WASHINGTON — A noteworthy shift is gaining traction in hair loss treatment, with an old pharmaceutical solution making a comeback in a different form. The focus is back on a drug that gained fame in the 1990s, known for its application as Rogaine — a topical solution previously advertised widely for tackling thinning hair, administered directly onto the scalp.
Currently, dermatologists are progressively advocating the use of minoxidil, the drug’s generic name, in the form of low-dose tablets, helping both men and women to either maintain or even regrow their locks. This change is being fueled by recent studies which indicate that the drug might deliver better results when ingested as a pill, rather than being applied to the hair follicles on the scalp. The increasing popularity of this trend is also boosted by telehealth companies offering a straightforward, hassle-free way of obtaining a prescription, with the medications conveniently delivered to people’s doorsteps.
A Historical Perspective on Hair Loss
Minoxidil originally emerged in the medical field during the 1970s as a treatment for high blood pressure. During its application, unforeseen hair growth was observed as a side effect amongst some users. It wasn’t until 1988 that Rogaine obtained FDA approval, marking it as the first sanctioned medication for tackling male pattern baldness. The topical treatment demonstrated a reduction in hair loss rates and, in some instances, facilitated hair regrowth when applied to the scalp.
Following this, in 1991, a lower dose variant was approved for women, with extensive marketing campaigns making it widely known as an over-the-counter solution. The perceived effectiveness of the drug in slowing down hair loss is attributed to its action on enhancing blood circulation, representatives from the dermatology realm suggest.
“By intensifying blood flow to the scalp, it encourages hair strands to remain in their growth phase for an extended period,” states Dr. Adam Friedman, chair of dermatology at George Washington University. “Our objective is essentially to prolong this growth phase as much as possible.”
A recent agreement among over 40 dermatologists from the U.S. and around the globe has verified the effectiveness and convenience of minoxidil pills, deeming them often more favorable and cost-effective compared to the liquid alternative.
Patient Preference
While direct comparisons between the pill and liquid form of minoxidil remain few, many dermatologists hold the belief that the oral option offers superior results.
At the core level, the digestive absorption of minoxidil is considered more efficient than topical application at the hairline. This transformation brings forth a convenient daily routine for patients who can take it once a day orally, as opposed to handling the liquid form once or twice daily with a dropper.
“Understandably, the routine can become burdensome,” says Dr. Susan Taylor from the University of Pennsylvania. “Many start the treatment with excitement — and witness results — but after a while, adherence tends to drop.”
The doses recommended for oral consumption are quite minimal. Men are often instructed to consume half of the lowest-dose pill, while women frequently require only a quarter of a pill. These modest doses tend to diminish the risk of side effects, which may include dizziness, quickened heartbeat, and leg swelling. Individuals with a history of heart conditions or those pregnant or nursing are generally advised against using the drug.
The only other FDA-approved medication for hair loss is finasteride, recognized commercially as Propecia, which works by blocking a testosterone byproduct that contributes to hair loss in men. Although seen as more potent than minoxidil, it may sometimes lead to unwanted sexual side effects, like erectile dysfunction. For superior outcomes, some dermatologists resort to prescribing both medications.
Why Are Minoxidil Pills Not FDA-Approved for Hair Loss?
Simply put, there’s little financial motivation. Minoxidil, having lost patent protection, is now available as a budget-friendly generic medication. This diminishes any incentive for pharmaceutical companies to invest millions in new studies required for obtaining FDA approval for hair loss treatment.
“For a drug like oral minoxidil — which has been around for ages — there really isn’t a compelling reason to pursue approval,” remarked Friedman. Dermatologists like Friedman frequently provide hair-loss sufferers with prescriptions for blood pressure tablets, employing a common practice known as off-label prescribing.
The advantage for patients lies in its affordability, often being available at many pharmacies for under $5 per monthly supply.
“None of my patients have ever complained about the cost of this medication, which is exceptionally rare,” remarked Dr. Luiz Garza from Johns Hopkins University.
The Role of Telehealth Providers
The vast majority of minoxidil hair loss prescriptions are issued by dermatologists, who frequently utilize older drugs off-label for different hair and skin ailments.
A recent survey highlighted that 80% of U.S. dermatologists reported prescribing oral minoxidil. Still, considering the presence of only about 12,000 dermatologists in the U.S., some patients could face difficulties finding a provider.
Telehealth enterprises like Hims and Ro are stepping in to bridge this gap. Their business model provides patients with quick access to desired medications, generally following the completion of a questionnaire about their medical background, current medications, and specific treatment aims. Following this, a health provider reviews and potentially approves a prescription, assuming no issues are raised.
Hims and Ro assure that their health professionals refrain from prescribing minoxidil to patients with complicating health conditions or medications that might adversely interact with the drug. In some scenarios, patients may be redirected for an in-person consultation.
Nonetheless, numerous dermatologists maintain that seeing a healthcare provider in person is crucial. An appointment typically includes a blood pressure measurement, a review of medical history, discusses existing prescriptions, and provides a comprehensive discussion about the drug’s side effects.
“I advise against opting for online services,” states Taylor. “I recommend consulting with a board-certified dermatologist who possesses the requisite training, knowledge of data, and can provide a thorough evaluation.”