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.

[BACKGROUND] Evidence for low-dose oral minoxidil (LDOM) and topical minoxidil in male and female pattern hair loss (MPHL and FPHL), particularly around hair transplant surgery, lack standardization. This study developed consensus-based guidance for their use in these patients.

[METHODS] An international panel involving hair transplant surgeons used a three-round modified Delphi process (consensus ≥ 70%) to rate 47 items on baseline assessment, dosing, monitoring, peri-operative use, safety, and topical minoxidil.

[RESULTS] Panelists agreed that body weight and blood pressure should be checked before initiating LDOM, with additional individualized testing. Recommended adult starting doses were 1.25-2.5 mg/day for MPHL and 0.625-1.25 mg/day for FPHL, with maximum daily doses of 5 mg and 2.5 mg, respectively. Clinical response is expected within 4-6 months. Therapy maybe continued long-term if effective and well tolerated. After hair-transplant surgery, LDOM can generally be taken 1-3 days post-procedure. Topical minoxidil can be applied to the grafted area at 7-14 days post-transplant. Topical minoxidil 5% is effective at the frontal scalp and vertex. Minoxidil should be avoided during pregnancy/breastfeeding.

[CONCLUSIONS] These consensus statements provide recommendations and a treatment algorithm for integrating LDOM and topical minoxidil into care of hair-transplant patients with pattern hair loss.