Season 7 Episode 3 - Randomized Trial of Oral Minoxidil vs Topical Minoxidil

[@MyLifeInTheDesert]

One thing to keep in mind is the likelihood of compliance and cost when it comes to oral minoxidil. It’s simply easier and cheaper for most people. Insurance doesn’t cover the topical products (in the U.S.)

[@donovanmedical9780]

There are actually four things that we must keep in mind at all times. They are safety, affordability, feasability and effectiveness. Cost is just one issue. Safety of oral minoxidil becomes an issue as the dose goes higher and higher and higher. At typical doses, it's reasonably safe. Long term safety is somewhat unknown. All four parameters need to be kept in mind. For many people, yes oral minoxidil has it's advantages. I agree with that. But a proportion of patients don't tolerate oral minoxidil very well.

[@mrponty9885]

Hi doc, I've switched from twice 2.5 mg daily of oral minoxidil to a full 5 mg capsule, once daily. I've noticed that it feels way different, even after a week of dosing. I feel light-headed and weird in the chest. I talked to my cardiologist and he said to stop if I found it too challenging to handle.. My questions are: 1) 5 mg oral min should stabilize its effect after a 2 week period. Does it mean that after 2 weeks my body could potentially adapt to the changes, and the side effect have a chance of subsiding? 2) I also take ritalin for ADHD. Do these drugs have any ill effect when taken together? My cardiologist couldn't help, weridly enough, and I can't find much info online about this. Thanks for your attention.

[@soije4440]

Hi Dr. Donovan, I switched over to 1.25mg OM daily from 1ml 5% TM once daily about a month ago. TM had been giving me decent results for a couple of years, but since switching I've noticed more shedding (10-20 hairs/day vs 1-5 previously). Does this mean OM is working or that the dose isn't high enough? Should I occasionally use TM in addition to OM throughout the week or even switch back?

[@donovanmedical9780]

@@soije4440 oh, I would need to know a lot more information and the opportunity to see your scalp up close. You are assuming that hair loss is quite straightforward! In addition to seeing your scalp, I would need to understand why really you made this switch. What really are the motivations to undertake this change? I would need to rule out other hair conditions that are present including any recent factors or triggers that might be driving a telogen effluvium. Blood work could be useful. I can’t say which ones you need without knowing your whole story. Of course, we would need to completely remove exclude comorbid or coexisting seborrheic dermatitis, alopecia areata, scarring alopecia which might be present - as well as any recent stress or recent COVID infections. We would also need to review the source of oral minoxidil and where exactly it’s coming from. We would also need to review any other prescription medications or supplements started or stopped in the last 2 years. Yes, it’s certainly possible that a shed like you describe is perfectly normal and part of a good growth response to oral minoxidil. But no, it’s not possible to assess hair loss without amassing all the facts and seeing the scalp up close. Be sure to follow up with your dermatologist or hair specialist.

[@guillermorivera6332]

Doctor, do you have any data ona oral minoxidil and prolactil levels ? I never have a sexual side effect ( 26 years none stop with topical minoxidil) but it was really hard to get an orgasm while on oral minoxidil ( 46 years old male , was on 2.5mg oral minoxidil , now back to topical ) . Could ‘t find much information about it . Thanks !

[@copetillirope178]

what's your thought on topical jak for ffa or lpp ? thanks

[@donovanmedical9780]

does not help everyone - but it's a reasonable second line approach. donovanmedical.com/qow-posts/topical-jaks-ffa

[@paulsmith2823]

Oral min is overrated do you think 10mg would work better

[@donovanmedical9780]

Yes. it works better. Many of these benefits are dose dependent. Side effects are dramatically increased by going up. I rarely ever prescribe such doses. Many men can’t even tolerate 5 mg. 10 mg dramatically increases cardiovascular side effects, hypertrichosis, headaches and other issues. Not a dose I recommend!

[@paulsmith2823]

@@donovanmedical9780 I get no sides on 5mg after 2 years, you think I could up titrate the dose up from 5mg with 1mg a day so 6mg then keep working up to a max dose ?