Oral Minoxidil: What’s The Best Dose (mg) For Men With Pattern Hair Loss?

Article Summary

Oral minoxidil improves hair growth in men with androgenic alopecia (AGA), with dosages of 0.25mg, 2.5mg, and 5.0mg showing positive effects. But the higher the dose, the higher your risk of side effects: namely, body hair growth and lower limb edema (swelling). So, which dose is best for you? While 2.5mg daily is a great starting point, the real answer depends on your tolerance for certain side effects and the severity of your hair loss. Read on for our case-by-case recommendations.

Full Article

Research continues to show that oral minoxidil is an effective off-label treatment for men with pattern hair loss. The general rule-of-thumb: the bigger the dose, the better hair regrowth. But there’s a catch…

Higher dosages of oral minoxidil come at a risk of higher risk of side effects: excessive body hair growth, limb swelling, low blood pressure, and even heart palpitations.

Knowing this, is there a “best dose” for oral minoxidil (in mg) for men with pattern hair loss? More specifically, which dose of oral minoxidil maximizes our chances for hair regrowth and minimizes our risks of adverse events?

This Quick Win uncovers the latest research. The short answer: studies show that 2.5mg daily seems to be a tolerable, effective dose for most men with pattern hair loss. But the right dose for you will depend on (1) your severity of hair loss, and (2) your tolerance with side effects (not all of them are bad).

Note: Quick Wins are short articles focused on answering one question about hair loss. Given their specificity, these articles are written in a more scientific tone. If you’re new to hair loss education, start with these articles.

Oral minoxidil: research at a glance

To date, there have been fewer than 10 studies published on oral minoxidil for androgenic alopecia (AGA). Doses studied range from 0.25mg to 5.0mg daily, and study durations (at least the ones we evaluated) range from 24-52 weeks.

Across studies, there is a clear trend: the higher the dose of oral minoxidil, the better the hair regrowth. But this relationship doesn’t tell the whole story ­– as these higher dosages seem to confer with higher reports of side effects.

So, here’s what you should know before starting any daily dose of oral minoxidil.

#1: Oral minoxidil dosages from 0.25mg to 5mg improve pattern hair loss

The three most recent (and most robust) studies on oral minoxidil all varied dosing by 0.25mg, 2.5mg, and 5.0mg daily. All of them showed benefit – with higher dosages demonstrating visual improvements. Just see these photos of a male who took 5mg of oral minoxidil daily for 3 months.^[1]Jimenez-Cauhe, Juan et al. Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. Journal of the American Academy of Dermatology, Volume 81, Issue 2, 648 – 649

Male with AGA: improvement with 5mg oral minoxidil over 3 months

So, let’s organize the findings of these three studies by dosage. Then, let’s evaluate their results in terms of:

1. Response rates (i.e., the percent of people who experienced an improvement), and…
2. Side effects (i.e., unintended effects of the drug)

Do we see any trends in data? Specifically, is there a “sweet spot” where most men can maximize their chances of hair regrowth from oral minoxidil while minimizing their risk of serious side effects?

Yes.

Oral minoxidil for AGA: study results by dosage

See each study’s summaries.

Daily Dose (Duration)	Response Rate	Side Effects
0.25 mg (6+ months)[2]Pirmez, Rodrigo et al. Very-low-dose oral minoxidil in male androgenetic alopecia: A study with quantitative trichoscopic documentation. Journal of the American Academy of Dermatology, Volume 82, … Continue reading	60%	90%: increased beard growth (52%), increased body hair (20%), hair shedding (16%), pedal edema (4%)
2.5 mg to 5 mg (6-12 months)[3]Jimenez-Cauhe, Juan et al. Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. Journal of the American Academy of Dermatology, Volume 81, Issue 2, 648 – 649	90%	29.3%: increased body hair (24.3%), lower limb edema (4.8%), hair shedding (2.4%)
5 mg (6 months)[4]Efficacy and safety of oral minoxidil 5 mg daily during 24-week treatment in male androgenetic alopecia. Journal of the American Academy of Dermatology, Volume 72, Issue 5, AB113	100%	100%: increased body hair growth (93%), pedal edema (10%), heart / EKG alterations (10%)

At first glance, the risk of side effects across even small dosages seems ridiculously high (90%+).

However, not all of these side effects are bad.

For instance, of the side effects reported in these studies, the overwhelming majority of them constituted increased body/facial hair growth. Most men aren’t going to care about this. In fact, man men might even prefer more body or facial hair.

Secondly, increased hair shedding was generally only reported at the beginning of each study. This is because, when starting minoxidil (topical or oral), the drug can “kickstart” a new anagen (growth) phase of hairs affected by androgenic alopecia (AGA). This can lead us to shed any hairs that were already primed to fall out soon anyway – specifically, catagen or telogen hairs – thereby giving the illusion of thinner hair in the first 1-2 months of treatment. However, as these hairs grow back, they’re usually much thicker, and thereby improve hair density. Long-story short: in most cases, hair shedding from minoxidil isn’t long-lived.

So, for this exercise, let’s discount increased body/facial hair growth and increased hair shedding as temporary and/or non-problematic side effects. Instead, let’s re-run our analysis and only consider serious side effects – edema, EKG alterations, etc.

Within this context, are all dosages of oral minoxidil as scary?

No. In fact, it seems like there’s a “sweet spot” for oral minoxidil where we can maximize hair regrowth while minimizing our risk of bad side effects: at 2.5mg daily.

Keep in mind the following chart is based on preliminary data on low-dose oral minoxidil, and that this article reflects the clinical studies available on oral minoxidil for androgenic alopecia as of 2020. As better-designed studies are published, these numbers will evolve:

Moreover, it’s really only at dosages of 5mg that we see an appreciable increase in concerning side effects – namely, edema (water retention / swelling) and cardiac alterations (i.e., lower heart rates).

So, 2.5 mg daily of oral minoxidil might be the “sweet spot” for most male pattern hair loss sufferers.

#2: Oral minoxidil’s efficacy may vary depending on hair loss severity

Most clinical trials on androgenic alopecia will select study participants who all have similar severities of hair loss. This is known as standardization. And for most trials, investigators usually prefer men who have medium-severity androgenic alopecia (i.e., Norwood 3-4). This is usually because men with Norwood 3-4 level hair loss (1) are representative of the population of hair loss sufferers who may later opt for this treatment, and (2) have enough hair follicle miniaturization and hair loss to effectively evaluate cosmetic improvements to hair thinning.

Having said that, most studies on oral minoxidil aren’t standardized to Norwood 3-4 participants. So, it’s a bit disingenuous to make comparisons across studies for response rates and side effects. In other words, please take our above analysis with a grain of salt.

With that said, with different age and/or hair loss severity across studies, we can get more granular data on who tends to respond well to oral minoxidil.

Based on the above studies (and others we looked into for our analysis), the trend aligned with intuition: if you don’t have severe hair loss, you can get away with lower dosages of oral minoxidil. If you do have severe hair loss, you’ll need a higher dose.

In other words:

• If you have mild male pattern baldness, 0.25mg daily might work fine as a starting point
• A more moderate case of hair loss might require a dose of 1-2.5mg daily
• If you have severe male pattern baldness, you’re probably going to need closer to 5mg daily
• If other treatments haven’t worked for you (resistant hair loss), you may also need a higher daily dose (2.5-5mg) or combination treatments with finasteride

Then again, higher doses come with more side effects. This is where dosing gets hyper-specific.

#3: If you’re going to try oral minoxidil, you’ll need to work with a doctor to figure out your unique risk profile and the right dose

Oral minoxidil is an antihypertensive drug (lowers blood pressure). It can also cause fluid retention. Therefore, if your health history indicates problems surrounding low blood pressure, fainting spells, or edema (swelling), you may be at a higher risk of complications from taking the drug.

Moreover, oral minoxidil can stimulate hair growth everywhere… not just on the scalp. For some men, this may be a bonus. For others, it might be a drawback. If this is a drawback for you, then it’s worth noting that reports of increased body / facial hair even occurred at lower dosages (0.25 mg) of oral minoxidil. So, if you’re concerned about this, maybe oral minoxidil isn’t right for you.

Long-tory short: for the safest and most effective use of oral minoxidil, discuss your medical history and preferences with your doctor. Then convince him or her to prescribe you oral minoxidil.

Note: a dermatologist specializing in hair loss is much more likely to write you a prescription. So, if you don’t want to waste any time, make a list of dermatologists in your area, call them to see if they’re open to prescribing oral minoxidil, and then only visit the ones who prescribe the drug.

#4: Like topical minoxidil, oral minoxidil likely works better alongside other treatments

When it comes to treating pattern hair loss, combination treatments tend to almost always outperform mono-treatments.

In some cases, combination therapies allow us to use the lowest dose of a drug possible without sacrificing results. Some studies suggest this is the case for women with pattern hair loss who take 0.25mg of oral minoxidil + 25mg of spironolactone: they minimize the risk of side effects of either drug while getting hair regrowth that often exceeds that of high dosages of either drug.

In other cases, combination therapies can actually enhance the efficacy of drugs. This tends to be true of men taking topical minoxidil, and who then add in once-weekly microneedling, thereby making topical minoxidil 400% more effective (according to some investigation groups). ^[5]English RS Jr, Ruiz S, DoAmaral P. Microneedling and Its Use in Hair Loss Disorders: A Systematic Review. Dermatol Ther (Heidelb). 2022 Jan;12(1):41-60. doi: 10.1007/s13555-021-00653-2. Epub 2021 Dec … Continue reading

While there aren’t many studies that exhaustively explore this relationship for oral minoxidil, the odds are that this medication also works better as a combination therapy. So, if you’re going to commit to oral minoxidil, consider stacking it with other therapies.

Again, research here is limited, but there are a host of things you can try in combination with oral minoxidil that might increase results.

• DHT reducers (finasteride, saw palmetto, etc.)
• Microneedling
• Massage
• Ketoconazole shampoo
• Low-level laser therapy (LLLT)
• Platelet-rich plasma therapy (PRP)

…and more.

The bottom line

When it comes to oral minoxidil, the best daily dosage for men with pattern hair loss may vary depending on(1) your tolerance for certain side effects, and (2) your severity of hair loss. Consider these recommendations a mere starting point until more research emerges:

• Men with mild AGA, men at a higher risk of complication, or men who don’t want extra hair growth on their body/face: 0.25-1mg.
• Men with moderate AGA: 1-2.5mg.
• Men with resistant AGA (you’ve tried other treatments and they haven’t worked) or severe AGA: 2.5-5mg.

Although these guidelines are a rough ballpark, chances are you fit into one of these categories and, with the help of a doctor, can find the best oral minoxidil dosage for you.

Questions? Comments? Please reach out in the comments section.