Minoxidil
Also known as Rogaine, topical minoxidil, oral minoxidil
First-line for regrowth in androgenetic alopecia. Works on the growth phase rather than the hormonal cause, so it pairs naturally with a DHT blocker.
Generic topical 5% roughly $15–40 for a three-month supply. Oral minoxidil is inexpensive but needs a prescription and monitoring.
How it works
A potassium channel opener and vasodilator. In hair it prolongs the anagen (growth) phase, shortens telogen, and enlarges miniaturised follicles. Topical minoxidil requires conversion by follicular sulfotransferase, which is why response varies so widely between people.
How it's used
Topical: 5% foam or solution, once or twice daily to a dry scalp, left for four hours minimum. Low-dose oral minoxidil is increasingly prescribed off-label by dermatologists and requires medical supervision for cardiovascular monitoring. Expect a shedding phase in weeks 2–8 — this is old hairs being pushed out by new growth, not failure.
Trade-offs
In favour
- Genuinely regrows hair, not just retention
- Available over the counter in topical form
- Works anywhere on the scalp, including the crown
- Non-hormonal, so no endocrine side effects
Against
- Must be continued indefinitely — stopping reverses gains within months
- Twice-daily application is a real adherence burden
- Solution contains propylene glycol, a common irritant
- Non-responders exist due to low sulfotransferase activity
Risks and side effects
- Initial shedding phase
- Scalp irritation and contact dermatitis
- Unwanted facial hair growth, more common with oral dosing
- Oral minoxidil can cause fluid retention, tachycardia and lowered blood pressure — supervision required
How good is the evidence?
Extensive randomised evidence for topical 5% in androgenetic alopecia. Low-dose oral use has rapidly growing but more recent evidence.
Sources
Sources point to guideline bodies and literature searches rather than single papers, so they stay accurate as the evidence moves.