Most practitioner - but not all - think oral minoxidil

I enjoyed reading a study by Sanfilippo and Friedman in the March issue of the Journal of Drugs in Dermatology about practitioners' opinions on the benefits of oral minoxidil.

Oral minoxidil is increasingly popular. What matters most to me is what the science says. Is oral minoxidil helpful, and is it better than topical minoxidil, and what are the long-term side effects of oral minoxidil after 35 years of use? It’s now clear that oral minoxidil is helpful. It’s not entirely clear if it’s better than topical minoxidil - at least based on wonderful studies like the study we reviewed by Penha et al. That study showed that oral minoxidil failed to beat topical minoxidil in hair growth. The two were somewhat similar. However, just when you think the case is sealed - and you are about to write in the history books forever that oral minoxidil and topical minoxidil are equivalent - those same authors showed that photographic assessments done by doctors suggested that oral minoxidil was, in fact, better than topical minoxidil for helping hair growth in the crown but pretty equivalent for helping improve hair in the frontal scalp.

If I spent my days simply reviewing the most incredibly well-conducted studies in the world, I’d miss out on a lot of important information. What matters to me is what patients think about specific diseases and treatments and what healthcare practitioners feel about specific diseases and treatments. I call these types of studies the “pulse” of the world!

I’m interested in this information not because it influences WHAT I do in my clinic but because it influences HOW I do it. If repeated studies show convincingly that drug A is better than drug B, but repeated surveys show that the entire planet (patients and doctors alike) still feels drug B is better than drug A, does it mean that I proceed to prescribe drug B? Well, no, but it means that I have my work cut out to counsel patients, and I have my work cut out to explain things to my colleagues.

The Sanfilippo and Friedman study of 2024 is one of those studies that tell me what sort of work I have waiting when discussing oral minoxidil with colleagues. The study showed that approximately 10 % of practitioners don’t feel comfortable prescribing oral minoxidil, 10 % don’t feel oral minoxidil is well tolerated by patients, approximately 20 % don’t feel oral minoxidil is better than topical, and 20 % feel their patients aren’t so satisfied with results.

Now, this is not a study of who is right and who is wrong—it is an estimate of practitioners' views. This is the pulse!

Sanfilippo and Friedman 2024

The authors set out to evaluate dermatology providers' attitudes and recommendation behaviours of oral minoxidil for treating AGA. They performed an online survey. The survey was sent to those attending the Orlando Dermatology Aesthetic and Clinical Conference. The survey participants included many types of dermatology practitioners, including MD/DOs, NPs, and PAs across the United States.

What were the results?

The survey was sent to about 2,200 providers. The response rate was poor, and just 201 (9.1%) of surveys came back. This, of course, opens the door to all sorts of bias. People who love oral minoxidil might be more likely to fill out the survey…. or maybe people who detest oral minoxidil might be more likely to fill out the survey. Who knows?

Overall, here are some key points:

a) 81% (n=139) of respondents supported using oral minoxidil for AGA.

b) Those in practice over 30 years gave the least support.

c) 92% of respondents stated they were comfortable prescribing oral minoxidil

d) 83% of respondents felt oral minoxidil was more effective than its topical formulation.

e) 78% of respondents felt their patients were satisfied with the results of using oral minoxidil

f) 89% of respondents felt oral minoxidil was well tolerated by their patients.

Comments

I liked this study. Despite the extremely low response rates, this study has much to offer. It’s clear that positive views outweigh the negative ones - but the negative ones should not be discarded. Not everyone shares the same love and infatuation for oral minoxidil. Not every one of our colleagues has set sail on the oral minoxidil cruise ship.

Let’s face it—at least in this study—10 % of practitioners don’t feel comfortable prescribing oral minoxidil, 10 % don’t feel it is well tolerated by patients, approximately 20 % don’t feel it is better than topical, and 20 % feel their patients aren’t so satisfied with results.

If you believe that long-time practitioners are wise and experienced, you’ll find it interesting that they are less likely to be in love with oral minoxidil.

If you believe that long-time practitioners are inflexible, rigid in their ways, and unwilling to try new things, then you may not be surprised that this group is less likely to be in love with oral minoxidil.

What’s your view?

Congratulations to these authors for a wonderful study highlighting the “pulse” of oral minoxidil amongst practitioners in the United States.

REFERENCES

Eric Sanfilippo and Adam Friedman. Survey of Dermatology Practitioners' Opinions and Prescribing Habits of Oral Minoxidil for the Treatment of Androgenetic Alopecia. J Drugs Dermatol . 2024 Mar 1;23(3):136-140. doi: 10.36849/jdd.7519.

Mariana Alvares Penha 1, Hélio Amante Miot 1, Michal Kasprzak 2, Paulo Müller Ramos. Oral Minoxidil vs Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial. JAMA Dermatol . 2024 Apr 10:e240284. doi: 10.1001/jamadermatol.2024.0284. Online ahead of print