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Research · Medication

Minoxidil

Topical minoxidil raised hair counts against placebo in men and women, by about 13 hairs per cm² in women. In a trial and a meta-analysis, oral minoxidil did not outperform topical on hair density. Unwanted hair growth elsewhere was the most common effect of oral use. Lightheadedness, fluid retention and a fast heart rate were reported less often.

Add to Bio HackChecked 2026-11-09
Status
Topical minoxidil (2% and 5%) is sold over the counter in the US for hereditary hair loss on the top of the scalp. Oral minoxidil tablets are a prescription drug FDA-approved only for severe high blood pressure, with a boxed warning. Low-dose oral use for hair loss is off-label.
Also called
Rogaine, Regaine, Loniten, topical minoxidil, oral minoxidil, low-dose oral minoxidil, LDOM, minox
Taken for
hair loss, hair regrowth, male pattern baldness, female pattern hair loss, beard growth, facial hair

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help4

Reported risks3

What people take it for, and what was found

Shown to help4

StrongStudied in womenVery common

Hair regrowth in women, topical

Shown to roughly double reported hair regrowth in women over placebo, adding about 13 hairs per cm². The 2% and 5% strengths did not differ.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Moderate to marked self-rated regrowth was reported by 157 of 593 on minoxidil and 77 of 555 on placebo (RR 1.93, 95% CI 1.51 to 2.47). Investigator ratings agreed (RR 2.35, 95% CI 1.68 to 3.28). Total hair count rose 13.18 hairs per cm² more than placebo (95% CI 10.92 to 15.44). Minoxidil 2% and 5% did not differ in regrowth [1]. A second meta-analysis also found 2% minoxidil raised hair growth against placebo in women [2].
Population
47 trials with 5,290 women, 17 of them on minoxidil [1]; good or fair quality RCTs to December 2016 [2].
Sources
[1], [2]
Caveats
Only 5 of 47 trials in [1] were at low risk of bias. Evidence for hair count was rated low quality [1]. [2] reported high heterogeneity.
ModerateStudied in men

Hair regrowth in men, topical

Shown to raise hair growth over placebo in men at 2% and 5%, though in indirect comparisons finasteride 1 mg added more hair than either.

The numbers and sources
Effect
Both 2% and 5% topical minoxidil raised hair growth against placebo in men [2]. In a network meta-analysis, 1 mg finasteride raised terminal hair count at 48 weeks by 32.1 hairs per cm² more than 2% topical minoxidil and 26.2 more than 5% [3].
Population
RCTs in men with androgenetic alopecia [2]; 23 studies in men [3].
Sources
[2], [3]
Caveats
The abstract of [2] reports significance without effect sizes. High heterogeneity [2].
Moderate

Beard and facial hair, topical

Shown to raise beard and mustache density over placebo, about 11 more beard hairs per cm², in one trial in transgender men on testosterone.

The numbers and sources
Effect
A systematic review of 19 RCTs of minoxidil for facial hair reported more facial hair growth with few side effects. Five trials were at high risk of bias and six at low risk [6]. In a 12-week trial of topical 3% minoxidil, beard density rose 11.16 hairs per cm² against 0.08 on placebo, and mustache density 18.45 against 1.74. Beard and mustache hair diameter also rose more than on placebo. Adverse events were similar between groups [7].
Population
19 RCTs [6]; 69 transgender men on stable testosterone therapy [7].
Sources
[6], [7]
Caveats
The abstract of [6] gives no pooled effect size. [7] studied people on testosterone therapy, so it may not apply to others.
Limited

Low-dose sublingual against placebo

Small trials found sublingual 1.35 mg twice daily raised front scalp hair count over placebo, with no change at the crown.

The numbers and sources
Effect
At 24 weeks, sublingual minoxidil 1.35 mg twice daily raised midfrontal hair count 15.7 hairs per cm² more than placebo (P 0.03). Vertex hair count did not differ. Testosterone levels did not change and no serious adverse events occurred [8]. In men in a 24-week trial, mean hair fiber diameter fell 2 µm on placebo and on 0.45 mg daily, and rose 3 µm on 1.35 mg and 6 µm on 4.05 mg in an open-label extension [9].
Population
46 transgender people on full-dose testosterone with mild androgenetic alopecia [8]; 33 men with androgenetic alopecia, plus 12 in the extension [9].
Sources
[8], [9]
Caveats
Two small trials. The higher doses in [9] were open-label and not compared with placebo. Sublingual minoxidil is not an FDA-approved form.

Mixed results1

Moderate

Low-dose oral against topical

Mixed results: oral 5 mg and topical 5% did not differ in direct trials, while an indirect comparison found more hair with oral.

The numbers and sources
Effect
At 24 weeks, oral minoxidil 5 mg daily and topical 5% twice daily did not differ in terminal or total hair density on the frontal scalp. On the vertex, terminal density differed by 23.4 hairs per cm² (95% CI -0.3 to 43.0), not significant, and photographs favored oral treatment (24%, 95% CI 0 to 48) [4]. In a network meta-analysis, oral minoxidil 5 mg produced the largest rise in terminal hair count at 24 weeks, 29.8 hairs per cm² more than topical 5% [3]. A meta-analysis of 4 head-to-head trials found no difference in hair density between oral and topical minoxidil (mean difference 0.95, 95% CI -24.98 to 26.87). Terminal hair density did not differ significantly either [5].
Population
90 men aged 18 to 55 with androgenetic alopecia, 68 completing, at one clinic in Brazil [4]; 23 studies in men [3]; 4 trials comparing oral with topical minoxidil in androgenetic alopecia [5].
Sources
[4], [3], [5]
Caveats
[4] had 24% dropout. The network estimate is indirect. The meta-analysis pooled only 4 trials, with a wide interval [5]. Few controlled trials have tested oral doses below 5 mg in men.

Doses studied

Trials of topical minoxidil in women used 2% twice daily, 5%, and in one study 1% [1]. The oral trial used 5 mg once daily against topical 5% twice daily [4].

Risks

Reported risks3

ModerateVery common

Unwanted hair growth elsewhere (hypertrichosis)

Unwanted hair growth elsewhere occurred in 15 to 49% of people on oral minoxidil, more often at higher doses.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In the oral trial, hypertrichosis occurred in 49% of men on oral minoxidil 5 mg [4]. In a multicenter series, it occurred in 15.1% of people on low-dose oral minoxidil and led 0.5% to stop [10]. Pooled individual data found hypertrichosis in 24%, more often at doses above 0.25 to 0.5 mg [11].
Population
45 men on oral minoxidil [4]; 1,404 patients, 67.2% women [10]; 442 patients in 14 studies at oral doses of 0.25 to 5 mg a day [11].
Sources
[4], [10], [11]
Caveats
[10] and [11] are uncontrolled. Rates differ widely with dose and how hair growth was recorded.
LimitedCommon

Lightheadedness, fluid retention and fast heart rate with oral use

Limited evidence: lightheadedness, fluid retention and fast heart rate each occurred in under 2% on low-dose oral minoxidil in uncontrolled studies.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
On low-dose oral minoxidil, lightheadedness occurred in 1.7%, fluid retention in 1.3%, tachycardia in 0.9%, headache in 0.4% and swelling around the eyes in 0.3%. These led 1.2% to stop. No life-threatening effects were observed [10]. Pooled, ankle swelling occurred in 2%, more often at higher doses, and postural low blood pressure and heart rate changes in 1.1% and 1.3% [11]. Headache occurred in 14% of men on oral 5 mg [4]. Pooled across 27 studies of oral minoxidil for hair loss, adverse events of any kind occurred in 27% (95% CI 18% to 36%) [12].
Population
1,404 patients [10]; 442 patients [11]; 45 men [4]; 27 studies with 2,933 patients [12].
Sources
[10], [11], [4], [12]
Caveats
[10] is retrospective with no control group. The authors of [10] and [11] describe these rates as low. [12] pooled single arms, without a comparison group.
LimitedHow often is not known

Heart warnings at blood pressure doses (oral)

The label warns oral minoxidil at blood pressure doses can cause pericardial effusion and worsen angina. Hair loss doses are lower.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The oral tablet label carries a boxed warning that minoxidil can cause pericardial effusion, occasionally progressing to tamponade, and can worsen angina. It is approved only for hypertension not controlled by a diuretic plus two other drugs, and is usually given with a beta blocker and a diuretic [13].
Population
Patients with severe hypertension treated at antihypertensive doses [13].
Sources
[13]
Caveats
The label describes use at blood pressure doses, which are higher than the low doses used for hair loss.

Checked, no increase found1

Moderate

Side effects of topical use

Side effects were about as common on topical 2% minoxidil as on placebo in women, 40 of 407 against 28 of 320.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Adverse events occurred in 40 of 407 on minoxidil 2% twice daily and 28 of 320 on placebo (RR 1.24, 95% CI 0.82 to 1.87). No concentration differed from placebo in adverse events [1]. The over-the-counter 5% foam is labeled for men, for the top of the scalp only [14].
Population
Women in placebo-controlled trials [1]; label [14].
Sources
[1], [14]
Caveats
Evidence on adverse events was rated low quality [1].

Sources

  1. van Zuuren EJ, Fedorowicz Z, Schoones J. Interventions for female pattern hair loss. Cochrane Database of Systematic Reviews. 2016. https://doi.org/10.1002/14651858.CD007628.pub4
  2. Adil A, Godwin M. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. Journal of the American Academy of Dermatology. 2017. https://doi.org/10.1016/j.jaad.2017.02.054
  3. Gupta AK, Venkataraman M, Talukder M, Bamimore MA. Relative Efficacy of Minoxidil and the 5-α Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients: A Network Meta-analysis. JAMA Dermatology. 2022. https://doi.org/10.1001/jamadermatol.2021.5743
  4. Penha MA, Miot HA, Kasprzak M, Müller Ramos P. Oral Minoxidil vs Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial. JAMA Dermatology. 2024. https://doi.org/10.1001/jamadermatol.2024.0284
  5. Fazal F, Malik BH, Mumtaz Malik H, et al. Can oral minoxidil be the game changer in androgenetic alopecia? A comprehensive review and meta-analysis comparing topical and oral minoxidil for treating androgenetic alopecia. Skin Health and Disease. 2025. https://doi.org/10.1093/skinhd/vzaf009
  6. Almutairi AG, Shadid A, AlAkrash L. Topical minoxidil effectiveness in enhancing facial aesthetics: A systematic review and meta-analysis. Journal of Family Medicine and Primary Care. 2025. https://doi.org/10.4103/jfmpc.jfmpc_39_25
  7. Wattanawinitchai K, Pomsoong C, Ratanapokasatit Y, Suchonwanit P. Efficacy and safety of topical 3% minoxidil for facial hair enhancement in transmen: a randomized, double-blind, placebo-controlled trial. Journal of Dermatological Treatment. 2026. https://doi.org/10.1080/09546634.2026.2638637
  8. Tang GT, Leemaqz S, Bhoyrul B, et al. Treatment of androgenetic alopecia in transgender people receiving testosterone therapy with sublingual minoxidil: A randomized, double-blind, placebo-controlled clinical trial. Journal of the American Academy of Dermatology. 2026. https://doi.org/10.1016/j.jaad.2026.05.020
  9. Sinclair R, Sicinska J, Bokhari L, Kasprzak M. Sublingual minoxidil increases fibre diameter in male androgenetic alopecia: a proxy for reversal of hair follicle miniaturization. Clinical and Experimental Dermatology. 2025. https://doi.org/10.1093/ced/llaf012
  10. Vañó-Galván S, Pirmez R, Hermosa-Gelbard A, et al. Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients. Journal of the American Academy of Dermatology. 2021. https://doi.org/10.1016/j.jaad.2021.02.054
  11. Jimenez-Cauhe J, Saceda-Corralo D, Rodrigues-Barata R, et al. Safety of low-dose oral minoxidil treatment for hair loss. A systematic review and pooled-analysis of individual patient data. Dermatologic Therapy. 2020. https://doi.org/10.1111/dth.14106
  12. Liu C, Liu X, Shi T, et al. Efficacy and safety of oral minoxidil in the treatment of alopecia: a single-arm rate meta-analysis and systematic review. Frontiers in Pharmacology. 2025. https://doi.org/10.3389/fphar.2025.1556705
  13. U.S. Food and Drug Administration. Minoxidil tablets, prescribing information. 2026. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0354a7f5-5917-44dc-9963-411104008cb5
  14. U.S. Food and Drug Administration. Men's Rogaine (minoxidil 5% topical foam), over-the-counter drug facts label. 2024. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1b5e2860-6855-4a65-8bbc-e064172a1adf

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