Topical minoxidil vs Oral Minoxidil: which works better?

Should I use topical or oral minoxidil?

 
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in the use of topical and oral minoxidil.

Question

Does oral minoxidil work better than topical minoxidil?

Answer

Thanks for the question. Super duper high dose oral minoxdiil works better than super mini low concentration minoxidil. Everything else lies somewhere in the middle.

For males, 5 mg oral minoxidil is much more likely to help than once daily application of 5 % minoxidil. It also has way way more side effects. This is not a yes or no answer.

For females, 2.5 mg oral minoxidil is much more likely to help than once daily application of 2 % minoxidil. It also has way way more side effects. This is not a yes or no answer.

In general, 5 % minoxidil once daily in women seems to be fairly similar to 1 mg oral minoxidil. This is based on some very nice work by Ramos and colleagues in 2020. In males, it’s not so clear, although 5 % minoxidil twice daily is probably somewhat similar to 1.25 mg. 2.5 mg dosing in males is probably superior to 5 % twice daily but good studies have yet to really be done.

All in all, topical minoxidil can be similarly effective compared to oral minoxidil in some patients. But this is assuming we are talking about standard dosing. If we increase the dose of oral minoxidil, we increase the chances that oral minoxidil works better than topical minoxidil for the patient we are talking about and we also increase the chances of side effects.

0.000000000000001 % minoxidil is not as effective as 5 % oral minoxidil.

5 % minoxidil is more effective than 0.00000000001 mg oral minoxidil.

Context is everything in these discussions.

REFERENCE

Ramos PM et al. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. .J Am Acad Dermatol. 2020 Jan;82(1):252-253.