Topical vs Oral Minoxidil in Singapore: Which is Better

Did you know that the discovery of Minoxidil for hair loss was an accidental one?

In the late 1950s, the Upjohn Company (now bought over by Pfizer) developed Minoxidil for the treatment of ulcers. Unfortunately, the scientists were disappointed to find that the treatment did not cure ulcers. What they found instead was that Minoxidil could widen blood vessels and reduce blood pressure dramatically.

In 1979, the FDA approved Oral Minoxidil for the treatment of severe high blood pressure. During the clinical trials for the treatment of high blood pressure, the “accidental” discovery came when researchers noticed that one patient grew new hair on the top of his head. The growth was significant because “it was dark, thick, terminal hair – the kind that is lost in baldness”.

Research then showed that up to 80% of patients taking Oral Minoxidil experienced a troublesome side effect known as hypertrichosis: increased hair growth on the face, arms, back and chest. Topical formulations of Minoxidil were developed and in August 1988, FDA approved Topical Minoxidil under the brand name “Rogaine” for the treatment of male-pattern baldness.

Topical Minoxidil

In Singapore, Topical Minoxidil is available over-the-counter, without a prescription as a lotion with concentrations of 2%, 3% or 5% and as a 5% foam. Men who start applying Topical Minoxidil in the early stages of their baldness, and who have smaller areas of baldness, respond best to Topical Minoxidil.

Topical Minoxidil must be used twice a day for at least 4 months. Hair shedding may occur at the initiation of treatment and usually decreases within two months. Hair growth may then be seen within 4-8 months and stabilizes at 12-18 months. A full year of treatment is usually recommended.

Side effects from Topical Minoxidil are infrequent. The most common side effect experienced is scalp irritation, some also do not like the oiliness of the experience, but that can be solved by using the foam version of Topical Minoxidil.

Although Topical Minoxidil is an effective treatment option for hair loss, many patients find it hard to adhere to applying a scalp treatment twice a day.

Some may not like the resulting hair texture after application (come on, the humidity in Singapore is just unbelievable) and some may experience the unwanted scalp irritation after application of Topical Minoxidil. This leads to a search for an alternative oral option.

Oral Minoxidil

Traditionally, Oral Minoxidil was used as a potent treatment in reducing high blood pressure. It often reduces blood pressure dramatically, increasing heart rate and retains fluid in the body which can be dangerous when not monitored closely. Oral Minoxidil fell out of favour due to the development of safer and more effective blood pressure medications. Presently, Oral Minoxidil is reserved only for cases of very-difficult-to-control high blood pressure.

In recent years, there has been growing evidence that a low dose of Oral Minoxidil can be safe and effective for the treatment of male-pattern baldness. However, more studies are still required to anchor its safety and effectiveness in the treatment of male-pattern hair loss before it can be approved by the FDA.

To date, there is no Oral Minoxidil product registered with the HSA in Singapore. The recommendation by the FDA is still for Topical Minoxidil in the treatment of male-pattern baldness.

Since Oral Minoxidil is not registered with the HSA for use in Singapore, that means that doctors need to apply for a special license to bring in Oral Minoxidil in Singapore. Your doctor will be able to advise you. If you don’t have one, you can book an appointment with SIRE’s doctor here.

Topical vs Oral Minoxidil: The Verdict

Even though Topical Minoxidil has been around for more than 30 years, the way it works as a hair loss treatment is still not fully understood.

One theory proposes that Topical Minoxidil widens blood vessels resulting in an increase in blood supply to the hair follicles, which may boost the supply of nutrients encouraging hair regrowth. Another theory suggests that Topical Minoxidil is absorbed through the skin, supporting hair follicles to create new hair DNA.

We may not yet fully understand why Topical Minoxidil works, but research done has been clear that it is safe and it does help some patients to prevent further hair loss and promote hair growth.

Currently, Oral Finasteride is the only other FDA approved medication for the treatment of male-pattern hair loss. However, we know that there are certain groups of patients that do not tolerate Oral Finasteride well. The unwanted effects on sexual function are genuine concerns that one would have.

Topical Minoxidil has a lot of research backing its effectiveness in helping you regrow your hair as long as you stick to the twice-daily application requirements.

However, Oral Minoxidil does not compare in terms of the massive research that has been done backing Topical Minoxidil and Oral Finasteride as a treatment of hair loss, however, that does not mean SIRE is shutting the door to Oral Minoxidil. If you discussed your concerns with our doctors, we might be able to provide a solution tailored to your needs.

Could finasteride be the solution for you?

We’ve now weighed the benefits and requirements for effective use of Minoxidil. However, SIRE does also offer Finasteride which is a tablet that is taken once a day. Could this be for you? We have a detailed article here.

Frequently Asked Questions (FAQs)

Q: Are you compatible with Oral Minoxidil?

There are two questions you need to ask yourself:

1. Is your hair loss a symptom of some underlying condition?

Hair loss can be a sign of underlying medical problems such as thyroid disease, nutrition deficiency or hormone imbalance. So speaking to a doctor before starting treatment is important.

2. Do you have low blood pressure or pre-existing health conditions?

Minoxidil for hair loss is usually a lower dose than blood pressure dose (standard 5mg-10mg for blood pressure). For hair loss, it ranges from 0.5mg to 5mg. Hence, the side effects are seldom noticeable. If you have low blood pressure, this can complicate treatment and hence you always need to discuss this with a doctor.

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