The key ingredient in a topical treatment for hair loss worked even better if taken orally.
There are ads everywhere – and they make inflated claims: Special shampoos and treatments will grow hair. Most of these products don’t work, according to dermatologists who specialize in hair loss.
Doctor, a dermatologist at Yale School of Medicine, said there is an endless array of useless hair growth remedies. Even so, he noted, “people continue to seek such hair growth remedies because they are desperate.”
He and other dermatologists say there is a cheap treatment, costing pennies a day, that restores hair in many patients. Known for its hair-loss treatments, minoxidil is used in a very different way. Instead of being applied directly to the scalp, it is prescribed as a pill in very low doses.
The treatment is relatively unknown to most patients and doctors, despite a growing number of dermatologists offering low-dose minoxidil pills. Since it is not FDA-approved for this purpose, it is prescribed off-label – a common practice in dermatology.
Doctor, professor and chair of dermatology at George Washington University, calls us the off-label bandits. Dermatologists are trained to understand how medicines work, which allows them to try drugs off-label. A dermatologist can often tell if a treatment is working. How long does it take for a rash to fade?
The dermatology department chair at Emory University School of Medicine, Doctor, agreed.
According to him, most of what we do is off-label since there is nothing on-label. The standard treatment for many conditions, including skin pigment disorders, skin inflammatory disorders, and relentless itching, is off-label.
The active ingredient in Rogaine, a lotion or foam that is applied to the scalp, was first approved for men in 1988, then for women in 1992, and it is now available as a generic product. Over decades ago, the medicine’s use as a hair-growth treatment was discovered by accident. Despite being prescribed high-dose minoxidil pills to treat high blood pressure, patients often noticed that they grew hair everywhere. A minoxidil lotion – eventually named Rogaine – was created to grow hair on balding heads by its manufacturer.
Some dermatologists, however, say the lotion or foam isn’t particularly effective for some patients, perhaps because they stop taking it. It must reach the scalp itself – and hair gets in the way. Women, especially, stop using it because they dislike leaving sticky residue in their hair.
Rogaine’s current owner, Johnson and Johnson, did not respond to requests for comment.
Others find it doesn’t work for them. To convert minoxidil into an active form, sulfotransferase enzymes must be present in sufficient quantities in hair roots. Orally taken drugs are automatically converted to active forms.
The low-dose pills were not discovered for that reason. The discovery was also made by accident 20 years ago.
In Australia, Doctor, a professor of dermatology at the University of Melbourne, had a patient with female pattern baldness. Her hair on top of her head had thinned, and she hated the way it looked. Unlike most of his patients, Rogaine worked for her, but she developed an allergic rash on her scalp. However, if she stopped taking it, her hair would thin again.
“I was stuck,” Doctor said. One thing we knew was that if a patient had an allergy to a topically applied medicine, giving very low doses orally can help desensitize them.”
In order to accomplish this, Doctor cut minoxidil pills into quarters. The low dose made her hair grow, but did not affect her blood pressure, as the higher dose was intended to do.
Later, he lowered the dose to one-fortieth of a pill and began routinely prescribing it. It is still taken by that first patient.
In Miami in 2015, Doctor reported that low doses of minoxidil induced hair growth in 100 successive women.
In 2017, he published those results, noting that rigorous studies were needed, in which some patients would take minoxidil and others sugar pills. However, that has not happened. Over 10,000 patients have been treated by him, he says.
With aging, more dermatologists are prescribing low-dose pills to patients with male and female pattern hair loss.
Doctor, a dermatologist at Johns Hopkins School of Medicine, said it is just getting popular. We are sharing our success stories more and more at conferences.”
Doctors who do not specialize in hair loss “would not be familiar with oral minoxidil,” except as a rare treatment for high blood pressure with a black box warning that it can cause heart problems. According to her and others, the warning is for much higher doses.
Minoxidil will not help if the hair loss is too severe, according to Doctor. “It won’t work, for example, if a man has a shiny scalp and is mostly bald. The ideal patient is not completely bald, but has lost enough hair that even a casual observer would notice.
However, the use of minoxidil pills for hair loss remains off-label without an FDA approval trial. According to dermatologists, it is likely to remain so.
According to Doctor, oral minoxidil costs pennies a day. In a clinical trial, there is no incentive to spend tens of millions of dollars. There will never, ever be a study like that.”
In some cases, patients taking low-dose minoxidil notice stray hairs growing on their faces and chins. To prevent unwanted hair growth, some dermatologists, including Doctor, have added spironolactone, a blood pressure drug that also blocks certain sex hormones called androgens.
Some dermatologists say over-the-counter remedies are useless and only two FDA-approved hair growth products are available to patients who don’t want to go off-label.
In men with benign enlarged prostates, these include Rogaine and finasteride, a generic medicine used at higher doses. As a hair-loss drug, it is only approved for men. Sexual dysfunction has also been linked to it.
There is also word of mouth about minoxidil pills.
Doctor said he had witnessed miracles.
Brandy Gray, 44, of Monkton, Maryland, was involved in one.
She said she had been losing her hair over time. “Then I started having circular patches without hair.”. “It got worse and worse.”
A dermatologist had given her shampoos and supplements without success. Ultimately, she said her dermatologist told her, “There is nothing else I can do for you.”
Doctor prescribed low-dose minoxidil to her. She had thick, abundant hair ten months later.
She said, “I can part my hair in different ways.”. Wigs are no longer a necessity for her.
This hair loss doesn’t seem to have happened at all.