation, however. Scientific literacy, especially source literacy, remains essential for anyone navigating research claims, whoever you are. This means not just reading headlines or abstracts, but digging into the methods, understanding what is being measured, and questioning whether the reported outcomes are truly meaningful in a real-world context. 

In today’s environment, where information can be amplified and distorted through social media and marketing, the responsibility for critical evaluation doesn’t just fall on scientists or peer reviewers; it’s shared by all of us who read, share, and act on scientific news.

Final Thoughts

The examples from TTFE, Niostem, and CB-03-01 illustrate how easily data can be misrepresented, whether intentionally or not. While press releases can be useful for quick updates, they are no substitute for full, peer-reviewed publications that allow for independent scrutiny. As the boundaries between scientific communication, marketing, and media continue to blur, the risk of misinterpretation and the consequences for patient care, consumer trust, and scientific progress only increase. 

Therefore, when it comes to companies that only publish their data through press releases, we would advise approaching with caution. It is good to have an open mind, but try not to blindly trust everything you see.

If you’d like a deeper dive into these topics, visit these videos here and here.