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Many of us can pinpoint the moment when our hair loss became irrefutable—when we could no longer normalize or rationalize the fallout. For me, it was March of 2019. I’d just turned 42 and was in Washington, DC, for a dermatology conference. I remember standing before a full-length mirror, deciding between slingbacks and boots, when the stark visibility of my scalp stole my focus. In an instant, the hotel lighting rudely exposed a truth I’d been denying for months: My hair was falling out.
Looking back, it’s obvious. The intense shedding, the soaking night sweats, the chronic insomnia—I was in perimenopause. But this was before the rise of Mary Claire Haver and the social media menoverse. I was clueless about menopause and assumed it was years off. I mean, I’d only stopped nursing my youngest a few years prior. I chalked up my symptoms to advancing age and my on-again, off-again relationship with the Pill, and tried to ignore the hair collecting in my brush. I continued to shed (slowly, steadily) throughout my 40s, but generally avoided dealing with it, save for a false start on Nutrafol and a few relatively unproductive rounds of platelet-rich plasma (PRP). The evidence-backed injections, which rely on the growth factors in our blood to stimulate hair growth, demanded more maintenance (booster treatments every six months) than I could manage. And each session can cost around $1,000.
Why didn’t I do more? Well, to the average passerby, my hair, which is long and dark, probably doesn’t appear to be thinning. I don’t have the telltale Christmas-tree part, and my scalp is still fairly well concealed overall. But if I had to guess, based on my cumulative fallout and the comparative density of my ponytails and braids, I’d say that, at 49, I’ve probably lost about half the abundance of hair I had in my 20s. I notice it’s thinner and it worries me, but I probably would’ve been more proactive about treatment if the sparseness were obvious to the world.
Also, in my defense, female hair loss wasn’t fully in the zeitgeist back in 2019. Most women weren’t baring their scalps on Instagram or swapping growth hacks at cocktail parties. It wasn’t until the confluence of the COVID pandemic and the GLP-1 boom set off a veritable hair loss epidemic that we saw a wave of content and conversation devoted to it—more specifically, telogen effluvium, a temporary type of shedding spurred by emotional or physical stressors (including pregnancy, illness, rapid weight loss, and global lockdowns). But even then, many of the hair loss stories reported in the early days of the pandemic—like this one in Allure and this other one in The New York Times and yet another one in The Atlantic—made no mention of oral minoxidil, a drug that’s now considered a go-to for thinning hair. Dermatologists weren’t collectively touting it—not until 2022, at least, when the widely read New York Times article, “An Old Medicine Remedies Hair Loss for Pennies a Day,” officially put oral minoxidil on the public radar.
A patient of Dr. Oma Agbai before and after 10 months on oral minoxidil.
I remember reading the piece, but for whatever reason—kids, deadlines, a slow shedding month—it didn’t immediately compel me to seek a prescription. I think I knew oral minoxidil was a thing, but at the time, the idea of taking a pill for hair loss just felt like a lot. Then I went on menopause hormone therapy (or MHT, which is the rebrand of HRT or hormone replacement therapy) and my perspective completely shifted.
When talking to doctors and friends who were also navigating estradiol patches, progesterone pills, and testosterone gels in an effort to address the symptoms of menopause, oral minoxidil frequently found its way into the conversation. It seemed to be the drug of choice for middle-aged women with hair loss. Whether I was peer-pressured or influenced, who knows? But one day this past spring, just after turning 49, I was chatting with a nurse practitioner at Midi Health (my longtime ob-gyn had just retired and I needed quick advice on adjusting my estradiol dose) and asked if she could prescribe minoxidil to slow my shedding, which had intensified after my periods officially stopped months prior. She obliged, without hesitation.
While there has been a lot of buzz about this hair loss pill, for once the hype isn’t outpacing the science. “Social media has certainly amplified awareness [of minoxidil]—and reduced some of the stigma that has historically prevented women from seeking help [with hair loss]—but the enthusiasm is also being driven by growing scientific evidence,” says Oma Agbai, MD, the founding director of multicultural dermatology and hair restoration at the UC Davis School of Medicine in Sacramento, California. “Over the last 5 to 10 years, there’s been an explosion of clinical studies demonstrating its efficacy and safety at low doses.” Not only is oral minoxidil “one of the biggest advances in hair loss treatment in the past decade,” she says, but it’s also one of the most commonly prescribed medications at her hair clinic.
For once, the hype isn’t outpacing the science.
Anna Karp, DO, a board-certified dermatologist in New York City, estimates that 30 to 40% of her female hair loss patients are currently taking oral minoxidil or discussing it as an option. She took it herself for a while to counter postpartum shedding after the birth of her second child. In recent years, she says, women have become “more attuned to their hair and are quicker to seek help” when they experience shedding.
Of course, you don’t need to visit a dermatologist for a minoxidil prescription, given the proliferation of internet pharmacies, notes Robert Finney, MD, a board-certified dermatologist in New York City. While some doctors worry about the lack of personalized counseling offered online, they say telehealth has helped mainstream minoxidil by broadening access. For me, it was easy and affordable to get an appointment and prescription through Midi, the menopause-focused platform. My insurance covered the 30-minute call, and I paid less than 10 bucks for the pills. Libby Windsor, 50, a friend of a friend, got oral minoxidil through Strut Health after dropping 20 pounds on a GLP-1 and realizing months later, “I could see through my hair.” (Was it because of the weight loss? Was it just aging? Perimenopausal hormone fluctuation? She thinks probably all of the above.) Allure contributor Marci Robin, 47, says her foray into oral minoxidil took the form of green apple gummies from Hers. She eventually upgraded to the traditional tablet, at a higher dose, prescribed by her dermatologist. The bottom line, according to board-certified dermatologist (and taker of oral minoxidil) Shereene Idriss, MD: “Oral minoxidil has become more mainstream because, very simply, it works.”
How does oral minoxidil work?
In 1979, the US Food and Drug Administration (FDA) approved oral minoxidil, a vasodilator, not to reverse balding, but to reduce blood pressure. When patients started seeing hair growth as a side effect of the medication, drug makers got to work developing a topical version for the scalp. In 1988, it was approved for male pattern hair loss (or androgenetic alopecia) and marketed as Rogaine. The agency approved the same solution for women in 1992—and it remains the only FDA-approved medication for female pattern hair loss.
Decades later, in the mid-2010s, dermatologists began investigating oral minoxidil for hair loss, using smaller doses than those known to affect blood pressure. “The doses for hair are much lower—0.25 to 2.5 mgs in women—and cardiovascular effects are generally minimal at those doses,” says Dr. Karp. “I like to start at half a pill (1.25 mgs) and will sometimes titrate up to one pill (2.5 mgs) a day if there are no side effects. Others may start at 0.25 mgs and go up.” Using oral minoxidil to treat hair loss is considered an off-label use, since the FDA has never approved the drug for this indication in men or women.
Allure contributor Marci Robin before and seven months after starting oral minoxidil.
So how, exactly, does a blood pressure medicine grow hair? Whether taken by mouth or rubbed on the scalp, minoxidil causes blood vessels to widen by relaxing the smooth muscle cells within their walls. This increases blood flow and enhances the delivery of nutrients and oxygen to the hair follicles. While minoxidil’s myriad mechanisms of action haven’t been completely borne out, “we know its hair-growth benefits extend far beyond circulation alone,” Dr. Agbai says. “It keeps hair follicles in the active growth phase for longer, it enlarges follicles that have become miniaturized over time, it stimulates follicle activity, and it increases the production of growth factors that support healthy hair growth.” All told, she adds, “these effects help follicles produce thicker, fuller hairs and can improve overall hair density.”
While you might assume, as I did, that the prescription pill is stronger than the over-the-counter topical foam, “head-to-head studies have shown that low-dose oral minoxidil is actually roughly comparable to, and in some analyses, modestly superior to topical 5% minoxidil,” Dr. Karp says. In practice, however, many dermatologists find that the pill ultimately works better, because “it bypasses the practical issues we see with topical formulations,” says Dr. Idriss. Foams can be hard to apply uniformly. They may be sticky or slick, leaving hair limp, stringy, and dirty-looking. They can irritate the scalp, causing itching, stinging, dryness, and flaking.
When Dr. Idriss saw her hair thinning after having her first child, she picked up a minoxidil foam. “It worked, but I developed a sensitivity to it,” she says. “My scalp started flaking to the point where it looked like I had really bad dandruff. I just couldn’t tolerate it.” She’s not alone: In a study looking at levels of compliance to topical minoxidil among people with androgenetic alopecia, 86% discontinued the treatment; the rate jumped to 93.6% when subjects experienced side effects. Conversely, trials involving people on low-dose oral minoxidil show that fewer than 2% discontinue treatment for any reason. Dr. Idriss eventually transitioned to oral minoxidil and has now been on it for 18 months. “Its biggest advantage is not that it’s dramatically more effective,” she reiterates. “It’s just so much easier to use consistently. And consistency and adherence matter. That’s what makes medicine work.”
Does oral minoxidil work for all kinds of hair loss?
Yes, with a caveat: “Minoxidil is going to act as a stimulator to jump-start growth regardless of what’s causing the hair loss,” says Dr. Idriss, but it’s not going to remedy the underlying problem, nthe thing that made your hair fall out in the first place, be it a hormonal imbalance, an autoimmune condition, a nutritional deficiency, or a dysfunctional thyroid. For the best long-term outcome, you need to stimulate growth with minoxidil while also addressing what’s behind the shedding. Which is why some doctors, when evaluating hair loss, will order labs to root out common instigators, like anemia or low vitamin D or ferritin (a protein that stores iron).
Marci, my fellow Allure contributor, assumed her hair loss was a mere consequence of aging until her rheumatologist linked it to an autoimmune condition called Sjögren’s syndrome. “I have a weird version of it that presents neurologically,” she says. “And as with most autoimmune diseases, it comes with the risk of your body attacking your hair follicles.” For the past seven months, she’s been taking 2.5 mgs of minoxidil. She didn't see tremendous growth in the first few months (“though it was enough to ease my mind a little bit”), and then around month five, “I realized I was no longer afraid to run my fingers through my hair. It was thicker all over, and my part had almost completely filled in.”
A patient of Dr. Amelia Hausauer before and 20 months after starting oral minoxidil. This patient also did three monthly PRP treatments, and now does a maintenance session once every six months. (Many people taking oral minoxidil are also pursuing at least one other hair loss treatment, at least initially, to both expedite and maximize their results.)
Because “oral minoxidil works best when there are still viable follicles capable of producing hair,” Dr. Agbai says, it’s a go-to for temporary “non-scarring” kinds of hair loss, including telogen effluvium (the abrupt shedding that can follow a stressor, like surgery or weight loss), certain types of alopecia areata (an autoimmune disease), and hereditary pattern hair loss, which is marked by a sensitivity to dihydrotestosterone (DHT), a hormone that causes follicles to shrink over time. (DHT is a derivative of testosterone; both are classified as androgens, or male sex hormones, but women make them too.) Dermatologists may also prescribe oral minoxidil (alongside other medications) when treating permanent or “scarring” forms of hair loss caused by autoimmune issues, infections, or trauma. In such cases, “Minoxidil is not going to reverse the course of scarring, but it is going to help strengthen and regrow hairs” around areas of concern, says Dr. Finney. “It truly is a Swiss Army Knife.”
“It’s just so much easier to use consistently. And consistency and adherence matter. That’s what makes medicine work.”
The drug’s versatility is a virtue, especially for female hair loss, which is almost always multifactorial, says Dr. Karp. While women most commonly present with androgenetic alopecia, “layered on top of it, you may have an iron deficiency (ferritin is often the culprit), thyroid dysfunction, significant physical or emotional stress triggering telogen effluvium, hormonal shifts, restrictive eating, or medications,” she says. One of those medications is increasingly likely to be a GLP-1. Weight loss can cause hair shedding and thinning, and according to one 2025 survey, 15% of women from 30 to 49 and 20% of women from 50 to 64 are taking or have taken a GLP-1. I would imagine those numbers are even higher today. Rarely is a single factor to blame, though.
One exception: chemotherapy-induced hair loss. After being diagnosed with an aggressive form of breast cancer during the pandemic, 39-year-old Amy* underwent eight rounds of chemo, two lumpectomies, and 25 radiation treatments. Her hair began to fall out after the second round of chemo; her brows and lashes hung on until a week after her final session. Ultimately, she lost about half the hair on her head; she credits cold capping with preserving what remained. Though she had a sizable bald patch on top of her head (likely from where the cap broke contact with her scalp), “headbands kind of concealed it,” she says, and since she still had hair in the front, “on Zoom, my coworkers couldn’t tell that I’d lost any hair at all.”
Still, her hair loss was an everyday reminder of her illness. “I was lucky I didn’t feel the chemo that much, but seeing my hair go was hard,” she says. “It’s so closely tied to identity.” Her surgeon referred her to a dermatologist, who started her on oral minoxidil as soon as she was done with chemotherapy. Within weeks, she saw her bald spot filling in and her brows and lashes coming back. Now, five years later, she says, “I have the thickest hair I’ve ever had in my life.” She still takes half a pill a day, per her dermatologist’s advice, mainly because the medications she’s on long-term to prevent the cancer from recurring all cite hair loss as a potential side effect.
Why does everyone seem to have (peri)menopausal hair loss?
Female pattern hair loss strikes approximately 40% of women by their 50th birthday, dovetailing, in many cases, with menopause. “While there are a couple of hormonal culprits behind female hair loss, the most important is DHT, which can basically shrink the hair follicles, causing them to come back finer and thinner,” explains Mona Mislanker, MD, a board-certified dermatologist in Cincinnati. As women produce testosterone, in the ovaries, adrenal glands, and other tissues, a portion is converted to DHT, which attaches to receptors in the hair follicles, causing the hallmark shrinkage seen in pattern hair loss. (The follicles of those prone to the condition are hypersensitive to DHT.)
Polly Blitzer Wolkstein, a 50-year-old beauty editor and brand consultant, noticed her hair thinning in her 40s when she “suddenly needed to wrap a ponytail holder three times instead of two.” Like many of her contemporaries, she blamed it on the stress of the pandemic. After experimenting unsuccessfully with supplements and her husband’s Rogaine, she met with a dermatologist, who reviewed her bloodwork (everything was normal) and examined her scalp (there was evidence of “miniaturized” follicles). Polly was ultimately diagnosed with androgenetic alopecia. Along with oral minoxidil (at 0.625 mgs), her dermatologist prescribed a small dose of spironolactone, a so-called antiandrogen, to directly address the hormonal component of her hair loss. In cases like Polly’s, spironolactone can enhance hair growth “by blocking androgen receptors and making it harder for DHT to bind with and exert its effects on the hair follicles,” says Dr. Idriss. Doctors often combine it with oral minoxidil because the two drugs do different jobs, each acting on the follicle in its own way to synergistically reduce shedding and yield greater growth.
In patients with hormonal hair loss, dermatologists may enlist an antiandrogen when hair loss seems unusually aggressive or slow to respond to minoxidil alone. “If a patient is on oral minoxidil for six months and we’re not seeing a good enough response, I might consider adding another medication, like spironolactone or finasteride or dutasteride, but it’s not a one-size-fits-all thing,” says board-certified New York City dermatologist Ellen Gendler, MD, who takes oral minoxidil herself to help with postmenopausal hair loss.
While spironolactone blocks androgen receptors, finasteride and dutasteride work by inhibiting the enzyme that turns testosterone into DHT, effectively “shutting off the production of the hormone that’s driving the follicular demise,” says Dr. Finney. Since finasteride and dutasteride pose a risk of birth defects, dermatologists generally reserve them for men and postmenopausal women. In female patients who still have regular periods, Dr. Finney will sometimes use microneedling and ultrasound to deliver sterile dutasteride directly into the scalp. This way, he can reap the benefits of dutasteride while skirting systemic side effects.
A patient of Dr. Robert Finney before and 16 months after starting oral minoxidil plus five ScalpStim treatments (dutasteride and growth factors delivered to the scalp through microneedling and ultrasound).
Before reporting this story, what confused me most about middle-aged women losing hair to androgenetic alopecia was that so many of us report low levels of testosterone—the very hormone that gives rise to DHT and sparks the condition. Like other hormones, testosterone dwindles with age, threatening not only libido, but also perhaps musculoskeletal health, mood, and more, though the jury is still out there. A libido boost alone, though, is enough for the throngs of women on social clamoring for the drug. But if menopausal women generally have so little T (and presuming they’re not treating the deficiency with excessive doses), then why are their follicles behaving like those of juiced-up gym bros?
“One of the biggest misconceptions is that you need high testosterone to lose hair,” Dr. Idriss explains. “So many menopausal women with androgenetic alopecia have completely normal or even low levels of testosterone.” Amelia Hausauer, MD, a board-certified dermatologist in Campbell, California, says the same thing: In some postmenopausal women, female pattern hair loss can develop or progress despite lab work showing low testosterone levels. “What’s happening systemically in the body and what’s happening locally at the hair follicle are two different things,” she says. Even if there’s scant testosterone in the blood, the follicles can become more sensitive to androgens, responding in dramatic fashion. Dr. Hausauer links the heightened sensitivity to an increase in both the expression of androgen receptors in the follicles as well as an uptick in the enzyme that changes testosterone into DHT, “which means that even low or declining circulating testosterone can be converted to the more potent DHT within the follicle.”
Waning estrogen exacerbates the situation. In youth, “estrogen is your hair’s best friend: It keeps hair in the growth phase longer, it supports a healthy follicle, and it acts as a natural counterbalance to androgens within the follicles,” Dr. Idriss says. “But as estrogen declines in menopause, that protective effect fades and you’re left with a state of relative androgen dominance.” Again, it’s not that your androgen levels are high; there’s just less estrogen around to offset them. Contributing to the imbalance is aromatase, yet another wizardly enzyme in our hair follicles. This one transforms androgens into beneficial estrogens, but “it seems to be decreased in the affected scalps of women with pattern hair loss,” notes Dr. Hausauer. But presumably if you’re on menopause hormone therapy, that estrogen will prevent a lot of this potential hair loss, right? Unfortunately wrong: "MHT may help soften the hormonal drop that can contribute to shedding, but it does not reliably prevent or treat female pattern hair loss," says Dr. Idriss.
Melissa Coleman (@mrs.derm) before and nine months after starting oral minoxidil.
Long story short: “When helpful hormones bottom out and androgens go unchecked, genetic hair loss gets unmasked,” Dr. Finney says. But it’s a gradual process, so you may not notice it right away. “It's not, ‘My hair just fell out,’” notes Dr. Idriss. “It's, ‘My ponytail feels thinner.’ ‘I can see my scalp more.’ ‘My hair isn't what it used to be.’”
Marci can relate. “I never paid much attention to how much hair was in the brush or going down the drain,” she says. “What made me nervous was how much I could see my scalp.” For others, the loss may not register until even later. When Melissa Coleman, the 47-year-old beauty consultant better known as @mrs.derm, started taking oral minoxidil in advance of her tummy tuck, she was simply hoping to stave off post-op shedding. “I didn’t even notice that I had been losing my hair until I saw all this new growth coming in,” she says. “Mushroom head,” she calls it. “I suddenly had two inches of new hair sprouting all over my scalp.”
What are the side effects of oral minoxidil?
Nearly every woman I spoke to for this story has experienced the minor side effects of oral minoxidil—most commonly, excess hair on the face or body. “While studies suggest that maybe 35 to 50% of people get hair on their face, in my office, it’s 90%,” says Dr. Gendler. Still, she says, “it’s rare for a woman to tell me, ‘I can’t deal with the facial hair. I’m going off of minoxidil.’” Dr. Gendler’s experience aligns with the findings of a 2026 study of patient-reported side effects. In women taking low-dose oral minoxidil, 71.6% reported unwanted hair growth, mostly on the face, arms, and legs; 93.2% continued to take the drug.
For some, this side effect is subtle: a little extra peach fuzz along the jawline. For others, not so subtle: Dr. Idriss didn’t realize the magnitude of her facial hair until she saw a photo of herself, blown up and unretouched, in a Sephora storefront. (Her skin-care line, Dr. Idriss, is sold there.) “I was like, ‘Uh, why do I have a beard?’” Other women shared similar (albeit less cinematic) stories of hair erupting in unexpected places. Melissa and Marci, for instance, discovered newfound knuckle hairs. “So, I guess we’re shaving our fingers now,” Melissa jokes. Polly noticed dark fur blooming on her temples. It looked very “woodland creature,” she says, particularly in her lighted magnifying mirror. She now routinely dermaplanes her face and plucks any rogue hairs. “It’s been ongoing but manageable,” she says. “Worth the trade-off.”
71.6% reported unwanted hair growth, mostly on the face, arms, and legs; 93.2% continued to take the drug.
Indeed, most women find they can easily manage unwanted hair with dermaplaning or laser hair removal. But if it’s extreme or bothersome, doctors can pair oral minoxidil with spironolactone to control the excess hair growth. In a 2026 study, combining the two decreased the risk of unwanted body hair by about 65%, or they can reduce the daily dose of minoxidil to curb side effects. “The goal is to find the lowest effective dose that gives you the most meaningful hair regrowth without causing crazy side effects,” says Dr. Idriss, who started doing laser hair removal after she saw that Sephora photo.
Out of the nine women who’ve taken oral minoxidil that I spoke to for this story, only one was among that 6.8% who quit because of the unwanted hair growth. “My whole face was just… furry,” says Vanessa*, 50, who started taking oral minoxidil early this year to regrow her hair after frying much of it off in an attempt to bring her dark hair to a more gray-concealing blonde. She got her 1.5 mgs prescription from the telehealth company Hers and by week four, was thrilled that she was already noticing thicker hair on her head. But by week eight, the hair on her cheeks (“my facialist asked me if I shaved my face because I had a layer of hair on it that was all exactly the same length”) and her newly bushy brows (“I’d never had to groom my brows in my life”) were too much; she quit. “I wanted fuller hair, but it wasn’t worth having a hairy face and adding brow-threading and mustache-bleaching to my list of beauty upkeep,” she says. Vanessa gave the pills to her 54-year-old husband. After taking them for three months, his receding hairline has inched forward to where it was a decade ago. “And he has to get his hair cut twice as often.”
And then there’s the “dread shed”—a colloquialism for the burst of shedding that some see when they start taking minoxidil. It tends to occur within the first two months and can last up to 12 weeks. “But I don’t describe dread shed as a side effect,” says Dr. Finney. “I tell patients that sometimes minoxidil likes to kick out damaged hairs before bringing healthier ones back in their place.” As a silver lining, he notes, “studies have shown that people who experience more of a dread shed actually have a better result in the long run.” In the short term, however, the initial shed can make hair look thinner and delay your results. “If I don’t warn patients about it in advance,” says Dr. Karp, “they’ll stop taking the minoxidil before it can work.”
A patient of Dr. Amelia Hausauer before and five years after starting oral minoxidil. This patient also did three monthly PRP treatments, with a maintenance session once every four months. (Full results were seen after 12 months and have been maintained with oral minoxidil and thrice yearly PRP.)
Less common and more serious side effects are those of the cardiovascular variety. “There’s plenty of data showing that minoxidil does not impact your blood pressure when you’re at 2.5 mgs or below,” says Dr. Finney. “But every so often, someone will complain of heart palpitations, headaches, chest tightness, or lightheadedness, even at baby doses.” Mild fluid retention is another possible side effect and can manifest as puffiness in the face or swelling in the legs and ankles. Exceedingly rare at low doses, but important to watch for, is pericardial effusion, a dangerous buildup of fluid around the heart. Caught early, it can be treated with diuretics and other meds, but “it can be deadly if it goes unchecked,” Dr. Finney says. While none of the women I interviewed mentioned swelling or heart problems, some did feel dizzy or lightheaded when they first started on minoxidil. The symptoms were fleeting, resolving as they adjusted to the drug.
Less of a side effect and more of a sticking point seems to be the forever nature of minoxidil, because, yes, if you stop taking it, it will stop working (meaning your follicles will return to their natural, unstimulated state). “After taking minoxidil consistently for a little over a year, I went on a three-week vacation and fell out of my routine,” says Polly. “At first, nothing happened. My hair looked the same for a couple of months. But then it gradually started to disappear, and I wound up back where I started.” After a year, Melissa tried to taper off the drug and “go into maintenance mode,” where she would take half a pill only three days a week instead of daily. It was “a total disaster," she says. She quickly saw her hair thinning and breaking. “I panicked and returned to taking minoxidil every day, bumping up the dose to 2.5 milligrams.” But backing off the pill doesn’t always spell trouble. Dr. Karp, who took oral minoxidil to counteract postpartum hair shedding, stopped after about a year, “because I felt like my results were good,” she says. “I wasn't sure what exactly would happen, but I haven't seen much shedding since.” That’s probably because postpartum shedding is a form of telogen effluvium, an abrupt and almost always temporary form of hair loss.
Who’s a candidate for low-dose oral minoxidil?
“This is a very interesting question, because it seems like everybody’s on it,” says Dr. Idriss. Indeed, for those of us seeing our parts widen and ponytails thin, oral minoxidil sounds like a welcome addition to the pill box. But who actually qualifies? Anyone looking to stimulate hair growth, who’s healthy enough to take the medication safely, says Dr. Idriss, especially people who can’t tolerate the minoxidil foam or know they won’t use it consistently. Poor candidates for oral minoxidil include people with heart conditions, blood pressure issues, a history of fluid retention, or kidney disease, as well as women who are pregnant or breastfeeding.
Dr. Karp finds oral minoxidil to be particularly useful for peri- or postmenopausal women, who are looking to treat their hair loss with a nonhormonal option. A lot of people in this group are already taking hormones, either oral contraceptives or MHT, and they may elect to stay away from additional hormonal-type treatments, like the antiandrogens spironolactone and finasteride/dutasteride. Good candidates for oral minoxidil also have reasonable expectations, Dr. Karp adds, “and understand that this is a long-term commitment, not a quick fix.” As she explains, the first three months of treatment are more about stabilization than dramatic regrowth, with most patients noticing early improvement by six months and best results at a year-plus. After about three months, I’m firmly in the stabilization phase, and what a relief to see fewer hairs in the brush post-shower.
A patient of Dr. Robert Finney, before and 20 months after starting oral minoxidil and doing six ScalpStim treatments.
In Dr. Gendler’s office, “minoxidil is always my first-line treatment for a woman with thinning hair that’s not related to a metabolic condition,” she says. She hesitates to prescribe the oral form to those with polyendocrine metabolic ovarian syndrome (PMOS), formerly called polycystic ovary syndrome (PCOS), because these women already struggle with face and body hair, and oral minoxidil can compound the problem. Topical minoxidil may be an option, but even that can cause hair growth on the face, she says. To address thinning hair in this group, Dr. Gendler usually leans on spironolactone. Dr. Agbai says she may use oral minoxidil to treat hair loss in women with PMOS (or those with signs of an androgen excess, in general), but she typically pairs it with spironolactone, finding “the combination is often more effective than either medication alone.” Since spironolactone has both antiandrogen and diuretic effects, it can also help mitigate minoxidil side effects, like excess hair growth and swelling in the face and legs.
Is a new and improved minoxidil on the horizon?
An extended-release version of oral minoxidil designed specifically for hair growth in men and women is currently in clinical trials. Allure first reported on the pill, known as VDPHL01, in fall 2025. Last spring, the drug manufacturer, Veradermics, announced the results of a randomized, double-blind, placebo-controlled trial involving 519 men with pattern hair loss. After six months of once- or twice-daily treatment, patients had, on average, 30 to 33 more hairs per square centimeter of scalp, with new growth observed as early as two months.
“The trial not only showed robust efficacy (we’re getting 1.5 times the number of hairs that people would typically grow from other [currently available] therapies), it found the drug to be very safe and well-tolerated,” says board-certified dermatologist Maryanne Makredes Senna, MD, an assistant professor of dermatology at Harvard Medical School and a paid member of Veradermics’s scientific advisory board. There were no cardiac-related adverse events, she says, and the most commonly seen side effects were lower leg swelling and excess hair growth.
The key to the extended-release formula is a “gel matrix designed to deliver a long-lasting, steady release of minoxidil for sustained absorption,” says board-certified dermatologist and Veradermics’s CEO Reid Waldman, MD. Since regular immediate-release minoxidil was made to swiftly lower blood pressure, it quickly peaks in the bloodstream before rapidly metabolizing and clearing from the body. This limits the time it has to interact with and stimulate hair follicles. With VDPHL01, the goal is to encourage more minoxidil to hang out at the hair follicles for a longer period of time, “while staying well below the blood concentrations that can lead to potentially scary side effects, like palpitations and blood-pressure changes,” says Dr. Senna.
While the promise of a new hair loss treatment is exciting, some dermatologists question the need for a modified minoxidil, since the classic pill has a solid track record. But Dr. Senna contends that the doses currently used to treat hair loss aren’t always effective. “Many patients aren’t where they want to be efficacy-wise," she says, particularly those who’ve seen their results plateau, and doctors can’t push the dose without risking side effects.
Dermatologists have also raised concerns about the potential for unwanted hair growth in women, since the doses used in Veradermics’s studies are higher than traditional doses. Even with an extended-release technology, “I can’t imagine a scenario where you’re able to deliver that much more of the medication, and do that much better on the scalp, if you’re not impacting hair all over,” Dr. Finney says. Only time will tell. Veradermics is actively recruiting for its phase three trial with female patients, and says that they expect topline results in the first half of 2027. Just this month, they released the results of a small study (not double-blind or placebo-controlled) on 28 women, which found improvements in nearly all participants, with signs of hair growth appearing as early as two months. No serious side effects or heart-related safety concerns were reported, and the company says hypertrichosis (unwanted hair growth) was “mild and manageable”—only one of the 28 women (or about 3.5%) dropped out of the study because of it. Dr. Senna says she’s eager to see where the data from the much larger female trial lands, but she doesn’t expect excess hair to be a deterrent, since medications like spironolactone can be given alongside minoxidil to reduce unwanted growth. (Although how much of a reduction varies. Polly, who is taking spironolactone alongside oral minoxidil, has still seen facial hair growth.)
Pricing may pose another obstacle. “One of the big benefits of [traditional] minoxidil is that it’s cheap, like $10 a month, which is not true for any other hair therapy,” notes Dr. Hausauer. While Veradermics hasn’t shared anticipated pricing, some speculate that they’ll have to charge a premium in order to recoup the costs of the FDA trials.
Hypotheticals aside, we can’t overlook the fact that VDPHL01 is poised to be the first FDA-approved oral treatment for female pattern hair loss, and, if approved, says Dr. Agbai, “it could represent a meaningful milestone for women.”
As for me, I’ve been dutifully taking half a pill of standard minoxidil each night for about three months. The biggest change I’ve seen so far hasn’t been gobs of hair growing in but rather fewer strands falling out, which is a win in itself. Still, I’m excited for the “mushroom-head” phase. I do sometimes wonder how much thicker my hair might be today had I jumped on oral minoxidil sooner, before it went mainstream. For now, though, I’m happy to have adopted this routine—to finally feel in control of an issue that’s been plaguing me for years. While I don’t consider myself a minoxidil proselytizer (as an old-school journalist, I was taught not to gush), I suppose this story is sort of like me shouting from the rooftops, in a not-at-all-breathless way, “Hey, this stuff works! And it’s cheap!” To me, oral minoxidil is a no-brainer for hair loss. If only all our midlife worries could be solved so easily.
*Name has been changed for privacy.
FREQUENTLY ASKED QUESTIONS
What is oral minoxidil?
It’s a prescription blood pressure medication that’s commonly used off-label, at low doses (under 2.5 mgs for women, less than 5.0 mgs for men), to treat all kinds of hair loss.
How does it treat hair loss in women?
It stimulates hair growth by boosting blood flow to the hair follicles. It’s also thought to keep hairs in the active growth phase for longer, to enlarge miniaturized follicles, and to increase the production of follicle-based growth factors.
What are the most common side effects?
Unwanted hair growth on the face and body is the most common side effect. Some people also experience what’s known as “dread shed,” a temporary period of pronounced shedding weeks after starting the drug. Headaches, lightheadedness, and ankle swelling are possible, but occur less frequently at the low doses taken for hair loss.
Is there anyone who can’t take it?
Oral minoxidil is contraindicated in women who are pregnant or breastfeeding. People with heart conditions, blood pressure issues, a history of fluid retention, or kidney disease are not good candidates and should talk to their doctors before taking it.
Where can you get it?
You’ll need to get a prescription from your doctor (be it a dermatologist, obgyn, or PCP) or a telehealth provider, like a nurse practitioner, with prescribing privileges.
How much does it cost?
Generic oral minoxidil can cost as little as $10 out-of-pocket for a month’s supply (which can be stretched to two months if you’re taking half a pill daily). Branded (like Loniten) or compounded forms (which might add vitamins or a DHT blocker to the oral minoxidil and are often sold by telehealth sites) tend to cost more. But remember that compounded drugs aren’t approved by the FDA for safety and effectiveness, and if there’s a safe, effective, and cheaper FDA-approved generic option, the choice seems clear.
