Oral vs Topical Minoxidil: Which Is Best for Hair Growth?

Choosing between 2 formulas of the same treatment can feel daunting. For most women with hair loss, topical minoxidil is the option that is tried first. However, it is possible to try oral minoxidil first if it is more suitable and a clinician agrees it’s right for you. Both have pros and cons, and it is possible to switch between them. The important thing is working with a clinician to find what works best for you.

What's the Difference Between Oral and Topical Minoxidil?

Oral and topical minoxidil are both hair loss treatments for women containing the same active ingredient, but there are still key differences. Not only are they used differently, they also have different effects due to how much medication the body absorbs.

About oral minoxidil

Oral minoxidil is a once-daily prescription tablet that works to support hair growth. Unlike topical minoxidil which is applied directly to the scalp, oral minoxidil is absorbed into the bloodstream helping to stimulate hair follicles to grow new hair.

Minoxidil was originally developed as a high blood pressure treatment and using it at a lower dose for hair loss is considered an off-label prescription. This just means the medication is being used for something other than what it was licensed for, not that it isn’t a suitable and effective treatment.

Minoxidil is usually prescribed at a low dose and the dose is then adjusted to meet your needs. Doses used for hair loss are normally lower than those used for blood pressure, between 0.25 and 2.5mg. Your dose is usually adjusted based on how effective your treatment is and whether you’ve had side effects.

About topical minoxidil

Topical minoxidil is a treatment you apply directly to your scalp to support hair growth. The medication affects hair follicles directly, stimulating hair growth without the whole-body effect that oral minoxidil can have.

Topical minoxidil is usually available at a 2 or 5% solution or foam, which are available over the counter. Hers offers an unlicensed prescription-only 7% blended solution, which can be recommended by clinicians as part of a personalised treatment plan.

Which Works Better for Female Hair Loss?

Both oral and topical minoxidil can be effective hair loss treatments and there isn’t strong evidence that suggests one is a more effective treatment over the other.

Most of the research comparing oral and topical minoxidil has focused on men, so evidence specific to female-pattern hair loss is more limited. One comparative study in male pattern baldness found oral minoxidil wasn't more effective than topical overall - but because it looked only at men, at a higher dose than is typically used for hair loss, it doesn't tell us much about what to expect for women.*

Another study that included both men and women taking low-dose oral minoxidil or topical minoxidil also found no significant difference between the groups in terms of the effectiveness of treatment.⁺

So, the type of minoxidil treatment that works best is the one that suits you. This may be based on which you find easier to use and which suits your lifestyle best. Those are the main factors to consider when deciding which one to choose between oral and topical minoxidil.

*Penha MA, et al. (2024). Oral Minoxidil vs Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial.

⁺Asilian A, Farmani A, Saber M. (2024). Clinical efficacy and safety of low-dose oral minoxidil versus topical solution in the improvement of androgenetic alopecia: a randomized controlled trial.

Side Effects for Oral and Topical Minoxidil

When it comes to the side effects of minoxidil, there are some differences between oral and topical forms. Because oral minoxidil affects the whole body and topical only affects the scalp, some side effects are more likely with one than the other.

Oral minoxidil may be more likely to cause:

• Increased body hair growth

• Changes to heart rate

• Stomach-related side effects

Topical minoxidil may be more likely to cause:

• Scalp irritation

• Headache

Both treatments can cause fluid retention and swelling as common side effects. Although topical minoxidil is less likely to cause body hair growth like unwanted facial hair, it is still a common side effect, affecting up to 1 in 10 people. For oral minoxidil this is more likely and a very common side effect, affecting more than 1 in 10 people.*

*Lucky AW, et al. (2004). A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss.

Ease of Use and Lifestyle Fit

Apart from possible side effects, this is the main difference between oral and topical minoxidil. They are used differently and so there are some changes to lifestyle and routine that can be specific to topical minoxidil which don’t apply to oral minoxidil.

Using topical minoxidil

Applying topical minoxidil comes with a few extra steps: 

• Apply to the scalp once or twice a day, depending on which formulation you’re using and how it is prescribed

• Let it dry and be absorbed into hair follicles to have an effect

• Wash your hands and avoid contact between your hair and skin or anything that might transfer the minoxidil to other areas, like clothes or bedding

Using oral minoxidil

Oral minoxidil is more straightforward:

• Because oral minoxidil only involves taking a tablet each day, there’s no need to wait for hair to dry or avoid contact with your hair after taking your treatment

• It can be taken with or without food, but some people may feel sick if they take it on an empty stomach 

• Consider limiting salt or alcohol intake since minoxidil may cause fluid retention or low blood pressure

• It is recommended to take oral minoxidil at night to help minimise the impact of any potential drop in blood

  pressure

Licensing and Safety in the UK

Oral and topical minoxidil aren’t regulated in the same way when it comes to treating hair loss in the UK.

Topical minoxidil

Minoxidil 2 and 5% solutions or foams are licensed, over-the-counter treatments specifically for female pattern hair loss. 

Oral minoxidil

Minoxidil tablets are licensed in the UK for high blood pressure and not hair loss, so using oral minoxidil for hair loss is considered an off-label use. 

However, oral minoxidil has been used to treat hair loss for many years, and a growing body of clinical studies supports its effectiveness in promoting hair growth. Because its use for hair loss is off-label, it needs to be prescribed by a clinician as part of an appropriate treatment plan and cannot be obtained over the counter. Prescribing oral minoxidil in this way is legal and may be suitable following assessment and approval by a clinician.

Which One Should I Use?

Both are effective, so the right choice usually comes down to what fits your routine and priorities: normally a trade off between ease of use and certain side effects. However, lots of patients prefer oral minoxidil as it is easier to stay consistent with, which tends to lead to better results.

Why choose topical minoxidil

Choose topical minoxidil if:

• You want to minimise the risk of whole-body side effects, like extra body hair growth

• You're comfortable applying a solution or foam to your scalp daily, and letting it dry before contact with clothing, bedding or other skin

• You're uncomfortable with taking oral medication and you wash your hair regularly

Why choose oral minoxidil

Choose oral minoxidil if: 

• You'd rather take a tablet than apply a treatment to your scalp

• You want to skip the daily routine of applying and waiting for a product to dry

• You're comfortable with a small risk of whole-body side effects, like extra body hair growth

• You have pets 

Can I Use Oral and Topical Minoxidil Together?

It is possible to use oral and topical minoxidil together, but this is not recommended by Hers. Since both contain the same active ingredient, just applied through different routes, combining them won’t make them more effective. Using both forms at the same time can increase the risk of side effects. It also means you’re still applying topical minoxidil daily, while increasing the risk of whole-body side effects from oral minoxidil. In short, it combines the disadvantages of both with no additional benefits. Instead, Hers recommends finding the one treatment that suits you best. A Hers clinician can help you work through that decision and support you trying each one separately if necessary.

Alternative Hair loss treatments for women

Minoxidil isn’t the only option for treating hair loss. There are other treatments and ingredients available for women with female pattern hair loss, including medications such as spironolactone, supplements, medical procedures and cosmetic solutions. However not all alternative options suit everyone and minoxidil is considered the gold standard treatment by dermatologists for hair regrowth. 

Spironolactone

Spironolactone is an anti-androgen medication that can be prescribed off-label for female hair loss. It works by blocking androgens (male hormones) and treats hair loss by minimising the hormonal effects of DHT, making it especially effective for treating female pattern hair loss where there is a hormonal root cause. 

Vitamins and supplements

Nutritional deficiencies can lead to increased hair shedding. Iron, vitamin D, vitamin B and zinc are all important in maintaining healthy hair follicles. Supplementary vitamins can correct nutritional imbalances that might be the underlying cause of hair loss in women. 

Supplements have been shown to support hair growth and reverse hair loss.* Supplements can usually be taken with or without medication, as an alternative to minoxidil or in combination.  *Wang R, et al. (2024). Micronutrients and androgenetic alopecia: a systematic review.

Biotin

Biotin, also known as vitamin B7, plays an important role in hair and nail development. Underlying biotin deficiency can cause problems with hair growth. There have been cases where biotin supplementation has improved hair growth in people with deficiency.* *Patel DP, Swink SM, Castelo-Soccio L. (2017). A review of the use of biotin for hair loss.

Platelet-rich plasma (PRP)

PRP involves taking a small sample of blood, processing it and then injecting it into platelet-rich plasma around the scalp. This procedure is available privately in the UK but evidence that it can promote hair growth or reverse hair loss is limited.

Cosmetic options

If you prefer not to use medication to treat hair loss, there are cosmetic alternatives available. Hair extensions or products used to conceal the scalp can improve the appearance of hair loss. Alternatively a wig can be used to cover hair loss.