Survey of Dermatology Practitioners’ Opinions and Prescribing Habits of Oral Minoxidil for the Treatment of Androgenetic Alopecia

March 2024 | Volume 23 | Issue 3 | 136 | Copyright © March 2024


Published online February 14, 2024

doi:10.36849/JDD.7519

Eric Sanfilippo BSa, Adam Friedman MD FAADb

aThe George Washington University School of Medicine and Health Sciences, Washington, DC 
bDepartment of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC

Abstract
Background: Utilization of low-dose oral minoxidil has increased in recent years in association with several clinical studies that have shown its efficacy in treating androgenetic alopecia (AGA). 
Objective: To assess dermatology providers' attitudes and recommendation behaviors of oral minoxidil for the treatment of AGA.
Methods: An online survey gauging the professional opinions, prescribing behaviors, and use of oral minoxidil was sent using the Orlando Dermatology Aesthetic and Clinical Conference email listserv which included multiple levels of dermatology practitioners including MD/DOs, NPs, and PAs across the United States.
Results: Overall, the survey was sent to 2200 providers, and 201 (9.1%) responses were collected. 81% (n=139) of respondents supported the use of oral minoxidil for AGA. Support varied significantly (P=.03) by providers' number of years in practice with those in practice for greater than 30 years with the least amount of support. 92% of respondents (130, n=141) reported feeling comfortable prescribing oral minoxidil, and 83% (116, n=140) found oral minoxidil to be better than its topical formulation. 78% (108, n=139) felt their patients were satisfied with their results, and 89% (124, n=140) felt oral minoxidil was well tolerated by their patients.
Conclusions: This study found that most prescribers use oral minoxidil as a treatment for AGA and find it to be an effective and tolerable option for patients. Support for oral minoxidil was significantly impacted by providers' years in practice. 

J Drugs Dermatol. 2024;23(3):136-140.  doi:10.36849/JDD.7519

INTRODUCTION

Androgenetic alopecia (AGA) results in progressive hair loss due to miniaturization of hair follicles secondary to androgen influence.1 AGA affects both men and women and is a common dermatologic complaint that causes significant patient distress. Minoxidil was initially developed as an anti-hypertensive medication and was incidentally found to increase hair density. While its use as an anti-hypertensive has fallen out of favor, it continues to be used in its topical formulation for various alopecic conditions and is one of only two Food and Drug Administration (FDA)-approved medications for AGA. Its mechanism of action for hair growth is not clearly defined; however, it is proposed to work by promoting increased regional scalp blood flow and stimulation of vascular endothelial growth factor.2 Attention has been drawn to oral minoxidil due to its superior efficacy compared to topical, as well as its cost and ease of use for patients.3,4 The side effect profile of oral minoxidil is more pronounced than its topical counterpart due to its systemic metabolism; these effects include hypertrichosis, pretibial edema, hypotension, and hypernatremia.5 

Utilization of low-dose oral minoxidil (LDOM) has increased in recent years in association with several clinical studies that have shown its efficacy in treating AGA and other hair loss conditions.6-9 Given that oral minoxidil is not FDA-approved for the treatment of AGA, there is a lack of guidance in prescribing, as well as a lack of consensus regarding its role in treatment. We assessed dermatology providers' attitudes and recommendation behaviors of oral minoxidil for the treatment of AGA.

MATERIALS AND METHODS

An online survey gauging the professional opinions, prescribing behaviors, and use of oral minoxidil was sent using the Orlando Dermatology Aesthetic and Clinical Conference email listserv which included multiple levels of dermatology practitioners including MD/DOs, NPs, and PAs across the United States. Data analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). This study was approved by the George Washington University Institutional Review Board #NCR224464.

RESULTS

Overall, the survey was sent to 2200 providers, and 201 responses were collected (9.1% response rate; Table 1). 81% were Board Certified Dermatologists, and most respondents practiced in a private setting, followed by an academic or VA
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