WASHINGTON — Treating hair loss with a familiar approach has been gaining traction, as dermatologists reintroduce a medication first popularized in the 1990s. Known generically as minoxidil, this drug was initially marketed as a topical solution under the brand name Rogaine, widely advertised on television as an effective way to combat thinning hair. Today, the same drug is being prescribed in low-dose pill form, offering an alternative method for both men and women to maintain or regrow hair.
Recent studies have suggested that ingesting minoxidil may be equally, if not more, effective than applying it directly to the scalp. Furthermore, telehealth companies are making it easier for consumers to acquire prescriptions by offering convenient online services that ship the pills directly to customers’ homes.
Originally developed in the 1970s as a blood pressure medication, minoxidil was found to promote hair growth as a side effect in some patients. In 1988, it became the first drug approved by the Food and Drug Administration (FDA) for treating male pattern baldness. For women, a lower dose became available for over-the-counter purchase in 1991, accompanied by an aggressive marketing campaign.
Experts explain that the drug’s ability to slow or reverse hair loss likely stems from its impact on circulation, boosting blood flow to the scalp and encouraging hair to remain in its growth phase longer. A consensus paper from over 40 dermatologists worldwide has concluded that minoxidil pills are not just effective but also more convenient and affordable compared to the liquid version.
Despite limited research comparing the two forms, many dermatologists assert that the oral form works more effectively. Minoxidil is absorbed directly when digested, making the pill form more convenient than the liquid, which requires frequent application. As Dr. Susan Taylor from the University of Pennsylvania notes, “Although people often start therapy with enthusiasm, many discontinue after a while.”
Prescribed doses for oral use are very low, reducing potential side effects such as dizziness, a rapid heartbeat, and swelling. However, minoxidil is not recommended for individuals with heart conditions or women who are pregnant or breastfeeding.
Aside from minoxidil, the only other FDA-approved medication for hair loss is finasteride (Propecia), which works by blocking testosterone byproducts responsible for hair loss. Although considered more effective at times, finasteride can cause troubling side effects. Some dermatologists may prescribe both medications for the best results.
One might wonder why minoxidil pills aren’t FDA-approved for hair loss. The simple answer is financial. With its patent expired, minoxidil is a low-cost generic. As Dr. Adam Friedman points out, there’s no financial motivation for drugmakers to pursue expensive new studies for FDA approval.
Despite its unapproved status, minoxidil remains very affordable, with patients usually spending under $5 on a month’s supply at some pharmacies. “Not a single patient has complained about the cost,” said Dr. Luiz Garza of Johns Hopkins University.
Most prescriptions for minoxidil come from dermatologists, who often prescribe older drugs off-label for various conditions. However, a survey found that 80% of U.S. dermatologists reported prescribing oral minoxidil, although the limited number of dermatologists could make access challenging for some.
Telehealth platforms like Hims and Ro aim to bridge this gap by offering easy access to medications via online consultations. These companies provide fast prescription approvals, although they ensure that patients with potential health risks are referred to in-person visits. Still, many dermatologists recommend consultations in person to ensure comprehensive evaluations.
