J Gandhara Med Dent Sci

April - June 2026

EFFICACY OF ORAL MINOXIDIL IN THE TREATMENT OF ANDROGENIC ALOPECIA IN MALE

PATIENTS PRESENTING AT A TERTIARY CARE HOSPITAL

Neelam Siraj

, Naheed Asghar

, Irum Shaukat

, Ayesha Naeem

, Ayesha Ahsan

, Ayesha Sadiq

, Faryal Arif

How to cite this article

Siraj N, Asghar N, Shaukat I, Naeem

A, Ahsan A, Sadiq A, et al. Efcacy

of Oral Minoxidil in the Treatment of

Androgenic Alopecia in Male Patients

Presenting at a Tertiary Care Hospital.

J Gandhara Med Dent Sci. 2026;13(2):

24-28.

Date Submission: 30-09-2025

Date Revised: 09-12-2025

Date Acceptance: 15-12-2025

Trainee Medical Ofcer, Department of

Dermatology, Hayatabad Medical

Complex, Peshawar

Specialist Registrar, Department of

Dermatology, Hayatabad Medical

Complex, Peshawar

Correspondence

Naheed Asghar,

Associate Professor,

Department of Dermatology, Hayatabad

Medical Complex, Peshawar

Peshawar

+92-316-4040189

drnaheedhmc@gmail.com

ABSTRACT

OBJECTIVES

This study aimed to determine the ecacy of oral Minoxidil in the treatment

of androgenic alopecia among male patients presenting to a tertiary care

hospital.

METHODOLOGY

A quasi-experimental study was conducted in the Department of

Dermatology, MTI-Hayatabad Medical Complex, Peshawar, from 08 August

2024 to 08 February 2025. Sixty-one male patients aged 18-60 years with

androgenic alopecia were enrolled consecutively after ethical approval. Oral

Minoxidil 5 mg once daily was administered for four months. Ecacy was

dened as ≥1 grade improvement on the Norwood–Hamilton scale after three

months of therapy. Data were collected on a st ructured proforma and

analyzed using IBM SPSS version 27. Mean ± SD was calculated for

continuous variables and n (%) for categorical variables. Chi-square or

Fisher’s exact test and logistic regression were applied, with p<0.05

considered signicant.

RESULTS

The mean age of participants was 40.31 ± 11.98 years, and the mean weight

was 74.76 ± 8.34 kg. Mean systolic and diastolic blood pressures were

124.92 ± 13.55 mmHg and 78.25 ± 11.33 mmHg, respectively, and mean

heart rate was 78.30 ± 14.43 beats/min. Dyslipidemia was present in 22

(36.1%) patients, and smoking in 25 (41.0%). Oral Minoxidil was eective in

55 (90.2%) patients. Stratied analysis and logistic regression showed no

signicant association between ecacy and patient characteristics (p>0 .05

for all).

CONCLUSION

Oral Minoxidil 5 mg once daily is highly eective in improving androgenic

alopecia in males, with response remaining consistent across demographic

and clinical subgroups.

KEYWORDS: Androgenic Alopecia, Minoxidil, Alopecia/Drug Therapy,

Hair Loss, Norwood-Hamilton Scale

INTRODUCTION

Androgenic alopecia is a hereditary condition

characterized by an exaggerated reaction to androgens

and aects around 50% of both males and females.¹

This disorder is marked by a gradual decline in hair

growth on the scalp. It usually begins after puberty and

follows a characteristic pattern in males. Hair loss is

primarily observed on the top and front sides of the

head, known as the vertex and frontotemporal regions.²

In one study of patients with androgenetic alopecia,

26.1% had grade 3, 40.6% had grade 4, 28.7% had

grade 5, and 4% had grade 6 alopecia.³ As the name

indicates, androgenic alopecia is strongly inuenced by

genetic factors and androgen activity. The condition

follows a polygenic inheritance pattern, with

contributions from both maternal and paternal genes.⁴

The likelihood of baldness is higher in individuals with

a family history of the condition. Pattern alopecia

occurs when androgen receptors are activated, typically

after puberty. Individuals with androgen insensitivity

syndrome or those castrated before puberty do not

develop pattern baldness.⁵

⁶ The development of

androgenic alopecia is closely related to hormonal

metabolism and androgen receptor activity. Activation

of androgen receptors shortens the anagen phase of the

normal hair cycle. As a result, the growth phase

becomes progressively shorter. This process leads to

follicular miniaturization. Hair follicles gradually

decrease in size and length and may eventually lose

their ability to penetrate the outer layer of the skin.⁷

⁸

Oral Minoxidil has emerged as an eective therapeutic

option for androgenetic alopecia. It helps reduce hair

loss progression and promotes hair regrowth.⁹

Minoxidil was originally developed as an

antihypertensive drug. Later, it gained attention for its

https://doi.org/10.37762/jgmds.13-2.834

J Gandhara Med Dent Sci

April - June 2026

unexpected side eect: hair growth. Although topical

formulations are widely used, oral Minoxidil has

recently attracted interest due to its potential systemic

effects on hair follicles.¹⁰

¹¹ A study reported an ecacy

of 90.2% of oral Minoxidil in male patients with

androgenetic alopecia.¹² Androgenic alopecia is one of

the most common causes of hair loss in men. However,

local literature on its treatment remains limited.

Therefore, this study was conducted to determine the

efcacy of oral Minoxidil in male patients presenting

with androgenic alopecia at our health care setup. The

findings of this study will help clinicians better

understand the benets and potential risks of oral

Minoxidil. This may support informed decision-making

and improve personalized management of hair loss.

METHODOLOGY

This quasi-experimental study was conducted at the

Department of Dermatology, MTI-Hayatabad Medical

Complex, Peshawar, after obtaining approval from the

Institutional Review and Ethical Board (Approval No.

1861) and the Research Evaluation Unit of the College

of Physicians and Surgeons, Pakistan. Data collection

commenced after ethical approval and continued for six

months from 08 August, 2024 to 08 February, 2025. A

total of 61 male patients aged 18-60 years presenting

with androgenic alopecia were enrolled consecutively.

The sample size of 61 was calculated using the WHO

sample size calculator, assuming an ecacy of oral

Minoxidil of 90.2%, a condence level of 95%, and a

margin of error of 7.5%. Male patients aged 18-60

years with androgenic alopecia were included, whereas

those with heart failure, medication-induced hair loss,

thyroid disorders, or cicatricial alopecia were excluded.

Androgenic alopecia was dened as progressive hair

thinning over the frontal or parietal scalp, with

relatively preserved occipital hair density, retention of

the frontal hairline, and the presence of miniaturized

hairs. Oral Minoxidil was administered at a dose of 5

mg once daily for four months. Ecacy was dened as

improvement of at least one grade on the Norwood-

Hamilton scale after 3 months of treatment, as assessed

by physical examination. Patients fullling the

inclusion criteria were enrolled consecutively after

written informed consent, and the purpose and benets

of the study were explained. A predesigned proforma

was used to record demographic details (age, weight,

educational and occupational status, socioeconomic

status, and residence), medical history (diabetes,

hypertension, dyslipidemia, and smoking status), and

baseline cardiovascular parameters (systolic and

diastolic blood pressure and heart rate). All participants

received oral Minoxidil 5 mg once daily for four

months under dermatological supervision, and hair

growth response was assessed at baseline and after

three months using the Norwood-Hamilton scale.

Statistical analysis was performed using IBM SPSS

Statistics version 27.0. For numerical variables such as

age, weight, systolic and diastolic blood pressure, and

heart rate, the mean ± standard deviation or the median

(interquartile range) was calculated depending on the

data distribution. Normality was assessed using the

Shapiro-Wilk test. Frequencies and percentages were

calculated for categorical variables, including ecacy,

dyslipidemia, smoking, educational status, occupation,

and socioeconomic status. Ecacy was stratied by

age, weight, heart rate, blood pressure, dyslipidemia,

smoking status, educational status, occupation, and

socioeconomic status to control for potential eect

modifiers. Post-stratification, the Chi-square or Fisher’s

exact test was applied where appropriate. A p-value

<0.05 was considered statistically signicant.

RESULTS

A total of 61 male patients with androgenic alopecia

were enrolled. The mean age was 40.31 ± 11.98 years,

and the mean weight was 74.76 ± 8.34 kg. The mean

systolic and diastolic blood pressures were 124.92 ±

13.55 mmHg and 78.25 ± 11.33 mmHg, respectively,

while the mean heart rate was 78.30 ± 14.43 beats/min.

Table 1: Baseline Characteristics of Study Participants (n = 61)

Categorical Variables Category Frequency

(n)

%age

Dyslipidemia

Yes 22 36.1

No 39 63.9

Smoking

Yes 25 41.0

No 36 59.0

Education Status

Educated 52 85.2

Uneducated 09 14.8

Occupation Status

Employed 40 65.6

Unemployed 21 34.4

Socioeconomic Status

Lower 22 36.1

Middle 32 52.5

Eicacy of Oral

Minoxidil

Upper 07 11.5

Yes 55 90.2

Ecacy of Oral Minoxidil in the Treatment of Androgenic

J Gandhara Med Dent Sci

April - June 2026

Table 2: Ecacy of Oral Minoxidil by Patient Characteristics

(n = 61)

Characteri

stic

Subcat

egory

Eicacy Total n

(%)

value

Yes n (%)

No n (%)

Dyslipidem

Yes 20 (90.9) 02 (9.1) 22

(100.0)

>0.99

No 35 (89.7) 04 (10.3) 39

(100.0)

Smoking

Yes 23 (92.0) 02 (8.0) 25

(100.0)

>0.99

No 32 (88.9) 04 (11.1) 36

(100.0)

Education

Status

Educated

48 (92.3) 04 (7.7) 52 (100.0)

0.212

Uneduc

ated

07 (77.8) 02 (22.2) 9

(100.0)

Occupation

Status

Emplo

yed

36 (90.0) 04 (10.0) 40

(100.0)

>0.99

Unemp

loyed

19 (90.5) 02 (9.5) 21

(100.0)

Socioecono

mic Status

Lower 21 (95.5) 01 (4.5) 22

(100.0)

0.176

Middle 29 (90.6) 03 (9.4) 32

(100.0)

Upper 05 (71.4) 02 (28.6) 07

(100.0)

Table 3: Logistic Regression of Factors Associated with Ecacy

of Minoxidil (n = 61)

Variable Category

(Reference)

Adjusted

Odds

Ratio

(OR)

95%

Confidence

Interval

(CI)

value

Dyslipidemia

Yes vs No 1.13 0.22 – 5.82 >0.99

Smoking

Yes vs No 1.32 0.22 – 7.76 >0.99

Education

Status

Educated vs

Uneducated

4.66 0.60 – 36.3 0.212

Occupation

Status

Employed vs

Unemployed

1.06 0.18 – 6.08 >0.9

Socioecono

mic Status

Middle vs

Lower

0.61 0.07 – 5.31 0.176

Upper vs

Lower

0.12 0.01 – 1.65

DISCUSSION

In this study, oral Minoxidil 5 mg once daily

demonstrated a high ecacy rate (90.2%) in improving

Androgenic alopecia in male patients, consistent with

previously reported results with low-dose oral

minoxidil regimens.¹³ This high response underscores

the potential of oral Minoxidil as a viable therapeutic

option, complementing or potentially substituting

topical formulations in cases of low compliance or

scalp intolerance. Comparative evidence suggests that

while oral and topical Minoxidil may yield similar

improvements in hair density over time, oral

formulations oer advantages in ease of administration

and adherence. A randomized trial comparing oral (5

mg/day) versus topical (5%) Minoxidil observed

comparable improvements in terminal and total hair

density over 24 weeks, although oral treatment was

associated with more hypertrichosis and some systemic

side eects.¹⁴ Similarly, a recent meta-analysis of

multiple studies conrmed the favorable tolerability of

oral Minoxidil, with adverse eects largely mild and

manageable.¹⁵ Our stratied analysis revealed no

statistically signicant dierences in ecacy across

subgroups dened by dyslipidemia, smoking status,

education, occupation, or socioeconomic status,

indicating that oral Minoxidil’s eect is largely

consistent across these demographic and clinical strata.

This uniformity is clinically reassuring, suggesting that

baseline comorbidities may not significantly alter

response in men with AGA. Safety remains a key

consideration for systemic therapy. Low-dose oral

Minoxidil has been generally well tolerated in the

dermatologic literature.¹⁶ In large series, hypertrichosis

is the most frequent adverse effect, while

cardiovascular events, such as hypotension or

tachycardia, are rare in otherwise healthy individuals.¹⁷

One safety study involving over 1,400 patients reported

hypertrichosis in ~15 % of patients, with treatment

discontinuation in <1 %.¹⁸ In our study, no serious

cardiovascular events or hypotension necessitating

withdrawal were observed, though we acknowledge our

sample size limits detection of rare events.

Mechanistically, Minoxidil acts as a potassium channel

opener and vasodilator, increasing capillary blood ow

and promoting the anagen phase of hair follicles.¹⁹

Dose-dependent responses have been noted, with some

evidence that higher low-dose regimens yield greater

hair growth but also increased risk of side eects.²⁰

This balance between efcacy and safety may guide

optimal dosing in future studies. In this study, oral

Minoxidil 5 mg once daily demonstrated high ecacy

(90.2%) in male androgenic alopecia, with no

significant dierences across demographic or clinical

variables. Logistic regression analysis revealed that

dyslipidemia, smoking, education, occupation, and

socioeconomic status were not signicant predictors of

response, suggesting a consistent therapeutic eect

across patient subgroups. These ndings are consistent

with previous reports showing that oral Minoxidil is

effective and safe regardless of comorbidities or

lifestyle factors.

The uniform ecacy may be

explained by its localized action on hair follicles

through potassium channel activation and stimulation of

vascular endothelial growth factor (VEGF),

mechanisms largely independent of systemic

conditions.

Overall, this study supports prior evidence

that low-dose oral Minoxidil provides reliable and

uniform therapeutic outcomes in male Androgenic

alopecia.

The slightly higher, though non-signicant,

odds of response among educated participants could be

attributed to better treatment adherence and

understanding of therapy, a pattern commonly observed

in chronic dermatological treatments.

Ecacy of Oral Minoxidil in the Treatment of Androgenic

J Gandhara Med Dent Sci

April - June 2026

LIMITATIONS

The quasi-experimental (non-randomized) design,

single-centre setting, and relatively small sample size,

which may limit generalizability and the power to

detect subgroup dierences or rare adverse events.

Moreover, our follow-up period (three months to assess

efcacy) is shorter than many longer-term trials;

sustained response and long-term safety require further

study.

CONCLUSIONS

Oral Minoxidil at a dose of 5 mg once daily

demonstrated high ecacy, with 90% of male patients

with Androgenic alopecia achieving at least a 1-grade

improvement on the Norwood-Hamilton scale after 3

months of treatment. The response was consistent

across dierent demographic and clinical subgroups,

and no serious adverse events were observed during the

study period. These ndings support the use of low-

dose oral Minoxidil as an eective and well-tolerated

therapeutic option for male Androgenic alopecia in our

local population. Larger randomized studies with longer

follow-up are recommended to conrm long-term

safety and comparative eectiveness. Oral minoxidil

efcacy showed no signicant association with

demographic or clinical variables. The treatment

demonstrated a uniform therapeutic response across all

patient subgroups.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

REFERENCES

1. Lolli F, Pallotti F, Rossi A, Fortuna MC, Caro G, Lenzi A, et al.

Androgenetic alopecia: A review. Endocrine. 2017;57(1):9-17.

doi:10.1007/s12020-017-1280-y

2. Sasaki GH. Review of human hair follicle biology: Dynamics of

niches and stem cell regulation for possible therapeutic hair

stimulation for plastic surgeons. Aesthetic Plast Surg.

2019;43(1):253-266. doi:10.1007/s00266-018-1248-1

3. Sheikh FZ, Butt G, Hafeez R, Maqsood A, Altaf F, Hussain I.

Association of early-onset androgenic alopecia and metabolic

syndrome. J Coll Physicians Surg Pak. 2021;31(2):123-127.

doi:10.29271/jcpsp.2021.02.123

4. Chan L, Cook DK. Female pattern hair loss. Aust J Gen Pract.

2018;47(7):459-464. doi:10.31128/AJGP-02-18-4498

5. Lee WS, Lee HJ. Characteristics of androgenetic alopecia in

Asians. Ann Dermatol. 2012;24(3):243-252.

doi:10.5021/ad.2012.24.3.243

6. Heilmann-Heimbach S, Hochfeld LM, Paus R, Nöthen MM.

Hunting the genes in male-pattern alopecia: How important are

they, how close are we and what will they tell us? Exp

Dermatol. 2020;29(9):814-827. doi:10.1111/exd.14130

7. Bienenfeld A, Azarchi S, Lo Sicco K, Marchbein S, Shapiro J,

Nagler AR. Androgens in women: Androgen-mediated skin

disease and patient evaluation. J Am Acad Dermatol.

7- 1506. doi:10.1016/j.jaad.2018.08.0622019;80(6):149

8. Suchonwanit P, Thammarucha S, Leerunyakul K. Minoxidil and

its use in hair disorders: A review. Drug Des Devel Ther.

2019;13:2777-2786. doi:10.2147/DDDT.S214907

9. Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A

review of ecacy and safety. J Am Acad Dermatol.

2021;84(3):737-746. doi:10.1016/j.jaad.2020.06.1009

10. Chen L, Zhang Y, Xu M, Wang S, Fu Z. The ecacy and safety

of nasteride combined with topical Minoxidil for androgenetic

alopecia: A systematic review and meta-analysis. Aesthetic

Plast Surg. 2020;44(5):1962-1972. doi:10.1007/s00266-020-

01621-5

11. Alherheli G. Oral minoxidil therapy in hair loss: Where do we

stand? Curr Dermatol Rep. 2023;12(1):1-7.

doi:10.1007/s13671-023-00395-z

12. Jiménez-Cauhé J, Saceda-Corralo D, Rodrigues-Barata R,

Hermosa-Gelbard Á, Moreno-Arrones OM, Fernández-Nieto D,

et al. Eectiveness and safety of low-dose oral Minoxidil in

male androgenetic alopecia. J Am Acad Dermatol.

2019;81(2):648-649. doi:10.1016/j.jaad.2019.04.054

13. Penha MA, Miot HA, Kasprzak M, Müller Ramos P. Oral

minoxidil vs topical Minoxidil for male androgenetic alopecia:

A randomized clinical trial. JAMA Dermatol. 2024;160(6):600-

605. doi:10.1001/jamadermatol.2024.0284

14. Vañó-Galván S, Pirmez R, Hermosa-Gelbard Á, Moreno-

Arrones OM, Saceda-Corralo D, Rodrigues-Barata R, et al.

Safety of low-dose oral Minoxidil for hair loss: A multicenter

study of 1404 patients. J Am Acad Dermatol. 2021;84(6):1644-

1651. doi:10.1016/j.jaad.2021.02.054

15. Ramos PM, Miot HA, Marques-Meirelles MF, da Silva MG,

Silveira D, Penha MA, et al. Minoxidil 1 mg oral versus

minoxidil 5% topical solution for the treatment of female-

pattern hair loss: A randomized clinical trial. J Am Acad

Dermatol. 2020;83(5):1290-1292.

doi:10.1016/j.jaad.2019.08.060

16. Pirmez R, Salas-Callo CI, Vañó-Galván S. Very low-dose oral

minoxidil in male androgenetic alopecia: A retrospective study

with trichoscopy-guided dose adjustment. J Am Acad Dermatol.

2020;83(1):e13-e14. doi:10.1016/j.jaad.2019.08.084

17. Messenger AG, Rundegren J. Minoxidil: Mechanisms of action

on hair growth. Br J Dermatol. 2004;150(2):186-194.

doi:10.1111/j.1365-2133.2004.05785.x

18. Han JH, Kwon OS, Chung JH, Cho KH, Eun HC, Kim KH.

Effect of Minoxidil on proliferation and apoptosis in dermal

papilla cells of human hair follicle. J Dermatol Sci.

2004;34(2):91-98. doi:10.1016/j.jdermsci.2004.01.002

19. Kwon OS, Han JH, Yoo HG, Kwon O, Chung JH, Cho KH, et

al. Promotive eect of Minoxidil combined with all-trans

retinoic acid (tretinoin) on human hair growth in vitro. J Korean

Med Sci. 2007;22(2):283-289. doi:10.3346/jkms.2007.22.2.283

20. Kwack MH, Kang BM, Kim MK, Kim JC, Sung YK. Minoxidil

activates β-catenin pathway in human dermal papilla cells: A

possible explanation for its anagen prolongation eect. J

Dermatol Sci. 2011;62(3):154-159.

doi:10.1016/j.jdermsci.2011.01.013

Ecacy of Oral Minoxidil in the Treatment of Androgenic

J Gandhara Med Dent Sci

April - June 2026

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Neelam Siraj - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Final Approval

Naheed Asghar - Concept & Design; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Irum Shaukat - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Final Approval

Ayesha Naeem - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Final Approval

Ayesha Ahsan - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Final Approval

Ayesha Sadiq - Concept & Design; Data Acquisition; Drafting

Manuscript; Final Approval

Faryal Arif - Concept & Design; Data Acquisition; Drafting

Manuscript; Final Approval

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Ecacy of Oral Minoxidil in the Treatment of Androgenic