You can cure baldness with one very old and cheap medicine: it is more effective than technological innovations

Hair loss is a concern for many. What is not advertised for this problem: special shampoos and treatments, sometimes costing thousands of dollars, are supposed to make hair grow. But many hair loss dermatologists say most of these products don't work. New York Times.

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"There are an endless supply of useless hair growth products," often at a "considerable price," said Dr. Brett King, a dermatologist at the Yale School of Medicine. However, he added, “since the problem exists, there are still plenty of such hair growth products.”

But there is a cheap treatment, he and other dermatologists say, that costs pennies and that restores hair in many patients. This is Minoxidil, an old and well-known hair loss drug used in a very different way. Instead of being applied directly to the scalp, it is prescribed in very low dose tablets.

Not for its intended purpose

Although a growing group of dermatologists offer low-dose minoxidil tablets, this treatment remains relatively unknown to most patients and many physicians. The drug has not been approved by the Food and Drug Administration for this purpose, so it is prescribed for indications not approved by government regulators, not mentioned in the instructions for use - this is a common practice in dermatology.

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"I call us the wrong bandits, a title I'm proud of," said Dr. Adam Friedman, professor and chair of the department of dermatology at George Washington University. He explained that dermatologists are trained to understand how drugs work, which allows them to prescribe off-label drugs. In dermatology, it is often clear whether a treatment is helping. The rash goes away or not, for example.

Dr. Robert Sverlik, professor and chair of the department of dermatology at Emory University School of Medicine, agreed.

“I tell people that most of the things we do are not as advertised because nothing is as advertised,” he said. He provided a long list of conditions, including skin pigmentation, inflammatory skin conditions, and incessant itching, for which standard treatments are inadequate.

Lotion and foam

Minoxidil, the active ingredient in Rogaine, a lotion or foam rubbed on the scalp, was first approved for men in 1988, then for women in 1992, and is now a generic drug. The positive effect for the treatment of hair growth was discovered by accident several decades ago. Minoxidil high dose tablets have been used to treat high blood pressure, but patients have often noticed that the tablets cause hair growth all over the body. Therefore, its manufacturer developed a minoxidil lotion, which was eventually named Rogaine, and received approval for its use to improve hair growth on balding heads.

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But dermatologists say the lotion or foam isn't particularly effective for some patients, perhaps because they stop using it. It should get on the scalp itself, and the hair gets in the way. Many, especially women, stop using it because they don't like leaving a sticky substance in their hair.

Others find it just doesn't work for them. Minoxidil must be converted to its active form by sulfotransferase enzymes, which may or may not be present in sufficient amounts in the hair roots. When taken orally, the drug is automatically converted to the active form.

Accidental discovery

But low-dose pills didn't come about for that reason. The discovery also happened by accident 20 years ago.

Dr. Rodney Sinclair, professor of dermatology at the University of Melbourne in Australia, had a patient with female pattern baldness.

The hair on top of her head was thinning and she hated the way it looked. Unlike other patients, Rogaine worked well for her, but the drug caused an allergic rash on her scalp. But as soon as the woman stopped lubricating the scalp, her hair became sparse again.

“It was a dead end,” Dr. Sinclair said. “The patient was very motivated, and the only thing we knew was that if the patient is allergic to a topical medication, one way to reduce sensitivity is to give very low doses orally.”

To do this, Dr. Sinclair tried to split a minoxidil tablet into four parts. To his surprise, the low dose caused hair growth but did not affect her blood pressure, which was the original purpose of the higher dose drug.

Subsequently, he reduced the dose more and more until he reached an effective dose of one fortieth of a tablet and began to regularly prescribe the drug.

At a meeting in Miami in 2015, Dr. Sinclair reported that low doses of minoxidil stimulated hair growth in 100 women.

He published these findings in 2017, noting that rigorous studies are needed in which some patients will be randomly assigned to take minoxidil and others to a sugar pill. But that did not happen. So far, he says he has already treated more than 10 patients.

The future of the drug

Recently, an increasing number of hair loss dermatologists have been prescribing low-dose pills to patients with male and female pattern hair loss, which is a normal occurrence with age.

"The surge in popularity is just beginning," says Dr. Crystal Agu, a dermatologist at Johns Hopkins School of Medicine. “More and more often we share our success stories at conferences.”

Doctors who don't specialize in hair loss are "not familiar with oral minoxidil," with the exception of a rarely used high blood pressure drug that can cause heart problems. But Cristal Agu and others say the warning applies to much higher doses.

Dr. Agu warned that if your hair loss is too severe, minoxidil will not help. “It does not work, for example, on a bald man with a shiny scalp. There is nothing to restore,” she said.

She added that the ideal patient is not completely bald, but one who has lost enough hair to make it noticeable.

Without rigorous testing leading to FDA approval, however, the use of minoxidil hair loss pills remains off-label. And, say dermatologists, it will most likely stay that way.

“Oral minoxidil costs pennies a day,” Dr. King said. “There is no point in spending tens of millions of dollars on clinical trials. This study will truly never be done.”

However, some patients who take low doses of minoxidil notice that they develop erratic hair on their face and chin.

So some dermatologists, including Dr. Sinclair, have added another drug — very low doses of spironolactone, a blood pressure medication that also blocks certain sex hormones called androgens — to try and prevent unwanted hair growth.

Alternative or...

Patients who don't want to take the off-label drug are left with what some dermatologists call useless over-the-counter products or one of two FDA-approved hair growth products.

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These include Rogaine and Finasteride, a generic drug used at higher doses in men to treat benign prostatic hyperplasia. As a remedy for hair loss, it is only approved for men. It has also been associated with sexual dysfunction.

“I have seen miracles happen with minoxidil,” Dr. Agu said.

One of them was 44-year-old Brandi Gray, who lives in Moncton, Maryland.

“Over time, my hair started to fall out,” she said. “Then I started getting round patches without hair. They got worse and worse."

She saw another dermatologist who gave her shampoos and supplements but to no avail. In the end, the dermatologist told her, "There's nothing I can do for you, there's nothing more I can do."

She went to Dr. Agu, who gave her a low dose of minoxidil. Ten months later, her hair was thick and full.

“I don’t wear wigs anymore,” the patient said. “It was as if there was no hair loss.”

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