Topical vs Oral Minoxidil: Which do you like?

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

What is your opinion on use of topical vs oral minoxidil as montherapy?

Answer

Thanks for the question.

Both good options to consider. They’ll are not options for everyone, but they are definitely on the table for discussion with your doctors. If you are lucky to be one of the low proportion who get great results with topical minoxidil, I often say go with that. But some just don’t get such good results - and oral can give better results for some people (but certainly not all).

We tend to forget that oral minoxidil has way way more side effects so be sure to review all with your doctor and make sure it’s right for you.

Here are some of the side effects of oral minoxidil that everyone person needs to be aware of.

The frequency of these side effects is approximately shown in the prior studies shown in the table below:

As far as monotherapy, some people have mild AGA that stays mild. A single treatment is sometimes all that is needed. Some have some pretty strong genetics driving AGA and just can’t completely stop it long term with a single treatment. Another treatment is needed also.

Again be sure to review with your doctors.

I make my decision on topical vs oral based on the precise details of the patient and their health and medical history. A 67 year old female with heart failure and 2 prior heart attacks can’t use either. A 32 year old trying to conceive with her second child can’t use either. A 42 year old male who wants a short term option before having a hair transplant at age 44 shouldn’t use either.