Special for Infobae of The New York Times.
Advertisements are everywhere, as are the hype: there are special shampoos and treatments, sometimes thousands of dollars, that make your hair grow; however, many hair loss dermatologists say that most of these products do not work.
“There are tons of useless hair-growth remedies out there,” and often at “considerable cost,” said Brett King, a dermatologist at Yale School of Medicine, but, he added, “because people are desperate, these remedies for hair growth continue to abound.”
However, according to him and other dermatologists, there is an inexpensive treatment that costs pennies a day and restores hair in many patients. This is minoxidil, an old and well-known drug for the treatment of hair loss that is used in a very different way. Instead of applying it directly to the scalp, it is prescribed in very low-dose pills.
Although a growing group of dermatologists offer low-dose minoxidil pills, the treatment remains relatively unknown to most patients and many doctors. It has not been approved by the US Food and Drug Administration (FDA) for this purpose, so it is prescribed without approval based on its data sheet, a common practice in dermatology.
“I call ourselves the unapproved product bandits, a title I’m proud to use,” said Adam Friedman, professor and chair of dermatology at George Washington University. He explained that dermatologists have been trained to understand how drugs work, which allows them to test unapproved drugs. In dermatology, it is often unclear whether a treatment is working. Does the rash fade or not?
Robert Swerlick, professor and chair of the dermatology department at Emory University School of Medicine, agrees.
“I tell people that most of what we prescribe is not approved because that use is not on the label,” he said. Swerlick offered a long list of conditions, such as skin pigmentation disorders, inflammatory skin disorders, and incessant itching, for which standard treatments are not approved according to his label.
Minoxidil, the active ingredient in Rogaine, a lotion or foam that is rubbed onto the scalp, was first approved for men in 1988, then for women in 1992, and is now generic. The drug’s use as a hair growth treatment was discovered by accident decades ago. High-dose minoxidil pills used to treat high blood pressure, but patients often found that the pills caused hair growth all over their bodies. So its manufacturer developed a minoxidil lotion (which ended up being called Rogaine) and got it approved for growing hair on bald heads.
However, dermatologists say that the lotion or foam is not very effective for some patients, perhaps because they stop applying it. It has to reach the scalp and the hair interferes. Many people, especially women, stop using it because they don’t like leaving the sticky substance in their hair.
Johnson and Johnson, the company that currently owns Rogaine, did not respond to requests for comment.
Others feel that it just doesn’t work for them. Minoxidil has to be converted into an active form by sulfotransferase enzymes, which may or may not be present in sufficient amounts in the hair roots. When the drug is taken orally, it automatically assumes an active form.
However, that was not the reason why low-dose pills were discovered, rather the discovery also happened by accident 20 years ago.
Rodney Sinclair, a professor of dermatology at the University of Melbourne, Australia, had a patient with female pattern hair loss. The hair on the top of her head had thinned and she hated the way she looked. Unlike most of her patients, the Rogaine worked for her, but she developed an allergic scalp rash from the medication; however, if she stopped taking it, her hair would thin again.
“So I was in a dilemma,” Sinclair said. “The patient was highly motivated, and all we knew was that if a patient is allergic to a topical medication, one way to desensitize them is to give them very low doses orally.”
To do so, Sinclair tried cutting minoxidil pills into quarters. To his surprise, the low dose caused his hair to grow, but did not affect his blood pressure, which is the original goal of the drug at higher doses.
Subsequently, he lowered the dose further and further until he reached effective doses of one fortieth of a pill and began prescribing the drug routinely. That first patient is still taking it.
At a meeting in Miami in 2015, Sinclair reported that low doses of minoxidil caused hair growth in 100 consecutive women.
Sinclair published those results in 2017, noting that rigorous studies were needed in which some patients would be randomly prescribed minoxidil and others a sugar pill, but that hasn’t happened. She said that so far she has treated more than 10,000 patients.
Recently, an increasing number of hair loss dermatologists have been prescribing the reduced-dose pills to patients with male and female pattern hair loss, a normal occurrence with aging.
“The popularity is starting to pick up,” said Crystal Aguh, a dermatologist at Johns Hopkins School of Medicine. “At conferences, we share our success stories more and more often.”
Doctors who don’t specialize in hair loss, he added, “wouldn’t be familiar with oral minoxidil,” except as a rarely used treatment for high blood pressure that comes with a warning that it can cause heart problems. According to her and others, the warning is for much higher doses.
If hair loss is severe, minoxidil won’t help, Aguh said. “For example, it won’t work if a man is mostly bald, with a shiny scalp. There is nothing to restore.” He added that the ideal patient is not completely bald, but he has lost enough hair for even a casual observer to notice.
However, without a rigorous trial leading to FDA approval, the use of minoxidil pills for hair loss remains off-label for such use, and, according to dermatologists, is likely to remain so.
“Oral minoxidil costs pennies a day,” King concluded. “There is no motivation to spend tens of millions of dollars to test it in a clinical trial. In reality, that study will never be done.”