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Associated Press

The latest trend in treating hair loss may sound familiar – essentially, it is a repurposed drug first popularised in the 1990s.
Back then, TV viewers were inundated with ads for Rogaine, a sticky topical solution that could help treat thinning hair when applied to the scalp.
Now dermatologists are increasingly prescribing the drug, known generically as minoxidil, in low-dose pills to help men and women maintain or regrow hair.
The practice follows several recent studies suggesting the ingredient works as well – or possibly better – when swallowed, rather than applied to hair follicles on the head.

In the United States, telehealth companies are driving new demand by offering a quick, easy way to get a prescription and have the pills shipped directly to customers’ doors.
Minoxidil was developed as a pill to treat high blood pressure in the 1970s. Researchers noticed that some patients taking it experienced increased hair growth as a side effect.
Rogaine was approved by the US Food and Drug Administration (FDA) in 1988, the first drug to win the agency’s endorsement for male pattern baldness. Studies showed that men using the medication, which was applied directly to the scalp, had a slower rate of hair loss and, in some cases, regrew hair.
Starting in 1991, a lower dose was approved for women and the brand was aggressively marketed as an over-the-counter medication on TV and in print.
The drug’s ability to slow hair loss is probably related to its effect on blood circulation, according to experts.

“By increasing blood flow to the scalp it signals hairs to stay in their growth phase for longer,” said Dr Adam Friedman, chair of dermatology at George Washington University. “We’re trying to keep those hairs in that growth phase as long as possible.”
A recent consensus paper by more than 40 US and international dermatologists concluded that minoxidil pills are effective and often more convenient and affordable than the liquid formulation.
Patients prefer the pill
There is little research comparing the two forms of minoxidil, but many dermatologists believe the drug works better as a pill.
At a chemical level, minoxidil is absorbed more directly when digested in the gut than when applied to the hairline. It is also more convenient, with patients taking the pill once a day, instead of applying the liquid once or twice daily using a dropper.
“As you can imagine, that can be rather onerous,” said Dr Susan Taylor of the University of Pennsylvania in the US. “Although people often enthusiastically begin therapy – and even see results – after a while there are many who drop off.”
Not a single patient has complained to me about the cost of this medication, which is extremely rare
Dr Luiz Garza, Johns Hopkins University
The doses prescribed for oral use are also very low. Dermatologists often direct men to take one half of the lowest-dose pill; women may only need a quarter of a pill.
Those low doses can also reduce the chances of side effects, which can include dizziness, rapid heartbeat and swollen legs. The drug is not recommended for people with a history of heart issues or who are pregnant or breastfeeding.
The only other FDA-approved medication for hair loss is finasteride, sold under the brand name Propecia, a drug that blocks a by-product of testosterone that triggers hair loss in men.
That drug is generally considered more effective than minoxidil, but it can occasionally cause troubling sexual side effects, including erectile dysfunction. For optimal results, some dermatologists prescribe the two drugs in combination.
Why aren’t minoxidil pills FDA-approved for hair loss? In short, because there’s very little money to be made.

Minoxidil’s patent has expired and it is now available as a low-cost generic medication. That means drug makers have little financial incentive to spend millions on the new studies that would be needed to win FDA approval for hair loss.
“For a drug like oral minoxidil – which is as old as dirt at this point – there are no reasons to do that,” said Friedman. Like other dermatologists, Friedman gives hair-loss patients a prescription for the pills intended to treat blood pressure, a practice known as off-label prescribing.
The upside for patients is that minoxidil is extremely affordable, with some pharmacies offering a month’s supply for less than US$5 (HK$39).
“Not a single patient has complained to me about the cost of this medication, which is extremely rare,” said Dr Luiz Garza of Johns Hopkins University.
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Minoxidil, once applied topically to treat hair loss, now comes in pill form. Photo: Shutterstock

A 1970s blood pressure drug was repurposed in the 1990s as a topical hair loss solution. A recent study shows taking minoxidil as a pill is more effective and convenient. Photo: Shutterstock

Minoxidil is absorbed more directly when digested in the gut than when applied to the hairline. It is also more convenient to take the pill form. Photo: Shutterstock

Minoxidil increases blood flow to the scalp, signalling hairs to stay in their growth phase for longer, says Dr Adam Friedman, chair of dermatology at George Washington University. Photo: George Washington University

Minoxidil’s patent has expired and it is available as a low-cost generic medication. Photo: Shutterstock

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Lifestyle

Health & Wellness

Health

Fashion & Beauty

Hair loss solution minoxidil in the 1990s was a sticky topical solution applied to the scalp. Now you can take it orally. It may work better


Hair loss solution minoxidil in the 1990s was a sticky topical solution applied to the scalp. Now you can take it orally. It may work better.


Beauty

Medicine

How to age well