Patient Barriers to Topical Minoxidil Treatment in Alopecia Identified

Fear of side effects, concern for life-long use, and lack of effectiveness are common patient barriers to minoxidil treatment for hair loss.

Minoxidil is an efficacious treatment with relatively few and mild side effects in patients with androgenetic alopecia (AGA), however significant barriers to minoxidil therapy include concern for life-long use, lack of effectiveness, and fear of side-effects, according to survey results reported in a letter to the editor published recently in the Journal of Drugs in Dermatology.

Investigators sought to identify perceptions, attitudes, and barriers-to-care related to therapy with topical minoxidil in patients with hair loss.

They initiated a survey that included 93 patients (79% women) at the George Washington University Dermatology Department who presented to clinic with a complaint of hair loss or alopecia (35% for >5 years). They found that although nearly 80% of survey respondents (42% Black, 34% White, 13% Hispanic or Latino, respectively) were aware of minoxidil, among that subgroup only 20% had used minoxidil in the past, and only 15% were currently using minoxidil. Current and past users rating satisfaction with minoxidil treatment using a Likert scale of 5 (very satisfied) to 1 (very unsatisfied) resulted in an average score of 2.78±1.18 with past users reporting lower satisfaction (2.22±1.22) than current users (3.50±0.65).

Investigators noted that the most common reasons respondents never tried minoxidil, or why they had tried but stopped treatment, included concern for unwanted side effects (39%), concern for cost (29%), and concern about life-long use (27%). They noted that 24% of respondents never tried minoxidil because they had “heard that when you stop treatment all of your hair falls out.”

…some of the common barriers to minoxidil include fear of side effects, concern for life-long use, and lack of effectiveness.

Investigators observed that the main reason for stopping treatment with minoxidil, seen in 13 of 19 respondents, was lack of effectiveness. Of these 13 respondents, 4 indicated that they used minoxidil for at least 6 to 12 months, and 9 respondents reported use of less than 6 months. Among all previous users, cost (47%) and life-long use (32%) were major concerns, and 21% experienced negative side effects. 

Investigators concluded that their survey showed “some of the common barriers to minoxidil include fear of side effects, concern for life-long use, and lack of effectiveness.” Investigators believe minoxidil to be an efficacious treatment with relatively few and mild side-effects and best results are seen with regular use that may take up to a year to realize. As there is no cure for AGA, and minoxidil can be a life-long treatment, they suggest “it may be helpful to counsel concerned patients that regular use of minoxidil will lead to the most benefit, much like brushing one’s teeth or sunscreen use.”


Nussbaum D, Murphy E, Nelson K, et al. A survey of patient attitudes towards topical minoxidil in the treatment of hair loss. J Drugs Dermatol. October 1, 2022;21(10):1140-1142. doi:10.36849/JDD.6943