Do you love your hair the way it is? Many of us wish our hair were different–curlier, straighter, darker or lighter. But what people worry about most with their hair is when they lose it. Can you keep your hair from falling out? Why does hair loss affect some people, including women as well as men? Why do others seem relatively unaffected? What’s the latest update on low-dose oral minoxidil for hair loss?

While there is some familial component to male pattern baldness (despite the name, it affects women too), the exact genetics are unclear. Other causes of hair loss include autoimmune disease such as alopecia areata or hormone imbalance such as thyroid disorders. Pregnancy is a common cause of hair loss after delivery. That’s because the hair that has been in anagen phase (growing) shifts to telogen phase in which the hair follicle rests and the hair is no longer growing. Stress can also make hair fall out.

What Can You Do About Hair Loss?

This week’s New England Journal of Medicine (Oct. 15, 2025) has an article titled:

“Hair Loss in Women“

The author of this article is Dr. Elise A. Olsen, a dermatologist at Duke University. She is Founder and Director of the Duke Dermatopharmacology Study Center.

Here is how she introduces the problem:

“Female-pattern hair loss is the most common cause of hair loss in women. The prevalence of this condition is 3 to 12% among women of European descent in their 20s and 30s, 14 to 28% among those in their 50s, and 56% among those older than 70 years of age.”

In other words, women lose hair as they age just as many men do.

You will shortly read about some of the causes of hair loss. But in this update I want to cut right to the chase and tell you what Dr. Olsen recommends for treating “Female-Pattern Hair Loss.”

She first mentions 2% topical minoxidil solution applied two times a day or a 5% topical foam applied once a day. Dr. Olsen mentions side effects such as contact dermatitis or hair growth on the face.

She goes on to describe low-dose oral minoxidil (5 mg or less) on a daily basis. Dr. Olsen says that a 1 mg dose of oral minoxidil is “at least as effective as a daily application of a 5% topical minoxidil solution.”

She goes on to describe side effects:

“Although low-dose oral minoxidil has no substantial effect on blood pressure in most persons, women may benefit from starting at a dose of 1.25 mg per day or less and escalating slowly as long as unacceptable side effects do not occur. Peripheral edema [fluid accumulation and swelling] and hypertrichosis [unwanted hair growth], both of which can manifest after approximately 2 to 4 months of treatment and are dose related, have been reported in 1.1% and 15.1% of patients, respectively.”

If you would like to read Dr. Olsen’s entire article you will need access to the New England Journal of Medicine (Oct. 15, 2025). Your dermatologist may be able to provide you a copy. It is an excellent overview of Female-Pattern Hair Loss.

Your doctor may wish to read it herself. This overview goes on to discuss the use of the diuretic spironolactone and the antifungal agent ketoconazole. A ketoconazole shampoo is sold over the counter as Nizoral and Dr. Olsen states that a ketoconazole “shampoo is commonly prescribed for female-pattern hair loss.”

What Causes Hair Loss?

Treating the conditions that trigger hair loss can be helpful. That’s why the first test might be for thyroid function. Once a thyroid imbalance is corrected, the hair loss will generally improve.

Infection and fever can also lead to hair loss.

According to the American Academy of Dermatology:

“Most people see noticeable hair shedding two to three months after having a fever or illness. Handfuls of hair can come out when you shower or brush your hair. This hair shedding can last for six to nine months before it stops. Most people then see their hair start to look normal again and stop shedding.”

Telogen Effluvium:

Dermatologists call temporary hair loss due to stress or a shock to the system “telogen effluvium.” The word telogen means “resting.” Your hair goes through various cycles of growth. The “anagen” phase is active, when the follicle is working hard to create and grow a hair. It can last for years.

The “catagen” phase is a transition phase that just lasts a few weeks. It is followed by the “telogen” phase. Think of this stage a bit like resting or hibernation. The hair stays in the follicle, but is no longer growing. Eventually, the old hair falls out. That is called the “exogen” phase.

Effluvium is dermspeak for hair loss. So telogen effluvium means excessive hair shedding brought on by stress, infection, childbirth, weight loss, surgery, medications and a whole lot more.

Hair Loss from COVID-19?

We stumbled across an article in the journal of Medical Virology (Dec. 20, 2021) titled:

“A Systematic Review of Acute Telogen Effluvium, A Harrowing Post-COVID-19 Manifestation.”

The authors report that:

“The mean duration from COVID-19 symptom onset to the appearance of acute TE [telogen effluvium] was 74 days, which is earlier than classic acute TE. Most patients recovered from hair loss, while a few patients had persistent hair fall. Our results highlight the need to consider the possibility of post-COVID-19 acute TE in patients presenting with hair fall, with a history of COVID-19 infection, in the context of COVID-19 pandemic. Despite being a self-limiting condition, hair loss post-COVID-19 is a stressful manifestation. Identifying COVID-19 infection as a potential cause of acute TE will help the clinicians counsel the patients, relieving them from undue stress. “

Other authors have also reported hair loss after COVID infection.

Minoxidil to Keep Hair from Falling Out:

Perhaps you have heard of minoxidil (Rogaine) for hair loss. An oral version of minoxidil (Loniten) was first approved in 1979 to treat high blood pressure.

A “side effect” of excessive hair growth prompted the manufacturer to investigate the topical application against hair loss. The FDA approved prescription Rogaine in 1988. Later, the FDA allowed over-the-counter sale of this topical compound. It was never the kind of blockbuster success one might have anticipated. A drug that really keeps hair from falling out should be a billion dollar best seller!

But perhaps the problem was not with minoxidil itself. Maybe it was the topical application of the drug that led to disappointing results.

Here is a question from a reader:

Q. I am concerned about my thinning hair. I tried Rogaine and it worked well until I developed an allergic reaction.

I just read about low-dose oral minoxidil. What can you tell me about it?

A. Science writer Gina Kolata stirred up a lot of excitement in her New York Times article (Aug. 23, 2022). It was titled:

“Dermatologists who specialize in hair loss say that the key ingredient in a topical treatment worked even better when taken orally at a low dose.”

Gina describes the off-label use of low-dose oral minoxidil as an alternative to topical Rogaine (minoxidil). Several dermatologists have reported success prescribing very low doses of this blood pressure pill for people with hair loss.

The usual oral dose ranges from 5 to 40 mg per day for hypertension. However, at those doses people may experience serious side effects.

Some dermatologists are prescribing amounts that range from 0.25 to 1.25 mg (Journal of the American Academy of Dermatology, March, 2021). They often add the diuretic spironolactone (25 mg) to reduce fluid retention and counteract facial hair growth.

Topical Minoxidil Can Help Keep Hair from Falling Out:

One reader recently asked us:

Q. About two years ago, I was seriously considering a wig because I was losing so much hair above my forehead. My doctor suggested minoxidil.

The bottle says to use it twice a day for at least six months before you will see a difference. I was faithful about using it, and it does work. My hairdresser is amazed at the difference.

Now I have cut back to using it just once a day and it’s still working. I have heard that if I quit using it, I will lose my hair again. I am not willing to try that! Is there anything I should know about this OTC medicine?

A. While minoxidil does stimulate hair growth, there are some