New Hair Transplant Physician Consensus Study is being published on the use of low dose minoxidil for managing hair loss.

Note from Dr. Wasserbauer: It was an honor to be asked to be a part of the group that created the consensus recommendations for Low-Dose Oral Minoxidil and Topical Minoxidil.  We reviewed data from the early days of prescribing oral minoxidil 20 years ago (how time flies!) to the New York Times article that popularized it in 2022 (https://www.nytimes.com/2022/08/18/health/minoxidil-hair-loss-pills.html)  Sometimes, when a medication is used off-label, the “subject experts” who use it have to assemble their opinions on what is effective and safe outside of a clinical trial, so that is how this paper – a “concensus study” was initiated.

Soon to be published, this paper will help those who are starting to help their patients have a guideline for effective treatment. 

Title:Low-dose oral minoxidil (LDOM) and topical minoxidil: consensus recommendations for managing male and female pattern Hair loss in Hair transplant patients using a modified delphi process.

Article highlights

Consensus statements were developed using a three-round modified Delphi process with a predefined consensus threshold of at least 70%.

Prior to starting LDOM, baseline tests include blood pressure monitoring and body weight measurement.

For MPHL, the recommended LDOM starting dose is 1.25–2.5 mg daily, with a maximum daily dose of 5 mg.

For FPHL, the recommended LDOM starting dose is 0.625–1.25 mg daily, with a maximum daily dose of 2.5 mg.

LDOM 5 mg/day produces more side effects than 2.5 mg/day, supporting a dose-dependent risk profile for many adverse effects. Clinical improvement is typically expected within 4–6 months, and treatment can be continued long-term if it remains effective and well tolerated.

In patients with no cardiovascular indication, a beta blocker is not routinely required when prescribing LDOM.

Side effects of LDOM include tachycardia (onset within 1–3 days), headache (onset at about one week), peripheral edema (onset around one month), and hypertrichosis (extra facial/body hair, onset after 60–90 days). Hypertrichosis is dose-related and manageable through dose-change and hair removal methods. Other adverse-effects that patients should remain vigilant for include light-headedness or dizziness, shortness of breath, a fast or abnormal heartbeat, chest pain, swollen feet or legs, facial swelling, and weight gain. Patients should promptly report any of these adverse effects to their healthcare professional. Possible ankle/hand/under eye swelling, and sudden weight gain (fluid retention): dose-related and generally treatable (dose change or diuretic such as spironolactone in women).

Temporary increase in shedding is common and often indicates follicles resetting into a growth phase.

After hair-transplant surgery, LDOM can usually be restarted 1–3 days post-procedure, while topical minoxidil can generally be applied in the grafted area after 7–14 days.

5% topical minoxidil is considered effective at both the frontal scalp and the vertex, and should be avoided during pregnancy and breastfeeding.

Author Contributions

The study was conceived and designed by the steering committee (A.K. Gupta, M. Talukder and G. Williams). The steering committee developed the protocol, drafted the initial item pool, piloted the survey instruments, prespecified consensus thresholds, and oversaw all Delphi rounds. A.K. Gupta and M. Talukder coordinated survey administration and data management. All other panel authors (H. Abdelhamid, Y. M. Akiska, D. Alpeter, S. A. Boden, R. Erfan, B. Farjo, N. Farjo, S. Gabel, J. A. Harris, K. J. Hekimian, S. Keene, J. Krejci-Manwaring, R. T. Leonard, L. A. Nader, D. Pathomvanich, D. Perez-Meza, N. E. Rogers, P. T. Rose, M. A. Schambach, R. L. Shapiro, M. Singh, D. B. Stough, R. H. True, S. M. Wasserbauer, and R. J. Welter) contributed to item generation/refinement, completed every Delphi round, and provided structured feedback. A.K. Gupta, M. Talukder and G. Williams conducted the analyses. All authors (A.K. Gupta, M. Talukder, G. Williams, H. Abdelhamid, Y. M. Akiska, D. Alpeter, S. A. Boden, R. Erfan, B. Farjo, N. Farjo, S. Gabel, J. A. Harris, K. J. Hekimian, S. Keene, J. Krejci-Manwaring, R. T. Leonard, L. A. Nader, D. Pathomvanich, D. Perez-Meza, N. E. Rogers, P. T. Rose, M. A. Schambach, R. L. Shapiro, M. Singh, D. B. Stough, R. H. True, S. M. Wasserbauer, and R. J. Welter) edited and reviewed the manuscript, and approved the submitted version.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2026.2642216