Treatments

Topical Minoxidil

Evidence

97%

Regrowth

Viability

Oral Minoxidil

Evidence

63%

Regrowth

Viability

Topical
Oral

Evidence Quality

97%

Regrowth Potential

Long-Term Viability

Written by Perfect Hair Health Team

Medically Reviewed by Rob English

First Published Oct 3, 2024

Last Updated Oct 24, 2024
Key Information
Free Resources
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KEY INFORMATION

What Is Minoxidil?

Minoxidil is a drug that lowers blood pressure. In the 1980's, topical minoxidil was approved by the FDA to treat androgenic alopecia at 2% strengths for women and 5% strengths for men. Today, minoxidil is available in oral and topical formulations.

How Does Minoxidil Work?

Minoxidil is believed to promote hair growth by opening potassium ion channels, which then promotes blood flow and angiogenesis (the formation of new blood vessel networks). Minoxidil may also have anti-inflammatory effects. Its primary mechanism of action remains unclear.

What You Should Know

Topical minoxidil is largely ineffective at treating hair loss – with studies suggesting response rates of just 40-60%. However, response rates and regrowth rates can be greatly enhanced when minoxidil is paired microneedling and/or topical retinoic acid. Finally, low-dose minoxidil seems to producer higher response rates and a good safety and adherence profile – all without the same risk of sexual side effects as finasteride.
Evidence Quality

63%

Regrowth Potential

Long-Term Viability

Written by Perfect Hair Health Team

Medically Reviewed by Rob English

First Published Oct 3, 2024

Last Updated Oct 24, 2024
Key Information
Free Resources
- Articles
- Research Tables
KEY INFORMATION

What Is Minoxidil?

Minoxidil is a drug that lowers blood pressure. In the 1980's, topical minoxidil was approved by the FDA to treat androgenic alopecia at 2% strengths for women and 5% strengths for men. Today, minoxidil is available in oral and topical formulations.

How Does Minoxidil Work?

Minoxidil is believed to promote hair growth by opening potassium ion channels, which then promotes blood flow and angiogenesis (the formation of new blood vessel networks). Minoxidil may also have anti-inflammatory effects. Its primary mechanism of action remains unclear.

What You Should Know

Topical minoxidil is largely ineffective at treating hair loss – with studies suggesting response rates of just 40-60%. However, response rates and regrowth rates can be greatly enhanced when minoxidil is paired microneedling and/or topical retinoic acid. Finally, low-dose minoxidil seems to producer higher response rates and a good safety and adherence profile – all without the same risk of sexual side effects as finasteride.

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Articles

Explore the science behind hair loss and hair growth. Our in-depth articles cover topics ranging from natural remedies to pharmaceuticals to breakthroughs in hair loss science. Want to request an article topic? Contact us.

Genetic Tests: A Breakthrough for Personalized Hair Loss Treatments?

By Sarah King, PhD

Nov 21, 2024

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Articles

By Sarah King, PhD

Nov 21, 2024

Genetic Tests: A Breakthrough for Personalized Hair Loss Treatments?

By Sarah King, PhD

Aug 21, 2024

PTGES2: Can This Gene Predict Regrowth from Minoxidil?

By Sarah King, PhD

Jul 16, 2024

SULT1A1: Can This Gene Predict Hair Regrowth From Minoxidil? | The Evidence

By Sarah King, PhD

Apr 11, 2024

Is Hair Loss Treatment Lifelong? Here’s What The Data Show.

By Perfect Hair Health Team

Feb 24, 2023

Regrowth from Minoxidil: How Much Should I Expect?

By Perfect Hair Health Team

Feb 23, 2023

How Does Minoxidil Work? 3 Hypotheses + Debates

By Perfect Hair Health Team

Apr 16, 2022

Hims vs Keeps vs Roman: Which Hair Growth Subscription Service Wins?

By Perfect Hair Health Team

Mar 10, 2022

How Long After Stopping Minoxidil Before We Lose Our Hair Gains?

By Perfect Hair Health Team

Mar 5, 2022

Three Ways to Improve Minoxidil Results

Oral Minoxidil For Female Hair Loss: How To Avoid Hypertrichosis (Unwanted Body Hair Growth)

By Perfect Hair Health Team

Jan 17, 2020

Oral Minoxidil For Female Hair Loss: How To Avoid Hypertrichosis (Unwanted Body Hair Growth)

Oral minoxidil improves hair loss in women, but at the expense of unwanted body hair growth. Fortunately, there is a way to leverage oral minoxidil’s hair-promoting effects and without much body hair growth: combine it with spironolactone. This article reviews the evidence on oral minoxidil fo...

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

By Perfect Hair Health Team

Jan 6, 2020

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

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...

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Research Tables

Want the latest research on Topical Minoxidil? Every quarter, our research team conducts a literature search on Topical Minoxidil to keep you up-to-date on new studies. See our search criteria & research tables below – including a summary of key findings from every single study.

Last updated: October 2024

Results

Search Criteria

Parameter	Inclusion Criteria	Exclusion Criteria
Patients	Patients of any age with hair loss	Patients with no hair loss disorder.
Intervention	Topical minoxidil as a standalone or adjunct therapy.	A study that doesn’t contain topical minoxidil either as a standalone or adjunct therapy
Comparator	Placebo and/or other therapies	Lack of control group (positive or negative)
Outcomes	Primary Endpoints of phototrichogram, investigator, and/or patient assessments.	Any study not designed to adequately test for the standalone or additive effect of topical minoxidil
Study Design	Prospective, retrospective, and case series studies	Literature reviews, non-human subjects, or ongoing clinical trials.

Search Terms

Search Terms:

topical hair loss alopecia minoxidil

Abbreviations:
FPHL

Female pattern hair loss
AGA

Androgenetic alopecia
AA

Alopecia areata
MX

Minoxidil
MTF

Topical minoxidil foam
MXT

Topical minoxidil
MN

Microneedling
PRP

Platelet-rich plasma
TAHC

Target area non-vellus hair count
AU

Alopecia Universalis
AT

Alopecia Totalis
AASIS

Alopecia Areata Symptom Impact Scale
SALT

Severity of Alopecia Scoring Tool
FGF

Fibroblast growth factor
SPT

Spironolactone
RCT

Randomized controlled trial
qPCR

Quantitative polymerase chain reaction
TUAD

Total unit area density
CIA

Chemotherapy-induced alopecia

Summarized Studies

Study	Participants		Design	Treatment				Results	Key Takeaway		Adverse Effects	Evidence Quality
Authors (year)	Sex	Hair Loss Type	Design	Dose	Usage	Duration	Endpoints	Hair Growth Assessments	Summary	Limitations	Adverse Effects	Jadad Score
Liang et al. (2023)	n=120 (F) Group 1: 40 Group 2: 40 Group 3: 40	FPHL	Prospective, single-center, parallel-group, evaluator-blinded, randomized trial	Group 1: 5% MXT Group 2: 5% MX + 80-100 mg SPT Group 3: 5% topical MX + MN	Group 1: Once daily. Group 2: Once daily. Group 3: MXT once daily, alongside MN every 2 weeks.	24 weeks	Dermascope evaluation, ultrasound biomicroscopy (UBM), physician's global assessment, and patient assessment.	Group 1:showed improvement at week 24 in hair density and shaft diameter. The effective rate was 55.27% at week 24. Group 2: The effective rate was 86.49% at week 24. Group 3: The effective rate was 95% at week 24. The degree of improvement of hair density at week 24 in Group 1 was less than in the latter two.	The combined therapies showed advantages in efficacy over 5% MXT alone. Group 3 showed significant improvement in most endpoints, including hair density, hair shaft, diameter, epidermal thickness, dermis thickness, follicle diameter, hair shedding score, and QoL score	Small sample size, exclusion of severe FPHL patients, and potential bias from unblinded treatments among the 3 groups.	Group 1: Facial hypertrichosis (n=4), trichomadesis aggravating (n=4), scalp pruritus (n=8), increased scurf (n=7), headache (n=1), palpitation (n=1), postural hypotension (n=1), urticaria (n=1). Group 2: facial hypertrichosis (n=5), trichomadesis aggravating (n=4), scalp pruritus (n=8), increased scurf (n=6), edema (n=1), headache (n=1), palpitation (n=3), hyperkalemia (n=1), menstrual disorder (n=15), urticaria (n=1)	4
Hassan et al. (2022)	n=60 (F) Group 1: 15 Group 2: 15 Group 3: 15 + 15 controls for vitamin D comparison.	FPHL	Comparative study.	Group 1: 5% MTF and oral vitamin D3 (5000 IU/day). Group 2: 5% MTF only. Group 3: Oral vitamin D3 (5000 IU/day)	Group 1: 6 puffs twice daily of MTF and 5000 IU/day. Group 2: 6 puffs of MTF twice daily. Group 3: 5000 IU/day.	12 weeks	Clinical evaluation (Ludwig scale) and dermoscopy.	Group 1: reduction in thin hairs to 10.47 ± 6.94 from 23.33 ± 7.94. Improvement in Ludwig classification: 6.7% in stage 0, 80% in stage I, and 13.3% in stage 2. Group 2: reduction of thin hairs to 16.67 ± 9.23 from 23.33 ± 8.8. Improvement in Ludwig classification: 13.3% in stage 0, 53.3% in stage I, 33.3% in stage II. Group 3: reduction of thin hairs to 24.33 ± 10.67 from 28.33 ± 9.39. Improvement in Ludwig classification: 6.7% in stage 0, 53.3% in stage I, and 40% in stage II.	Vitamin D treatment alone had no notable effect on hair growth compared to MX or combination therapy. A combination of MX and vitamin D appeared to improve hair growth outcomes the most.	Small sample size.	Not reported.	0
Bao et al. (2022)	N=71 (M) Group 1: 23 Group 2: 23 Group 3: 25	AGA	RCT	Group 1: 5% MXT Group 2: Electrodynamic MN treatment Group 3: Combination of MXT and MN treatment.	Group 1: twice daily Group 2: every 3 weeks (8 treatments total) treatment Group 3: once daily MXT + every 3 weeks (8 total treatments).	24 weeks followed by a 6-month follow-up period.	Non-vellus hair density and diameter, hair growth evaluation, qPCR microarray, protein expression.	Hair density: All 3 groups showed significantly increased non-vellus hair density (p= <0.05): Group 1 – 28.01 ± 7.42, Group 2 – 32.09 ± 4.51, and Group 3 – 56.45 ± 7.82. Hair diameter: Group 1 and group 3 showed significant improvements (p=<0.01). Group 1: 18.70 ± 6.17 µm, Group 2: 10.41 ± 4.83 µm, and Group 3 – 22.46 ± 3.87 µm.	Combination treatment of MXT and MN showed the most improvement in non-vellus hair density and hair diameter	Small sample size, participants in the combination group received scalp massages.	12 people had adverse reactions. Group 1: seborrheic dermatitis (n=1), scalp itching (n=1), eczema (n=1). Group 2: increased dandruff (n=2), scalp infection (n=1), enlarged lymph nodes in the neck (n=1). Group 3: seborrheic dermatitis (n=1), increased dandruff (n=1), enlarged lymph nodes (n=3).	3
Singh et al. (2019).	n=80. (M) Group 1: 20 Group 2: 20 Group 3: 20 Group 4: 20	AGA	RCT, double-blind, placebo-controlled.	Group 1: 5% MXT. Group 2: 5% MXT + intradermal injection of PRP. Group 3: topical placebo and intradermal placebo injection. Group 4: topical placebo and intradermal injection of PRP.	Group 1: twice daily. Group 2: twice daily topical + once monthly intradermal injection. Group 3: twice daily topical + once monthly intradermal injection. Group 4: twice daily topical + once monthly intradermal injection	12 weeks followed by 2 months of follow-up.	Change in total, terminal, vellus, and non-vellus hair density, change in degree of hair pigmentation, patient self-assessment of hair loss using the visual analog scale, and assessment of hair loss by investigators using the 7-point Sinclair scale. Global photographic assessment (GPA) of hair density and thickness.	Hair Density: By the final follow-up, Group 1: 123.95 ± 35.41 Group 2: 150.45 ± 28.27 Group 3: 89 ± 37.39 Group 4: 143.2 ± 33.35 Patient satisfaction: Found to be highest in group 2, followed by Group 4 and Group 1, whereas none were satisfied in group 4.	PRP with MXT was found to be more effective than PRP or topical MXT alone in treating male-type baldness.	Lack of long-term follow-up, no hair counts or thickness measurements, and the use of patient self-assessment as a subjective measure	By the final follow-up: Group 1: scalp pruritus (n=3), increased facial hair (n=1), hyperpigmentation (n=1). Group 2: increased facial hair (n=1). Group 3: no adverse effects. Group 4: no adverse effects.	3
Blume-Peytavi et al (2019).	N=220 (M) Group 1: 110 Group 2: 44 Group 3: 44 Group 4: 22	AGA	Phase II multicenter, double-blind, randomized, placebo-controlled, split scalp study.	Group 1: 5% MXT (DCO120) + comparator. Group 2: 5% MXT (DCO120) + comparator vehicle. Group 3: DCO120 vehicle + comparator. Group 4: DCO120 vehicle + comparator vehicle.	Products are applied twice daily morning and evening.	16 weeks	Trichoscan, cumulative hair thickness, safety, and tolerability.	Non-vellus TAHC: At 16 weeks, both DCO120 and the comparator showed an increase in non-vellus TAHC. Change from baseline = +22 hairs/cm2 and +20.5 hairs/cm2 respectively. Hair thickness: Significantly increased following both DCO120 and comparator treatments compared to the vehicles. Heart rate, systolic blood pressure, and diastolic blood pressure remained stable over the treatment period.	The study demonstrated that the new topical minoxidil was non-inferior to the comparator in stimulating hair growth over 16 weeks. The treatment was generally well-tolerated, with mild or moderate treatment-related adverse events.	Products were only applied to small areas of the scalp, and the study was not large enough to detect less common adverse events	3 subjects discontinued the study because of AEs related to the study treatment: Group 1 – contact dermatitis (n=1), erythema (n=1). Group 2 – contact dermatitis (n=1). When present, erythema, pruritus, and burning sensation at application sites were generally mild and did not worsen during the study.	4
Bergfeld et al (2016).	n=404 (F) Group 1: 202 Group 2: 202	FPHL	Phase III, multicenter, parallel-design clinical trial.	Group 1: 5% MTF. Group 2: Vehicle foam.	Both treatments = once daily.	24 weeks	Change from baseline in target area hair count (TAHC) at weeks 12 and 24, subject assessment of scalp coverage, and change from baseline in total unit area density (TUAD).	At 12 and 24 weeks, 5% MTF treatment resulted in regrowth of 10.9 hairs/cm2 and 9.1hair/cm2 more than the vehicle foam respectively (P<0.0001). Improved scalp coverage was observed at week 24 over vehicle foam (P<0.0001). TUAD increased by 658 µm/cm2 and 644 µm/cm2 with 5% MXT than the vehicle foam (P<0.0001).	5% MTF once daily for 24 weeks was well-tolerated and promoted hair regrowth in women, leading to improved scalp coverage and increased hair density compared to the vehicle.	Not specified	5% MTF was well tolerated with a low incidence of scalp irritation and facial hypertrichosis observed.	3
Blume-Peytavi et al. (2016)	n=322 (F) 5: 161 Group 2: 161	FPHL	Phase III, randomized, investigator-blinded study.	Group 1: 5% minoxidil topical foam (MTF). Group 2: 2% minoxidil topical (MXT).	MTF = once-daily. MXT = twice daily.	52 weeks	Change from baseline in total area hair count (TAHC) at 12 and 24 weeks. Total unit hair density and change in overall scalp coverage.	Once-daily 5% MTF increased TAHC from baseline by 23.9 ± 2.1 hairs/cm2 by week 24. Twice-daily 2% MXT increased TAHC 24.2 ± 2.1 hairs/cm2 at week 24.	While both groups were able to induce hair regrowth, the MTF group could not meet the non-inferiority criteria.	Not specified	Both treatments were reported to be well tolerated. 10 total participants withdrew due to adverse effects.	3
Mirmirani et al. (2015).	n=16 (M) Group 1: 10 Group 2: 6	AGA	A placebo-controlled, double-blinded prospective pilot study.	Group 1: MTF. Group 2: Placebo.	Apply twice daily.	8 weeks	Stereotactic scalp photographs and scalp biopsies, and microarray analysis.	Group 1: MTF-induced hair growth in both the frontal and vertex scalp of patients. MTF treatment induced the expression of hair keratin-associated genes and decreased the expression of inflammatory genes and epidermal differentiation complex (EDC) in both scalp regions.	MTF is effective in the treatment of both the frontal and vertex scalps of AGA patients.	Small study size, short-term study, and lack of long-term follow-up.	No adverse events were specified.	1
Olsen et al. (2007)	n=352 (M) Group 1 : = 176 Group 2 : = 176	AGA	Multicenter, randomized, placebo-controlled, double-blind clinical trial.	Group 1: 5% MTF. Group 2: placebo	One-half capful (1g) was applied directly to the affected vertex balding scalp twice daily	16 weeks	Safety evaluations at weeks 1, 4, 8, 12, and 16; target area hair counts (TAHC), patient self-assessment, global photographic review, and safety evaluation	Statistically significant increase in hair counts in the 5% MTF group compared to the placebo (p<0.0001), and subjective assessment of improved hair loss condition (p<0.0001).	5% MTF is a safe and effective treatment for men with AGA.	No collection of efficacy data beyond 16 weeks.	At week 16: Group 1 – dryness/scaling (5%), folliculitis (2%), erythema (7%), burning (3%), itching (8%), stinging (4%). Group 2 - dryness/scaling (7%), folliculitis (2%), erythema (8%), burning (2%), itching (2%), stinging (4%). Minoxidil levels were within normal levels and consistent with PK study results.	3
Lucky et al (2004)	N=381 (F) Group 1: 153 Group 2: 154 Group 3: 74	FPHL	A double-blind, placebo-controlled, randomized, multicenter trial.	Group 1: 5% MXT. Group 2: 2% MXT. Group 3: vehicle for 5% solution.	Applied twice daily.	48 weeks.	Change in non-vellus TAHC (through macro photography), patient self-assessment of hair growth/scalp coverage, and investigator assessment of hair growth/scalp coverage.	Hair Count at Week 48: Group 1 -24.5 ± 21.9 Group 2 -20.7± 17.6 Group 3 -9.4±14.6 Scalp Coverage (0-100) patient: Group 1 - 60 ±27.6 Group 2- 50.5 ±32.5 Group 3- 41.8 ±29.9 Scalp Coverage (0-100) investigator: Group 1 -42 ±27.1 Group 2 -37.4 ±30.1 Group 3 -30.2 ±27	5% MXT was superior to placebo on each of the 3 primary efficacy endpoints. 2% MXT was superior to placebo for assessments of non-vellus hair counts.	No limitations specified.	Drug-related adverse events of a dermatologic nature (e.g., pruritus, dermatitis, hypertrichosis, scaling) were more prevalent in the 5% topical minoxidil group than in the 2% or placebo groups.	4
Olsen et al (2002)	N=393 (M) Group 1: 157 Group 2: 158 Group 3: 78	AGA	Double-blind, placebo-controlled, randomized, multicenter trial.	Group 1: 5% MXT Group 2: 2% MXT. Group 3: placebo (vehicle for 5% solution).	Applied twice daily.	48 weeks	Hair counts from macro photographs of clipped hair, patient and investigator assessments of hair growth done by validated hair growth questionnaires.	Hair Counts at Week 48: Group 1: 18.6 ±25.4 Group 2: 12.7 ±20.7 Group 3: 3.9 ±21.7 Scalp Coverage (0-100) patient: Group 1: 62 ±17 Group 2: 56.9 ±11 Group 3: 51 ±14.9 Scalp Coverage (0-100) investigator: Group 1: 12.3 ±23.1 Group 2: 7 ±20.4 Group 3: 2.5 ±19.5	5% MXT was superior to 2% MXT and placebo at increasing hair regrowth in men. Men who used 5% MXT also had an earlier response to treatment than those who used 2% MXT.	Not specified	Group 1: Pruritus and dermatitis (6 participants), local intolerance leading to withdrawal (5 participants), and headache (5 participants). Group 2: Pruritus and dermatitis (2 participants), local intolerance (1 participant), headache (1 participant). Group 3: Pruritus and dermatitis (2 participants), headache (1 participant).	5
Duvic et al (1996)	N=22 (F) Group 1: 11 Group 2: 9	CIA	A randomized, double-blind pilot study.	Group 1: 2% MXT Group 2: placebo	Applied twice daily.	Throughout the course of chemotherapy and up to 4 months post-chemo treatment.	Investigator and patient evaluation of a 2-inch diameter circle on the patient’s scalp.	Baseline to maximal hair loss (days): Group 1: 61.8 ±18.43 Group 2: 50.3 ±14.26 Baseline to maximal hair regrowth (days): Group 1: 148.5 ±37.37 Group 2: 187.2 ±51.07 Period of baldness: Group 1: 86.7 ±40.09 Group 2: 136.9 ±51.25 Baseline to first moderate or dense regrowth: Group 1: 131.2 ±42.37 Group 2: 155.3 ±79.99	2% MXT appears to reduce the period of baldness from chemotherapy by more than a month in some patients.	Small sample size, imbalance in each group.	Group 1: Pruritus (4 participants), folliculitis (2 participants), facial hair growth (5 participants). Group 2: Pruritus (8 participants), scalp folliculitis (3 participants), facial hair growth (3 participants).	3
Jacobs et al (1993)	N=294 (F) Group 1: 176 Group 2: 170	FPHL	A double-blind, placebo-controlled trial	Group 1: 2% MX Group 2: placebo	Applied twice daily	32 weeks	Hair counts (photography with computer-assisted counting), investigator and patient assessments of visible new hair growth from global photographs.	Hair Count: Mean increase in non-vellus hair count was 33 hairs for group 1 compared to 19 hairs for group 2. Investigator Assessment: 44% of Group 1 achieved new hair growth compared to 29% of Group 2. Patient Assessment: 55% of participants in Group 1 believed they achieved new hair growth compared to 41% in Group 2.	Topical MX was more effective than the placebo in the treatment of FPHL.	Not specified	No clinically significant changes in vital signs were observed during the study, and no serious or unexpected medical events were recorded.	3
Whiting and Jacobson (1992)	N=33 (F) Group 1: 17 Group 2: 16	FPHL	A multicenter, randomized, double-blind, placebo-controlled trial.	Group 1: 2% MXT Group 2: placebo (vehicle only)	Applied twice daily at 12-hour intervals.	32 weeks.	Hair counts (macrophotography), investigator and patient subjective evaluations of hair shedding.	Hair Counts: For Group 1, the mean no. of hairs increased by 16.8%, and for group 2, the mean no. of hairs increased by 12.7%. Hair shedding: For group 1, 67% noted decreased shedding compared with 54% in the placebo.	Patients with FPHL regrew a minimal to moderate amount of hair after 32 weeks of twice daily application of 2% minoxidil.	Small sample size.	No side effects were reported.	3

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Research Tables

Want the latest research on Oral Minoxidil? Every quarter, our research team conducts a literature search on Oral Minoxidil to keep you up-to-date on new studies. See our search criteria & research tables below – including a summary of key findings from every single study.

Last updated: October 2024

Results

Search Criteria

Parameter	Inclusion Criteria	Exclusion Criteria
Patients	Patients of any age with hair loss.	Patients with no hair loss disorder.
Intervention	Oral minoxidil as a standalone or adjunct therapy.	A study that doesn’t contain oral minoxidil either as a standalone or adjunct therapy.
Comparator	Placebo and/or other therapies or baseline, or in the observational studies - none.
Outcomes	Primary Endpoints of phototrichogram, investigator, and/or patient assessments.	Any study not designed to adequately test for the standalone or additive effect of oral minoxidil.
Study Design	Prospective, observational, retrospective, and case series studies.	Literature reviews, non-human subjects, or ongoing clinical trials.

Search Terms

Search Terms:

oral hair loss alopecia minoxidil

Abbreviations:
FPHL

Female pattern hair loss
AGA

Androgenetic alopecia
MX

Minoxidil
pCIA

Persistent chemotherapy-induced alopecia
EIA

Endocrine therapy-induced alopecia
TE

Telogen effluvium
AU

Alopecia universalies
SALT

Severity of Alopecia Scoring Tool

Summarized Studies

Study	Participants		Design	Treatment				Results	Key Takeaway		Adverse Effects	Evidence Quality
Authors (year)	Sex	Hair Loss Type	Design	Dose	Usage	Duration	Endpoints	Hair Growth Assessments	Summary	Limitations	Adverse Effects	Jadad Score
Minta et al. (2023)	n=24 (F) Group 1: 13 Group 2: 11	pCIA or EIA	Retrospective	Group 1: oral MX 2.25 mg/day Group 2: 5% solution or foam	Once-daily	16 weeks	Pre- and post-treatment standardized clinical photos (vertex, frontal, lateral, and occipital scalp) and degree of alopecia (Dean Scale).	Pre-treatment Dean scores were similar between both groups: 1.7 in group 1 vs. 1.5 in group 2. No significant difference between the two groups post-treatment (p=0.9).	There is no significant difference between oral and topical MX for patients with EIA. However, oral MX was superior for pCIA patients.	Retrospective study design, small sample size, and absence of trichometric analysis.	Group 1: Hypertrichosis (n=1), scalp irritation (n=2), headache (n=1) – led to discontinuation. Group 2: Hypertrichosis (n=1) - led to discontinuation, orthostasis/hypotension (n=1).	1
Feaster et al (2022)	n=210 Group 1: 105 (25 M, 80 F) Group 2: 105 (25 M, 80 F)	AGA and/or TE	Multi-center, retrospective	Group 1: 0.625-2.5 mg MX. Group 2: Nothing, or other medications that are not minoxidil (unspecified).	Once daily	52 weeks	Clinical response (improvement, stabilization, worsening) based on provider assessment. Clinical photographic evaluation using a 3-point scale. Safety and tolerability	55 patients (of Group 1) (52.4%) demonstrated clinical improvement in hair growth, 44 patients (41.9%) demonstrated stabilization of hair loss, and 6 patients (5.7%) demonstrated worsening of their conditions.	Oral MX is an effective treatment option for male and female AGA/TE. Adverse effects reported by patients were generally mild and did not result in discontinuation.	Retrospective, no blinding, patients in both groups were also using other medications, no placebo-controlled group.	Adverse effects in Group 1: Edema - 1.9% Shedding - 1% Hypertrichosis - 4.8% Lower extremity cramping - 1% Palpitations - 1% Burning scalp - 1%	1
Silva et al (2022)	n= 26 (F) Group 1: 14 Group 2: 12	FPHL	Randomized, double-blind trial.	Group 1: 0.25 mg MX Group 2: 1 mg oral MX	Once daily	24 weeks	Change in total hair count from baseline to week 24 (photographic review of target area). Hair shedding scores on two scales (Sinclair and Martinez-Velasco). Quality of life was assessed using a questionnaire.	Hair shaft count/cm2: Group 1: (baseline 292±63.1 24 weeks 299.8±70.7) p=0.2. Group 2: (baseline 277.2±46.6 24 weeks 304±39) p<0.001 Shedding: Both groups showed significant improvements in both shedding scales - however, there was no significant difference between treatments. QoL: Scores improved significantly for both treatments.	Both 0.25 mg/day and 1 mg/day oral MX were effective in reducing hair shedding and improving QoL in patients with FPHL. However, the 1 mg/day dose was superior to the 0.25 mg/day dose in terms of increasing hair shaft count in the target area. No significant adverse effects observed in either group.	Single-center study, no placebo group, duration of the study was relatively short, small sample size.	Group 2: Mild facial hypertrichosis (n=2), and temporary worsening of hair loss (n=1) at the 8-week visit, but this resolved by the 24-week visit. No patients withdrew due to adverse effects.	2
Vahabi-Amlashi et al (2021)	n=72 (F) Group 1: 36 Group 2: 36	FPHL	Triple-blind, randomized clinical trial.	Group 1: 0.25 mg MX and 1cc topical placebo solution. Group 2: 1cc of 2% topical MX	Oral treatment - once daily. Topical treatment - twice daily.	36 weeks	Shedding and Sinclair scores, recorded by 3 different evaluators, Trichoscopy to measure hair density and diameter, liver, kidney, and electrolyte tests. Side effects measured.	Both groups showed significant increases in hair diameter and hair density over the treatment period. Group 1: Improved 13% from baseline. Group 2: Improved 6% from baseline. Sinclair and shedding scores decreased significantly in both groups by the end of the study. No significant differences were found between the two groups for any of the endpoints.	Both treatments resulted in significant improvements in hair diameter, density and clinical indexes for women with FPHL. Oral MX showed slightly better recovery in hair density, and topical minoxidil showed slightly better recovery in hair diameter.	Pilot study with a relatively small sample size, participants were predominantly in Sinclair stage II and III FPHL, which might limit the generalizability of the findings to more advanced cases. The study also did not address potential underlying causes of hair loss or include a placebo.	Group 1: Hirsutism (7.7%), weight gain (3.8%). Gastrointestinal tolerance (7.7%) and hypotension (3.8%) - leading to study exclusion. Group 2: Hirsutism (8%).	2
Kumar et al (2021)	n=95 (M) Group 1: 47 Group 2: 48	AGA	Pilot study	Group 1: PRP + 1.25 mg MX Group 2: PRP + 2.5 mg	MX - Once daily PRP - Every 4 weeks	24 weeks (PRP treatment lasted 16 weeks)	Photographic assessment, trichoscopic evaluation, and patient self-assessment.	Photographic Assessement: Group 1: marked improvement seen in 40% of participants. Group 2: marked improvement seen in 58.3% of participants. % increase in total hairs: Group 1: 15.41% Group 2: 22.15% % increase in hair diameter: Group 1: 25.14% Group 2: 33.98%	Low dose oral MX (1.25 or 2.5 mg) in combination with PRP can be used effectively in patients who are apprehensive of taking finasteride or dutasteride, and are less responsive to MX alone.	Small sample size.	Group 1: Peripheral edema (1/47), Hypertrichosis (36/47) Group 1: Peripheral edema (1 - leading to withdrawal), urticaria (1 - leading to withdrawal) and hypertrichosis (39/48). Mild pain noted in all patients during PRP.	1
Dincer et al (2021)	n=1 (31-year-old male)	Treatment resistant AU	Retrospective case study.	Tofacitinib 10 mg/kg for 6 months. Then MX powder(concentration unknown)	Once daily	24 weeks	SALT scores were assessed by an expert investigator.	SALT score was originally 100% and dropped to 35% after 24 weeks of minoxidil.	A combination of tofacitinib and oral minoxidil may be an effective alternative treatment approach in severe AA cases.	Single-case study, with unknown concentration of minoxidil used.	None specified	0
Panchaprateep and Lueangarun (2020)	n=30 (M)	AGA	Open-label, prospective single-arm study.	5 mg Oral MX	Once daily	24 weeks	Hair counts, hair diameter, photographic assessment, and self-administered questionnaire.	Hair Count - significant increase in total hair count compared to baseline (+35.1±18.9 hairs/cm2) P = 0.003 Hair Diameter - significant increase baseline by 15.21% at 24 weeks (p<0.001). Global Photographic Assessment: 43% of patients achieved an excellent improvement score by the end of the study.	Oral MX at 5 mg once daily significantly increased hair growth in men with AGA by 24 weeks of treatments.	Open-label, small study, no placebo, and relatively short duration.	Pedal edema was present in 3 patients at 1-2 months into treatment, which resolved after 2-3 months, of which 2 patients had obesity. Hypertrichosis occurred in 93.3% of patients at 24 weeks.	1
Beach et al (2020)	n=51 F:39 M:122	AGA \| 23 Multiple  diagnoses \| 15 LPP or FFA \| 6 TA \| 3 CCCA \| 1 TE \| 1 CIA \| 1	Retrospective case series.	1.25 mg MX nightly	Once daily	12 weeks	Expert assessment at in-clinic visits.	65% of patients showed increased scalp hair growth. 27% of patients showed decreased hair shedding. Patients with nonscarring alopecia showed the most improvement. Patients generally continued therapy for an average of 10 months.	Oral MX could lead to increased hair growth and decreased shedding in patients with alopecia, with many patients experiencing positive results.	Retrospective, small sample size, lack of comparator, and multiple hair loss disorders.	Hypertrichosis - 22 Urticaria - 1 Parasthesia - 1 Ankle edema - 1 Palpitation - 2 Hypotensive symptoms - 4	1
Ramos et al (2020)	n=52 (F) Group 1: 26 Group 2: 26	FPHL	Randomized, open-label, comparative study.	Group 1: 1 mg oral MX Group 2: 5% topical MX	Once daily	24 weeks	Total hair density), change in terminal hair density, global photographic evaluation (by 3 dermatologists), and Sinclair hair shedding score.	Total hair density: Increased by 12% in Group 1and 7.2% in Group 2. Global photograph: Group 1: slightly impaired = 1, no change = 7, slightly improved = 16, and greatly improved = 2. Group 2: slightly impaired = 2, no change = 12, slightly improved = 11, and greatly improved = 1. Hair Shedding: Group 1: reduced from 5 - 3. Group 2: stayed the same (from 4 to 4).	Oral MX showed superior performance to topical MX in the majority of outcomes. Oral MX can be considered an option for FPHL patients with poor compliance or who cannot tolerate topical minoxidil.	Open-label, small sample size, lack of placebo group.	Group 1: Edema of limbs =1, Hypertrichosis = 7. Group 2: Hypertrichosis = 1.	2
Perera and Sinclair (2017)	n=36 (F)	AGA and/or TE	Retrospective	0.25 - 2.5 mg oral MX	Once daily	52 weeks	Change in hair shedding scores (HSS). Patient improvement of trichodynia, changes in blood pressure, and adverse events.	Mean baseline score = 5.64. After 6 months of treatment there was a reduction in mean HSS by 1.7 (p<0.001), and after12 months there was a reduction by 2.58 (p<0.001). Five women with trichodynia at baseline noted improvement or resolution within 3 months.	Once-daily oral MX appears to reduce hair shedding in Chronic TE. The treatment was generally well-tolerated, with mild adverse events.	Retrospective, non-standardized dose, small study size.	Postural dizziness that resolved with continued treatment = 2 Ankle edema = 1 Facial hypertrichosis = 13	1

Topical Minoxidil

Oral Minoxidil

Topical

Oral

Evidence Quality

97%

Regrowth Potential

Long-Term Viability

Key Information

Free Resources

What Is Minoxidil?

How Does Minoxidil Work?

What You Should Know

Evidence Quality

63%

Regrowth Potential

Long-Term Viability

Key Information

Free Resources

What Is Minoxidil?

How Does Minoxidil Work?

What You Should Know

Articles

Genetic Tests: A Breakthrough for Personalized Hair Loss Treatments?

PTGES2: Can This Gene Predict Regrowth from Minoxidil?

SULT1A1: Can This Gene Predict Hair Regrowth From Minoxidil? | The Evidence

Is Hair Loss Treatment Lifelong? Here’s What The Data Show.

Regrowth from Minoxidil: How Much Should I Expect?

How Does Minoxidil Work? 3 Hypotheses + Debates

I Am Experiencing Side Effects From Topical Minoxidil. What Should I Do?

Hims vs Keeps vs Roman: Which Hair Growth Subscription Service Wins?

How Long After Stopping Minoxidil Before We Lose Our Hair Gains?

Three Ways to Improve Minoxidil Results

Why Most Hair Loss Topicals Fail To Regrow Hair

Articles

Genetic Tests: A Breakthrough for Personalized Hair Loss Treatments?

PTGES2: Can This Gene Predict Regrowth from Minoxidil?

SULT1A1: Can This Gene Predict Hair Regrowth From Minoxidil? | The Evidence

Is Hair Loss Treatment Lifelong? Here’s What The Data Show.

Regrowth from Minoxidil: How Much Should I Expect?

How Does Minoxidil Work? 3 Hypotheses + Debates

Hims vs Keeps vs Roman: Which Hair Growth Subscription Service Wins?

How Long After Stopping Minoxidil Before We Lose Our Hair Gains?

Three Ways to Improve Minoxidil Results

Oral Minoxidil For Female Hair Loss: How To Avoid Hypertrichosis (Unwanted Body Hair Growth)

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

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