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

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.
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.
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.
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.