Low dose oral minoxidil - Share your story or opinions

[Westview]

Ran into this article today.  Very interesting.

It appears very low doses of oral minoxidil works MUCH better than topical minoxidil.

Has anybody tried this?? Or do you know of anyone who has tried this??

If you have any other information on this, please post ITT.

I want to know if it works as well on women as it does on men

 

An Old Medicine Grows New Hair for Pennies a Day, Doctors Say

Dermatologists who specialize in hair loss say that the key ingredient in a topical treatment worked even better when taken orally at a low dose.

The ads are everywhere — and so are the inflated claims: Special shampoos and treatments, sometimes costing thousands of dollars, will make hair grow. But many dermatologists who specialize in hair loss say that most of these products don’t work.

“There is an endless array of useless hair growth remedies,” often at “significant cost,” said Dr. Brett King, a dermatologist at Yale School of Medicine. Yet, he added, “because people are desperate, such hair growth remedies continue to abound.”

But there is a cheap treatment, he and other dermatologists say, costing pennies a day, that restores hair in many patients. It is minoxidil, an old and well-known hair-loss treatment drug used in a very different way. Rather than being applied directly to the scalp, it is being prescribed in very low-dose pills.

Although a growing group of dermatologists is offering low-dose minoxidil pills, the treatment remains relatively unknown to most patients and many doctors. It has not been approved by the Food and Drug Administration for this purpose and so is prescribed off-label — a common practice in dermatology.

“I call us the off-label bandits — a title I am proud to bear,” said Dr. Adam Friedman, professor and chair of dermatology at George Washington University. He explained that dermatologists have been trained to understand how medicines work, which allows them to try drugs off-label. In dermatology, it is often clear if a treatment is helping. Does a rash fade, or not?

Dr. Robert Swerlick, professor and chair of the dermatology department at Emory University School of Medicine, agreed.

“I tell people most things we do are off-label because there is nothing on-label,” he said. He provided a long list of conditions, including skin pigment disorders, skin inflammatory disorders and relentless itching, for which the standard treatments are off-label.

Minoxidil, the active ingredient in Rogaine, a lotion or foam that is rubbed on the scalp, was first approved for men in 1988, then women in 1992, and it is now generic. The medicine’s use as a hair-growth treatment was discovered by accident decades ago. High-dose minoxidil pills were being used to treat high blood pressure, but patients often noticed that the pills prompted hair growth all over their bodies. So its manufacturer developed a minoxidil lotion — eventually named Rogaine — and got it approved to grow hair on balding heads.

But dermatologists say the lotion or foam is not particularly effective for some patients, perhaps because they stop taking it. It has to get on the scalp itself — and hair gets in the way. Many, especially women, stop using it because they dislike leaving the sticky substance in their hair.

Johnson and Johnson, the current owner of Rogaine, did not respond to requests for comment.

Others find it simply does not work for them. Minoxidil has to be converted to an active form by sulfotransferase enzymes that may or may not be present in sufficient quantities in hair roots. When the drug is taken orally, it is automatically converted to an active form.

But that was not the reason the low-dose pills were discovered. Instead, the discovery occurred also by accident 20 years ago.

Dr. Rodney Sinclair, a professor of dermatology at the University of Melbourne in Australia, had a patient with female pattern baldness. The hair on top of her head had thinned, and she hated the way it looked. Unlike what happened with most of his patients, Rogaine worked for her, but she developed an allergic rash on her scalp from the drug. Yet if she stopped taking it, her hair would thin again.

“So I was stuck,” Dr. Sinclair said. “The patient was very motivated, and the one thing we knew was that if a patient has an allergy to a topically applied medicine, one way to desensitize is to give very low doses orally.”

To do that, Dr. Sinclair tried cutting minoxidil pills into quarters. To his surprise, the low dose made her hair grow but did not affect her blood pressure, the original purpose of the higher-dose drug.

He subsequently lowered the dose more and more until he got down to effective doses of one-fortieth of a pill and began routinely prescribing the drug. That first patient still takes it.

At a meeting in Miami in 2015, Dr. Sinclair reported that low doses of minoxidil prompted hair growth in 100 successive women.

He published those results in 2017, noting that rigorous studies were needed, in which some patients would be randomly assigned to take minoxidil and others a sugar pill. But that has not happened. He says he has now treated more than 10,000 patients.

Recently, a rising number of hair-loss dermatologists have been giving the low-dose pills to patients with male and female pattern hair loss, a normal occurrence with age.

“It is just starting to see a surge in popularity,” said Dr. Crystal Aguh, a dermatologist at Johns Hopkins School of Medicine. “More and more at conferences, we are sharing our success stories.”

Doctors who do not specialize in hair loss, she added, “would not be familiar with oral minoxidil,” except as a rarely used treatment for high blood pressure that comes with a black box warning that it can cause heart problems. But, she and others say, the warning is for much higher doses.

If hair loss is too severe, minoxidil will not help, Dr. Aguh warned. “It will not work, for example, if a man is mostly bald, with a shiny scalp. There is nothing to restore.” She added that the ideal patient is not completely bald but has lost enough hair that even a casual observer would notice.

Without a rigorous trial leading to F.D.A. approval, though, the use of minoxidil pills for hair loss remains off-label. And, dermatologists say, it is likely to remain so.

“Oral minoxidil costs pennies a day,” Dr. King said. “There is no incentive to spend tens of millions of dollars to test it in a clinical trial. That study truly is never, ever going to be done.”

Some patients taking low-dose minoxidil, though, notice stray hairs growing on their faces and chins. So some dermatologists, including Dr. Sinclair, have added another drug — very low doses of spironolactone, a blood pressure drug that also blocks certain sex hormones called androgens — to try to prevent unwanted hair growth.

Patients who do not want to go the off-label route are left with what some dermatologists say are useless over-the-counter remedies or one of two F.D.A.-approved products for hair growth.

They include Rogaine and finasteride, a generic medicine used at higher doses in men to treat a benign enlarged prostate. As a hair-loss drug, it is approved for men only. It has also been linked to sexual dysfunction.

Then, there is the word of mouth about minoxidil in pill form.

“I’ve seen miracles happen,” Dr. Aguh said.

One involved Brandy Gray, 44, who lives in Monkton, Md.

“I had been losing my hair over time,” she said. “Then I starting having circular patches” with no hair. “They got worse and worse.”

She had seen another dermatologist who gave her shampoos and supplements, to no avail. Finally, she said her dermatologist told her, “There is nothing left I can try for you, nothing more I can do.”

She went to Dr. Aguh who gave her low-dose minoxidil. Ten months later, her hair was thick and abundant.

“I can part my hair in different ways,” she said. “I don’t wear wigs any more.”

It is as though that hair loss never happened.

Edited August 25, 2022 by Westview

[BurnieBurns]

tried 1mg, felt dizzy and faint so had to stop

[Westview]

26 minutes ago, BurnieBurns said:

tried 1mg, felt dizzy and faint so had to stop

What dosage did you take??  The article talks about 1/40th of a regular dose.

So around 250 micrograms if you're talking about a standard 10mg tablet

[BurnieBurns]

2 minutes ago, Westview said:

What dosage did you take??  The article talks about 1/40th of a regular dose.

So around 250 micrograms if you're talking about a standard 10mg tablet

as I said, 1mg. I don't know what the 'regular dose; they refer in this article is

[Westview]

8 minutes ago, BurnieBurns said:

as I said, 1mg. I don't know what the 'regular dose; they refer in this article is

My bad, I missed the 1mg part of your post.  So even 1mg caused a drop in your blood pressure then??

Wow, thats interesting.  I wonder what 250mcg might do though.  Or even less than that

[civic]

From what i understand, oral minox does not regrow hair , rather, keeps existing hair longer in non sleep phase, possibly also making it look denser. Inmo, i would not risk taking it, as it does not adress the root cause, eventualy nature will take its course sooner or later, & that hair will go to sleep-) In regards to volume, there are  otc gels that can make hair look denser without sides -))

Edited August 25, 2022 by civic

[ciaus]

If you use the forum search oral minoxidil has been talked about quite a bit in recent years. Someone already started a topic on this article a few days ago linked below. 

 

 

[GoliGoliGoli]

22 minutes ago, civic said:

From what i understand, oral minox does not regrow hair , rather, keeps existing hair longer in non sleep phase, possibly also making it look denser. Inmo, i would not risk taking it, as it does not adress the root cause, eventualy nature will take its course sooner or later, & that hair will go to sleep-) In regards to volume, there are  otc gels that can make hair look denser without sides -))

Are you saying oral minox does not regrow hair whereas topical does regrow hair? Or are you saying both simply keep hair in non-sleep phase longer?  I can say with topical I seem to be regrowing especially on the hairline. This stands in line with people who are able to grow beards out of basically nowhere as well. 

As far as it not addressing the root cause, I mean maybe that's true but a huge number of people continue losing on Fin/Dut as well. So mileage will vary person to person, but neither of them really "halts" hair loss. 

[Mike10]

It works better than the topical with potentially more serious sides but there is still the unknown.

Will it work long term? We know the topical generally does not. 

And what will happen if you drop oral minox? From the topical, we know that you could be worse off as if you never started minox.  

At this stage, I am not convinced oral minox does better than the topical on both of these points

Edited August 25, 2022 by Mike10

[MissMyLongHair]

I made a thread on this about my experience. I've taken it for over 7 months now, around 4 months on 2.5mg and then 3 months on 5mg. Seen minor improvement in density on my only bald patch, however hair all over my scalp feels healthier and thicker. I experienced low blood pressure and high heart rate on 5mg so am now splitting it into two doses, 2.5mg twice a day. 2.5-5mg is the optimal dose for men, according to most doctors.

[GoliGoliGoli]

14 minutes ago, Mike10 said:

It works better than the topical with potentially more serious sides but there is still the unknown.

Will it work long term? We know the topical generally does not. 

And what will happen if you drop oral minox? From the topical, we know that you could be worse off as if you never started minox.  

At this stage, I am not convinced oral minox does better than the topical on both of these points

1. Honestly, I haven't seen anything that substantially proves oral works better than topical. Maybe in high enough doses, but I wouldn't ever consider taking oral minox at 2.5 mg. 

2. Nothing works long term for hair loss tbh. Maybe some lucky people get on Fin/Dut and completely stop their hair loss, but that seems to be the exception not the rule? 

3. I don't think it's true that Minox leaves you worse off. It may induce a shed when you get off that makes you appear worse off as the Minox hairs fade, but you would've been in that situation anyways. Kevin Mann (Who I normally dislike) did a video on this referencing a peer reviewed paper.

4. I agree here, I'm not 100% convinced oral is better and certainly comes with higher risks. 

[sunsurfhair]

I posted this article the other day. There are big benefits to oral vs topical and the article covers them in great deal. Konior uses oral minox (max dose of 5) just to give you an example of who believes in it. Several other top HT docs are using it and the dermatologists are really on board. The oral form has much more capability and <5mg a day has an extremely low chance of any side effects. This does not operate like the topical. My friend and I have been on 2.5mg for many months, and have had zero sides at all. In fact, I even had an EKG and labs done and everything looks beautiful. 

Edited August 25, 2022 by sunsurfhair

[asterix0]

I would expect oral to work better than topical, but the risk of side effects is higher.

Is it worth it? For me personally, no, but I am also reluctant to try dutasteride, so my risk tolerance is probably lower than many others here.

[civic]

32 minutes ago, GoliGoliGoli said:

Are you saying oral minox does not regrow hair whereas topical does regrow hair? Or are you saying both simply keep hair in non-sleep phase longer?  I can say with topical I seem to be regrowing especially on the hairline. This stands in line with people who are able to grow beards out of basically nowhere as well. 

As far as it not addressing the root cause, I mean maybe that's true but a huge number of people continue losing on Fin/Dut as well. So mileage will vary person to person, but neither of them really "halts" hair loss. 

Agree! Fin/dut are also not guranteed to work for everyone. I was on fin a decade ago, worked really well for 2 yrs but eventualy stopped working.

Edited August 25, 2022 by civic

[sunsurfhair]

Just now, asterix0 said:

I would expect oral to work better than topical, but the risk of side effects is higher.

Is it worth it? For me personally, no, but I am also reluctant to try dutasteride, so my risk tolerance is probably lower than many others here.

As someone who got slammed with oral fin, I can tell you right now the side effects of oral minox are massively less. The sides that are scary were in MUCH higher doses - 50-100mg a day for blood pressure, not LDOM (low dose oral minox). That being said, people can experience sides and everyone should watch closely as they start the medicine. I am also much more pro getting it from a retail pharmacy and prescription vs ordering on a website since you never know what you will get with these online pharmacies. Watch for sides, follow with your doc for labs and heart monitoring. 

[Mike10]

8 minutes ago, GoliGoliGoli said:

1. Honestly, I haven't seen anything that substantially proves oral works better than topical. Maybe in high enough doses, but I wouldn't ever consider taking oral minox at 2.5 mg. 

2. Nothing works long term for hair loss tbh. Maybe some lucky people get on Fin/Dut and completely stop their hair loss, but that seems to be the exception not the rule? 

3. I don't think it's true that Minox leaves you worse off. It may induce a shed when you get off that makes you appear worse off as the Minox hairs fade, but you would've been in that situation anyways. Kevin Mann (Who I normally dislike) did a video on this referencing a peer reviewed paper.

4. I agree here, I'm not 100% convinced oral is better and certainly comes with higher risks. 

I guess the jury is till out there for oral minox, a lot of open question. I can see why you would not take this stuff.

As for Propecia in the long tem, for some lucky it continues to maintain.  For others it works to a lesser effect or it stops working or sides may appear. It is difficult to assess the proportions. 

[sunsurfhair]

Even after decades of use, we still do not completely understand how minoxidil improves alopecia. According to Sharma et al, vasodilatory effects are propagated by upregulation of vascular endothelial growth factor (VEGF), increasing cutaneous blood flow with resultant increase in oxygen and growth factor delivery to the hair follicle. Additionally, minoxidil leads to hair follicle potassium channel activation, prolonging anagen and shortening the telogen phase. Minoxidil may also have T-cell immunomodulatory effects, causing suppression of T-cells that may partially explain its use in autoimmune alopecias. (4) Applied on the scalp, TM is converted to its active form, minoxidil sulfate, by sulfotransferase enzymes located in the follicular outer root sheath. Variations in sulfotransferase activity might clarify why some patients fare better than others with TM. It has been suggested that oral minoxidil may also be converted by liver and platelet sulfotransferase, thereby reaching a higher follicular accumulation. (5)

Study link: https://www.aad.org/dw/dw-insights-and-inquiries/archive/2022/low-dose-oral-minoxidil-alopecia

[Westview]

It didnt work for this guy

https://ashleyandmartin.com.au/why-low-dose-oral-minoxidil-treatments-for-baldness-should-be-avoided/

 

[thetdog666]

1 hour ago, Westview said:

It didnt work for this guy

https://ashleyandmartin.com.au/why-low-dose-oral-minoxidil-treatments-for-baldness-should-be-avoided/

 

I dont believe anything on that page. Trying to sell snake oil 

[MissMyLongHair]

2 hours ago, Westview said:

It didnt work for this guy

https://ashleyandmartin.com.au/why-low-dose-oral-minoxidil-treatments-for-baldness-should-be-avoided/

 

Lol ashley and martin, don't they rob people blind for basic fin and min? The Australian version of the Belgravia centre.

[Whipaway]

Take a look at my thread I posted a while back … 

[Whipaway]

Take a look at my thread I posted a while back … 

 

[uk005801]

I’ve been on minoxidil for 4 months ish in the lead up to my bisanga opp in July no side effects and definitely had improvements in hair quality pre transplant. Hoping it has helped me not get any real donor shock loss and aid in growth of the new hair 

[sunsurfhair]

30 minutes ago, MissMyLongHair said:

Lol ashley and martin, don't they rob people blind for basic fin and min? The Australian version of the Belgravia centre.

Can’t stand those two !!! Horrid advice always. 

[BurnieBurns]

8 hours ago, Westview said:

My bad, I missed the 1mg part of your post.  So even 1mg caused a drop in your blood pressure then??

Wow, thats interesting.  I wonder what 250mcg might do though.  Or even less than that

Yeah I can't say 100% it dropped blood pressure as I didn't get readings but I definitely felt the symptoms.. Wondering whether to try 0.25mg but some say that's worse that topical in terms of efficacy