EFFICACY AND SAFETY OF LOW-DOSE ORAL MINOXIDIL IN THE TREATMENT OF ANDROGENETIC ALOPECIA – A LITERATURE REVIEW
Abstract
Introduction: Androgenetic alopecia (AGA) is a chronic progressive form of hair loss affecting a significant portion of the adult population. Although topical minoxidil has a proven efficacy, it is often associated with low adherence due to adverse effects and the inconvenience of use. Increasing attention is being paid to low-dose oral minoxidil (LDOM), which may represent a therapeutic alternative with a favorable safety profile.
Purpose of The Work: The aim of this study was to assess the efficacy and safety of low-dose oral minoxidil (≤5 mg/day) in the treatment of androgenetic alopecia based on current clinical trial data.
Material and Methods: A narrative literature review was conducted, including studies published in English between 2019 and 2024, concerning the efficacy and safety in patients with AGA. A total of 9 publications meeting the inclusion criteria were analyzed.
Results: The analyzed studies demonstrated that LDOM increases both the number and diameter of hair in patients – in both men and women. The best results were observed at doses of 1-5 mg/day, although even very low doses (0.25 mg/day) yielded measurable effects. Adverse events were generally mild – most commonly hypertrichosis and cardiovascular symptoms (e.g., tachycardia), with incidence increasing with dose. Serious complications were rare and occurred primarily in patients with pre-existing heart disease.
Conclusion: Low-dose oral minoxidil is an effective and well-tolerated treatment option for AGA. Further studies are needed to standarize dosing and assess the long-term safety of the therapy.
References
Wirya, C. T., Wu, W., & Wu, K. (2017). Classification of male-pattern hair loss. International Journal of Trichology, 9(3), 95–100. https://doi.org/10.4103/ijt.ijt_46_17
Bertoli, M. J., Sadoughifar, R., Schwartz, R. A., Lotti, T. M., & Janniger, C. K. (2020). Female pattern hair loss: A comprehensive review. Dermatologic Therapy, 33(6), e14055. https://doi.org/10.1111/dth.14055
Cash, T. F. (1999). The psychosocial consequences of androgenetic alopecia: A review of the research literature. British Journal of Dermatology, 141(3), 398–405. https://doi.org/10.1046/j.1365-2133.1999.03030.x
Messenger, A. G., & Rundegren, J. (2004). Minoxidil: Mechanisms of action on hair growth. British Journal of Dermatology, 150(2), 186–194. https://doi.org/10.1111/j.1365-2133.2004.05785.x
Hunt, N., & McHale, S. (2005). The psychological impact of alopecia. BMJ, 331(7522), 951–953. https://doi.org/10.1136/bmj.331.7522.951
Ramírez-Marín, H. A., & Tosti, A. (2022). Role of oral minoxidil in patterned hair loss. Indian Dermatology Online Journal, 13(6), 729–733. https://doi.org/doi: 10.4103/idoj.idoj_246_22
Jimenez-Cauhe, J., Saceda-Corralo, D., Rodrigues-Barata, R., et al. (2020). Safety of low-dose oral minoxidil treatment for hair loss: A systematic review and pooled-analysis of individual patient data. Dermatologic Therapy, 33(6), e14106. https://doi.org/10.1111/dth.14106
Rodrigues-Barata, R., Moreno-Arrones, O. M., Saceda-Corralo, D., Jiménez-Cauhé, J., Ortega-Quijano, D., Fernández-Nieto, D., Jaén-Olasolo, P., & Vaño-Galvan, S. (2020). Low-dose oral minoxidil for female pattern hair loss: A unicenter descriptive study of 148 women. Skin Appendage Disorders, 6(3), 175–176. https://doi.org/10.1159/000505820
Gupta, A. K., Talukder, M., Shemar, A., Piraccini, B. M., & Tosti, A. (2023). Low-dose oral minoxidil for alopecia: A comprehensive review. Skin Appendage Disorders, 9(6), 423–437. https://doi.org/10.1159/000531890
Ellis, J., Sinclair, R., & Harrap, S. B. (2002). Androgenetic alopecia: Pathogenesis and potential for therapy. Expert Reviews in Molecular Medicine, 4(22), 1–11. https://doi.org/10.1017/S1462399402005112
Kaufman, K. D., Olsen, E. A., Whiting, D., Savin, R., DeVillez, R., Bergfeld, W., Price, V. H., Van Neste, D., Roberts, J. L., Hordinsky, M., Shapiro, J., Binkowitz, B., & Gormley, G. J. (1998). Finasteride in the treatment of men with androgenetic alopecia. Journal of the American Academy of Dermatology, 39(4 Pt 1), 578–589. https://doi.org/10.1016/s0190-9622(98)70007-6
Ding, Y., Wang, C., Bi, L., Du, Y., Lu, C., Zhao, M., & Fan, W. (2024). Dutasteride for the treatment of androgenetic alopecia: An updated review. Dermatology, 240(5–6), 833–843. https://doi.org/10.1159/000541395
Sinclair, R. D. (2018). Female pattern hair loss: A pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. International Journal of Dermatology, 57(1), 104–109. https://doi.org/10.1111/ijd.13838
Gentile, P., Garcovich, S., Bielli, A., Scioli, M. G., Orlandi, A., & Cervelli, V. (2015). The effect of platelet-rich plasma in hair regrowth: A randomized placebo-controlled trial. Stem Cells Translational Medicine, 4(11), 1317–1323. https://doi.org/10.5966/sctm.2015-0107
Jimenez, F., Alam, M., Vogel, J. E., & Avram, M. (2021). Hair transplantation: Basic overview. Journal of the American Academy of Dermatology, 85(4), 803–814. https://doi.org/10.1016/j.jaad.2021.03.124
Higgins, C. A., Chen, J. C., Cerise, J. E., Jahoda, C. A., & Christiano, A. M. (2013). Microenvironmental reprogramming by three-dimensional culture enables dermal papilla cells to induce de novo human hair-follicle growth. Proceedings of the National Academy of Sciences, 110(49), 19679–19688. https://doi.org/10.1073/pnas.1309970110
Garza, L. A., Yang, C. C., Zhao, T., Blatt, H. B., Lee, M., He, H., Stanton, D. C., Carrasco, L., Spiegel, J. H., Tobias, J. W., & Cotsarelis, G. (2011). Bald scalp in men with androgenetic alopecia retains hair follicle stem cells but lacks CD200-rich and CD34-positive hair follicle progenitor cells. Journal of Clinical Investigation, 121(2), 613–622. https://doi.org/10.1172/JCI44478
Messenger, A. G., & Rundegren, J. (2004). Minoxidil: Mechanisms of action on hair growth. British Journal of Dermatology, 150(2), 186–194. https://doi.org/10.1111/j.1365-2133.2004.05785.x
Suchonwanit, P., Thammarucha, S., & Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: A review. Drug Design, Development and Therapy, 13, 2777–2786. https://doi.org/10.2147/DDDT.S214907
Rossi, A., Cantisani, C., Melis, L., Iorio, A., Scali, E., & Calvieri, S. (2012). Minoxidil use in dermatology, side effects and recent patents. Recent Patents on Inflammation & Allergy Drug Discovery, 6(2), 130–136. https://doi.org/10.2174/187221312800166859
Lachgar, S., Charveron, M., Gall, Y., & Bonafe, J. L. (1998). Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells. British Journal of Dermatology, 138(3), 407–411. https://doi.org/10.1046/j.1365-2133.1998.02115.x
Boyera, N., Galey, I., & Bernard, B. A. (1997). Biphasic effects of minoxidil on the proliferation and differentiation of normal human keratinocytes. Skin Pharmacology, 10(4), 206–220. https://doi.org/10.1159/000211506
Han, J. H., Kwon, O. S., Chung, J. H., Cho, K. H., Eun, H. C., & Kim, K. H. (2004). Effect of minoxidil on proliferation and apoptosis in dermal papilla cells of human hair follicle. Journal of Dermatological Science, 34(2), 91–98. https://doi.org/10.1016/j.jdermsci.2004.01.002
Garza, L. A., Liu, Y., Yang, Z., Alagesan, B., Lawson, J. A., Norberg, S. M., Loy, D. E., Zhao, T., Blatt, H. B., Stanton, D. C., Carrasco, L., Ahluwalia, G., Fischer, S. M., FitzGerald, G. A., & Cotsarelis, G. (2012). Prostaglandin D2 inhibits hair growth and is elevated in bald scalp of men with androgenetic alopecia. Science Translational Medicine, 4(126), 126ra34. https://doi.org/10.1126/scitranslmed.3003122
Roberts, J., Desai, N., McCoy, J., & Goren, A. (2014). Sulfotransferase activity and minoxidil. Dermatologic Therapy, 27(4), 252–254. https://doi.org/10.1111/dth.12130
Panchaprateep, R., & Lueangarun, S. (2020). Efficacy and safety of oral minoxidil 5 mg once daily in the treatment of male patients with androgenetic alopecia: An open-label and global photographic assessment. Dermatology and Therapy (Heidelberg), 10(6), 1345–1357. https://doi.org/10.1007/s13555-020-00448-x
Penha, M. A., Miot, H. A., Kasprzak, M., & Müller Ramos, P. (2024). Oral minoxidil vs topical minoxidil for male androgenetic alopecia: A randomized clinical trial. JAMA Dermatology, 160(6), 600–605. https://doi.org/10.1001/jamadermatol.2024.0284
Jimenez-Cauhe, J., Saceda-Corralo, D., Rodrigues-Barata, R., Hermosa-Gelbard, A., Moreno-Arrones, O. M., Fernandez-Nieto, D., & Vaño-Galvan, S. (2019). Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. Journal of the American Academy of Dermatology, 81(2), 648–649. https://doi.org/10.1016/j.jaad.2019.04.054
Nascimento E Silva, M., Ramos, P. M., Silva, M. R., Nascimento E Silva, R., & Barbosa Raposo, N. R. (2022). Randomized clinical trial of low-dose oral minoxidil for the treatment of female pattern hair loss: 0.25 mg versus 1 mg. Journal of the American Academy of Dermatology, 87(2), 396–399. https://doi.org/10.1016/j.jaad.2022.01.017
Vahabi-Amlashi, S., Layegh, P., Kiafar, B., Hoseininezhad, M., Abbaspour, M., Khaniki, S. H., Forouzanfar, M., & Sabeti, V. (2021). A randomized clinical trial on therapeutic effects of 0.25 mg oral minoxidil tablets on treatment of female pattern hair loss. Dermatologic Therapy, 34(6), e15131. https://doi.org/10.1111/dth.15131
Ramos, P. M., Sinclair, R. D., Kasprzak, M., & Miot, H. A. (2020). Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. Journal of the American Academy of Dermatology, 82(1), 252–253. https://doi.org/10.1016/j.jaad.2019.08.060
Vastarella, M., Cantelli, M., Patrì, A., Annunziata, M. C., Nappa, P., & Fabbrocini, G. (2020). Efficacy and safety of oral minoxidil in female androgenetic alopecia. Dermatologic Therapy, 33(6), e14234. https://doi.org/10.1111/dth.14234
Pirmez, R., & Salas-Callo, C. I. (2020). Very-low-dose oral minoxidil in male androgenetic alopecia: A study with quantitative trichoscopic documentation. Journal of the American Academy of Dermatology, 82(1), e21–e22. https://doi.org/10.1016/j.jaad.2019.08.084
Kincaid, C. M., Sharma, A. N., Sargent, B., Gradus-Pizlo, I., Dineen, E. H., & Mesinkovska, N. A. (2024). Evaluation of pericardial effusions in alopecia patients on low-dose oral minoxidil therapy. Journal of Drugs in Dermatology, 23(9), 725–728. https://doi.org/10.36849/JDD.8029
Views:
217
Downloads:
124
Copyright (c) 2025 Filip Kieloch, Agnieszka Fitas, Karol Kanon, Mathias Spitaleri, Wiktor Gąska, Oskar Sienkiel, Julia Głowacka, Wojciech Gąska, Dawid Sewruk, Karolina Dębek-Kalinowska

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.