2023-05-10 10:25:35
Dermatologists are increasingly prescribing minoxidil (the active ingredient in topical products such as Rogaine) to be taken orally for hair regrowth.
This weekend, I received many messages from friends regarding an article that appeared in the New York Times regarding oral minoxidil, a drug that is not approved by the Food & Drug Administration (FDA) but is often given by doctors for the treatment of hair loss. If I am asked these kinds of questions, as I am only a specialist in grooming without a medical degree, I dare not even imagine the number of inquiries addressed to dermatologists on the subject. So I caught up with one of my most reputable hair doctors, Alan J. Bauman, board-certified hair restoration surgeon at Bauman Medical in Florida, to answer some of the most common questions.
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Before we get into generic minoxidil, let’s quickly review the most common ways to maintain hair – short of a transplant, here are the main medical options for balding men. Any additional effort, such as shampoos and supplements, is unfortunately just a little extra without much value.
How to treat hair loss?
Oral finasteride : it is the generic version of Propecia which is generally prescribed in the form of tablets of 1 mg. It works, but it comes with an important disclaimer: regarding 2-3% of users suffer from low libido or erectile dysfunction. Topical finasteride, which seems to avoid some of the worst sexual side effects, is less common.
topical minoxidil : The generic version of Rogaine is now available over-the-counter and is most commonly administered (as a serum or topical foam) to the area of loss, with extremely favorable success rates. Minoxidil works by increasing blood flow (and therefore nutrient supply) to the hair follicles, which strengthens them and produces stronger, more anchored hair. It also increases the time this hair spends on top of the head and minimizes its “sleeping” time between the fall and regrowth phases. The result ? Stronger hair, at longer intervals. Minoxidil is especially useful for treating even thinning and plaques around the top of the head. The main complaints regarding this topical medication are that it leaves a residue on the scalp or hair.
Both are treatments for thinning hair, not for people who have gone completely bald, a condition too advanced to recover from.
But then, what is minoxidil exactly?
As explained in the article of Times, many doctors have been prescribing an unapproved oral minoxidil tablet for years and find that the ingestion method gives great results, without the irritation of a topical product. Since these tablets are very cheap and available in generic form, it would not be very wise to ask medical authorities to approve their use if you want to continue selling them. This type of custom processing, which does not come from an approved commercial vendor, is called “composition” processing.
“In the United States, pharmacies that do compounding therapy aren’t supposed to advertise the benefits of off-label medications; this is the very reason for FDA approval: to allow commercialization”, explains Dr. Bauman. “Sometimes drug companies try to suppress information if they have an alternative or competing drug coming to market. The effective lifespan of a drug’s benefits is the short period that the drug is protected. by a patent.
Oral minoxidil is not the only option available. For example, Dr. Bauman himself swears by a recipe called Formula 82M, which is a topical combination of tretinoin (a retinol), fluocinolone (a corticosteroid), minoxidil, and finasteride. He has been prescribing it in his clinic with what he calls extraordinary results for almost twenty years, and this without FDA approval.
Is oral minoxidil right for you?
The best advice for anyone wishing to start a hair loss treatment is to consult a dermatologist (or a surgeon specializing in hair restoration like Dr. Bauman). This is also the only way to get oral minoxidil.
Dr. Bauman suggests starting with the proven methods, such as oral finasteride and topical minoxidil. “Then, as we move forward, we can make adjustments and take a more nuanced approach if needed,” he explains.
You should get clear guidance from your doctor regarding the possible risks of these and any other compounded medications, as they have prescribed them many times and know what to expect. “In the event of an overdose of oral minoxidil, you can end up in the hospital,” says Dr. Bauman. “The good news, however, is that this would only happen if you didn’t follow the recommended low dose strategy. The risks are minimal with minoxidil microdosing and if you have a systemic side effect it goes away following a day or two.”
One more thing to know: Oral ingestion of minoxidil can lead to thicker, darker hair growth all over your body – it’s not like the drug knows how to target just the top of your head. On the one hand, you may finally be able to grow a real beard (something Dr. Bauman says he’s seen in some patients), but on the other, you may have to revamp your body grooming routine.
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