Randomized Trial of Oral Minoxidil vs Topical Minoxidil

Comparing Oral and Topical Minoxidil for Hair Loss: A Study Overview

Dr. Jeff Donovan discusses a study comparing oral and topical minoxidil for treating male androgenetic alopecia. Published in JAMA Dermatology, the study by Penha et al. found that 5mg oral minoxidil daily was not significantly better than 5% topical minoxidil twice daily over 24 weeks. While oral minoxidil showed some improvement in the crown area, it was not statistically superior overall. The study emphasizes the need for rigorous randomized controlled trials in hair loss research and tempers the enthusiasm for oral minoxidil.

Key Findings

The results showed that both oral and topical minoxidil resulted in similar increases in hair count and density. Oral minoxidil showed better photographic results in the crown area, but this was not a statistically significant difference in overall hair density measurements.

Side Effects

Hypertrichosis was more common in the oral minoxidil group (49%) compared to the topical group (25%). Oral minoxidil users reported higher incidences of headaches and lower incidences of scalp eczema compared to topical minoxidil users.


This study challenges previous assumptions about the superiority of oral minoxidil. It underscores the importance of randomized controlled trials in advancing hair loss treatments, guiding treatment decisions, and improving patient outcomes.

For a more detailed review and in-depth discussion, watch the full podcast episode on the Evidence-Based Hair Podcast hosted by Dr. Jeff Donovan.