Does Oral Minoxidil for Hair Loss Really Work? Dermatologists Explain

When you first notice your hair thinning, it can feel comforting to throw your wallet at the problem. Tingly scalp serums, LED helmets, and expensive supplements can all boost hair’s health in various ways, but the gold standard in growth has always been minoxidil. It’s the drug that powers Rogaine and other topical hair-loss treatments, and it’s been FDA-approved for women since 1991.

But did you know the drug is also available in a prescription-pill form that dermatologists say is not only highly effective (more so than anything topical) but also wildly inexpensive? Seriously: A month’s supply can start as low as $4. “Oral minoxidil has become a game changer for treating hair loss in women, especially when topical treatments aren’t enough,” says Dendy Engelman, a board-certified dermatologist in New York. So why isn’t it more popular? “It’s still considered an off-label use, which makes some patients and even providers hesitant,” she says. “Many people also don’t know about it, or they’re wary of taking a systemic medication for a cosmetic concern—even though side effects at low doses are minimal.”

Before you rush to your dermatologist for a prescription, there are some potential side effects you should consider. Ahead, everything you need to know about oral minoxidil for hair growth, with insight from expert dermatologists and plastic surgeons.

Whether in pill form or topical-foam form, the drug works the same way: “Minoxidil increases blood flow to hair follicles,” says Joshua Korman, a board-certified plastic surgeon and founder of Korman Plastic Surgery in Northern California. “The idea is that lengthening the growth phase in the hair growth cycle will increase hair growth.”

Unlike a lot of popular hair-growth supplements, minoxidil pills are small, need to be taken only once a day, and can cost just a few dollars a month with insurance. “The oral form delivers more consistent absorption and systemic effects than the topical form, which can help stimulate dormant hair follicles more effectively,” says Engelman. “It’s especially helpful for diffuse thinning or genetic hair loss, where the goal is to slow shedding and boost regrowth.”

Oral minoxidil is most dermatologists’ preferred Rx treatment for hair loss. “For women, it has the added benefit over other medications like oral spironolactone of not affecting the menstrual cycle,” says Tracy Evans, a board-certified dermatologist and medical director of Pacific Skin and Cosmetic Dermatology. “It is an easy medication to take, with very few side effects.” She notes that some patients even report fuller and longer eyelashes and brows when taking it, as well as increased body hair (more on that later).

“Topical minoxidil needs activation by an enzyme called sulfotransferase in the scalp after it is applied in order to be effective,” says dermatologist and hair-restoration surgeon Christine M. Shaver at Bernstein Medical Center for Hair Restoration in NYC. “Many people have low amounts of this enzyme or lack it entirely, making the application of minoxidil less effective for hair thickening. Also, many women find it frustrating to apply the topical liquid or foam since it can be difficult to apply and can make the scalp itchy and the hair sticky.”

Plus, foam minoxidil formulas often contain propylene glycol, an alcohol, which dermatologists say can dry the scalp skin and cause flaking. The length of your hair matters too. “The foam topical can be difficult to apply for women with long hair since it can get caught in the hair strands rather than reach the scalp, where it is needed to be effective,” Shaver adds.

Musely The Hair Pill

“Low-dose oral minoxidil (usually 0.25–2.5 mg) is well tolerated, and results often show up within three to six months,” says Engelman. “Oral minoxidil is generally safe when prescribed at low doses, but it’s still an off-label treatment that requires medical oversight.”

The most common side effects include fluid retention, dizziness, or increased facial or body hair, but they tend to be more common with higher doses. “However, side effects of body hair and water retention can often be alleviated when women choose to take a very low dose of spironolactone alongside their oral minoxidil,” advises Shaver. “Oral spironolactone, often prescribed as a 25 mg or 50 mg daily dose, has the benefit of acting as both a weak diuretic and an anti-androgen. The diuretic property of oral spironolactone helps eliminate excess water weight, and the anti-androgenic property limits the thickening effect of male hormones (androgens) on body hair.”

There are, however, some individuals who should absolutely not take it. “It is important to screen new patients wanting to try oral minoxidil for heart arrhythmia, as people who have abnormal EKGs and palpitations from an arrhythmia can find the addition of oral minoxidil to worsen palpitations,” Shaver adds. “For people who have a risk of heart conditions, it is advisable to consult a cardiologist before starting. Women who are pregnant or breastfeeding should not take oral minoxidil since it has not been studied in this population. Also, people with advanced liver or kidney disease should be cleared by their respective doctors before starting.”

“You need to continue to take the medication to see the results,” says Korman. However, it’s not as if your hair will fall out if you skip a pill. “Over time, your hair may return to what it would have been like if you never took the medication,” says Evans. “This may appear as if you are losing hair, but it’s really using the hair you may never have been able to grow without the medication.”

“Combining treatments for hair growth can be very beneficial,” says Korman. “For example, red-light-therapy caps targeting the scalp are very popular. Other oral hair-growth medications are often prescribed with oral minoxidil, including spironolactone and finasteride. Microneedling, combined with topical exosomes and/or platelet-rich plasma injections [PRP], can also be used in conjunction with oral or topical minoxidil.”

There’s another in-office procedure for hair loss you may not have heard about: “My preferred treatment to couple oral minoxidil with is ALMA-TED, an ultrasound-based device that is used to create painless, temporary microchannels in the scalp tissue,” Shaver explains. “A nutrient-rich solution containing growth factors and peptides is then applied on the scalp and eased painlessly down to the follicles using the ultrasound to deliver these nutrients to the follicles, with no discomfort or downtime. I find ALMA-TED to be a great alternative for people who cannot tolerate the blood draws or injections associated with PRP.”

• Joshua Korman, board-certified plastic surgeon and founder of Korman Plastic Surgery, based in Northern California
• Tracy Evans, MD, MPH, board-certified dermatologist and medical director of Pacific Skin and Cosmetic Dermatology
• Christine M. Shaver, MD, FAAD, dermatologist and hair-restoration surgeon at Bernstein Medical Center for Hair Restoration in NYC
• Dendy Engelman, director of dermatology, Mohs surgery, and laser medicine at Shafer Clinic Fifth Avenue