This cutting edge hair loss treatment is a repurposed drug from the 1990s
The latest trend in treating hair loss may sound familiar — essentially, it's a repurposed drug first popularized in the 1990s.
Back then, TV viewers were inundated with ads for Rogaine, a sticky topical solution that could help treat thinning hair when applied to the scalp.
Now dermatologists are increasingly prescribing the drug, known generically as minoxidil, in low-dose pills to help men and women maintain or regrow hair.
The practice follows a handful of recent studies suggesting the ingredient works as well — and possibly better — when swallowed, rather than applied to hair follicles on the head. Telehealth companies are also driving new demand by offering a quick, easy way to get a prescription and have the pills shipped directly to customers' doors.
Here's a look at the drug:
A retro approach to hair loss
Minoxidil was originally developed as a pill to treat high blood pressure in the 1970s. Researchers noticed that some patients taking it experienced increased hair growth as a side effect.
Rogaine was approved by the Food and Drug Administration in 1988, the first drug to win the agency's endorsement for male pattern baldness. Studies showed that men on the medication, which was applied directly to the scalp, had a slower rate of hair loss and, in some cases, regrew hair.
Starting in 1991, a lower dose was approved for women and the brand was aggressively marketed as an over-the-counter medication on TV and in print.
The drug's ability to slow hair loss is likely related to its effect on blood circulation, according to experts.
'By increasing blood flow to the scalp it signals hairs to stay in their grow phase for longer,' said Dr. Adam Friedman, chair of dermatology at George Washington University. 'We're trying to keep those hairs in that growth phase as long as possible.'
A recent consensus paper by more than 40 U.S. and international dermatologists concluded that minoxidil pills are effective and often more convenient and affordable than the liquid formulation.
Patients prefer the pill
There's little research comparing the two forms of minoxidil, but many dermatologists believe the drug works better as a pill.
At a chemical level, minoxidil is absorbed more directly when digested in the gut than when applied to the hairline. It's also more convenient, with patients taking the drug by mouth once a day, instead of applying the liquid once or twice daily using a dropper.
'As you can imagine, that can be rather onerous,' said Dr. Susan Taylor of the University of Pennsylvania. 'Although people often enthusiastically begin therapy— and even see results — after a while there are many who drop off.'
The doses prescribed for oral use are also very low. Dermatologists often direct men to take one half of the lowest-dose pill; women may only need a quarter of a pill.
Those low doses can also reduce the chances for side effects, which can include dizziness, rapid heartbeat and swollen legs. The drug isn't recommended for people with a history of heart issues or who are pregnant or breastfeeding.
The only other FDA-approved medication for hair loss is finasteride, sold under the brand name Propecia, a drug that blocks a byproduct of testosterone that triggers hair loss in men. That drug is generally considered more effective than minoxidil, but it can occasionally cause troubling sexual side effects, including erectile dysfunction. For optimal results, some dermatologists prescribe the two drugs in combination.
Why aren't minoxidil pills FDA-approved for hair loss?
In short, because there's very little money to be made.
Minoxidil's patent has expired and it is now available as a low-cost generic medication. That means drugmakers have little financial incentive to spend millions on the new studies that would be needed to win FDA approval for hair loss.
'For a drug like oral minoxidil — which is as old as dirt at this point — there are no reasons to do that,' said Friedman. Like other dermatologists, Friedman gives hair-loss patients a prescription for the pills intended to treat blood pressure, a practice known as off-label prescribing.
The upside for patients is that minoxidil is extremely affordable, with some pharmacies offering a month's supply for less than $5.
'Not a single patient has complained to me about the cost of this medication, which is extremely rare,' said Dr. Luiz Garza of Johns Hopkins University.
Telehealth firms open up access
The vast majority of doctors prescribing minoxidil for hair loss are dermatologists, who often turn to older drugs off-label for various hair and skin conditions.
A survey of U.S. dermatologists published last year found 80% reported prescribing oral minoxidil. But with only about 12,000 dermatologists in the U.S., some patients may have trouble finding a provider.
Telehealth providers like Hims and Ro say they are helping fill the gap. The companies' business model offers patients quick access to the medications they are seeking, often after simply filling out a questionnaire about their medical history, medications and treatment goals. The information is reviewed by a health provider who can quickly approve a prescription, assuming there are no red flags.
Hims and Ro each say that their providers won't prescribe minoxidil for patients who have complicating health conditions or prescriptions that could negatively interact with the drug. In some cases, patients may be referred for an office visit.
Many dermatologists say patients are better served by an in-person appointment, where a doctor will usually take a blood pressure reading, evaluate medical history, prescriptions and discuss the drug's side effects.
'I'm not a proponent of going to an online service,' said Taylor. 'I recommend seeing your board-certified dermatologist who's trained, who knows the data and can evaluate all of you.'
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
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June 19, 2025, 5:00 AM EDT By Suzy Khimm When Robert F. Kennedy Jr. became health and human services secretary, advocates for raw milk were thrilled to have one of their own at the helm in Washington. A self-professed fan of the drink,Kennedy had included raw milk in a list of foods and drugs that he felt federal officials had unfairly suppressed. 'FDA's war on public health is about to end,' he wrote shortly after the November election. But Kennedy hasn't actively taken up the cause yet — even amid his sweeping effort to upend federal health agencies and his Make America Healthy Again campaign to change how Americans eat, frustrating and concerning some of the most prominent raw milk advocates. Federal officials have long warned that raw milk is unsafe for drinking because it hasn't gone through the heat process of pasteurization that kills off harmful bacteria, and sales across state lines have been banned since 1987. 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There's a long-standing consensus among U.S. public health agencies that pasteurization is an essential step to kill bacteria in milk — one of the most important mainstays of the American diet, especially for children. Then again, there's also consensus that vaccines don't cause autism and that they're necessary for public health and safety, and that hasn't stopped Kennedy from raising the issue. 'We've had this message, all of these decades, that raw milk is dangerous,' said Judith McGeary, executive director of the Farm and Ranch Alliance in Texas, which has advocated for expanding access to raw milk. 'It's not going to change overnight, no matter who's in charge.' Meghan Davis, an epidemiologist at Johns Hopkins University, said the federal warnings and restrictions on selling raw milk have been in place for good reason. 'Humans drank raw milk for a long time, but they got diseases from it for a long time,' said Davis, a former dairy veterinarian. 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The Food and Drug Administration has approved a highly effective new HIV-prevention medication, Gilead Sciences reported Wednesday. In clinical trials, the drug nearly eliminated HIV's spread among people given an injection every six months. Called lenacapavir, the highly effective drug has inspired feverish anticipation among advocates for HIV prevention. The hope is the medication could accelerate the stubbornly slow decline of HIV transmission in the United States. 'This is the single best opportunity in 44 years of HIV prevention,' said Mitchell Warren, executive director of the HIV advocacy nonprofit group AVAC. Lenacapavir, which is given by health care workers in clinics, is significantly more effective than the existing oral HIV-prevention drugs, experts said, because it appears to address the challenges of sticking to a daily pill regimen for people who are at high risk of HIV. 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Lenacapavir was first approved in 2022, under the brand name Sunleca, for use with other medications to treat highly drug resistant strains of the virus. All forms of PrEP work in the same way: If enough of the drug is present in the body when a person is exposed to HIV, it's highly effective at preventing the virus from taking hold and establishing a lifelong infection. Lenacapavir is so long-acting, it only needs to be injected twice a year. However, lenacapavir's use as PrEP against HIV emerges into a political climate that experts warn could derail progress against the virus' spread. The Trump administration's recent sweeping cancellations of research grants and its severe cuts to the Centers for Disease Control and Prevention's staffing have dramatically affected the HIV-prevention field in particular. HIV experts are concerned that lenacapavir's full potential might remain unrealized. Lenacapavir's cost could be another hurdle if health insurance companies don't pay for the new drug. Health insurers, at least in the near term, might decline to cover lenacapavir in favor of other forms of PrEP, including the cheaper generic version of Truvada pills, which cost as little as $30 per month. Or insurers might impose higher copays for lenacapavir, said Elizabeth Kaplan, director of health care access at Harvard Law School's Health Law and Policy Clinic. A pending Supreme Court decision concerning a pillar of the Affordable Care Act could also be a barrier to insurance coverage for medications that prevent HIV. The ACA, or Obamacare, mandates no-cost coverage for certain preventive interventions like PrEP. Mixed success for PrEP drugs Older forms of PrEP have had mixed success. Truvada, also made by Gilead, was the first approved PrEP drug in 2012, followed by a similar oral medication from the company, Descovy, in 2019. They have steadily gained popularity among gay and bisexual men, who, according to the CDC, account for 7 in 10 new HIV cases and comprise the overwhelming share of PrEP users. However, considering how much higher the HIV rate is among Black and Latino gay men compared with their white peers, PrEP use among men of color has remained disproportionately low. Experts believe PrEP has most likely hastened HIV's considerable decline among white gay and bisexual men, but the HIV rate among Black and Latino gay and bisexual men has persisted at markedly high rates. In addition, when they are prescribed PrEP, Black gay men are less likely to take the pill regimen as prescribed. When they are taken daily, Truvada and Descovy each slash HIV risk by at least 99%. But inconsistent use diminishes PrEP's effectiveness. In late 2021, ViiV Healthcare's Apretude was approved as an injectable PrEP given every two months. Despite being much more effective than Truvada at lowering HIV cases across a population of gay and bisexual men and transgender women in a major clinical trial, Apretude has gained scant traction until recently. About 21,000 people are taking it, ViiV reported. It's possible that, in part, people have been alienated by the requirement to visit a clinic every two months for Apretude, instead of every three months for an oral PrEP prescription. Lenacapavir has the potential, but will it deliver? Lenacapavir offers an alternative for people who won't or have trouble remembering to take a pill every day, and it reduces the number of required annual clinic visits from four to two. According to CDC estimates, during the decade after PrEP's debut, the annual HIV transmission rate declined by only 17%, from 38,300 cases in 2012 to 31,800 cases in 2022. Much of the decline occurred since 2018, with case numbers falling by 12% during that four-year period. In 2019, the Trump administration launched the Ending the HIV Epidemic, or EHE, initiative, which has since targeted nearly $3 billion in new spending to combat HIV, including by promoting PrEP, in 48 hot-spot counties in particular. The target jurisdictions had a swifter 21% decline in estimated HIV transmissions from 2018 to 2022. In a study published in October, CDC investigators reported that PrEP use has risen steadily since 2014 and that about 200,000 people were receiving some form of it during any month of 2023. But that is only a small fraction of the 1.5 million gay and bisexual men who are good PrEP candidates, according to estimates in a new CDC study published in May. The crucial question is whether a critical mass of people who otherwise wouldn't have stuck to an oral PrEP regimen can routinely be provided lenacapavir while they are at risk of HIV. Dr. Susanne Doblecki-Lewis, chief of the division of infectious diseases at the University of Miami Miller School of Medicine, is the site principal investigator for the lenacapavir clinical trial in gay men and a separate trial in people who inject drugs. She said lenacapavir could mitigate HIV-related racial disparities, provided it is made 'available easily and at low or no cost to people who can benefit from it who are uninsured or underinsured.' But, she said, 'if there are barriers, like complicated prior authorizations or high copays that will prevent people from easily starting it, we could see disparities just get worse.' Political challenges The Trump administration's 2026 budget request seeks a $1.5 billion, or 35%, cut for domestic HIV funding. That includes shuttering the CDC's $794 million HIV-prevention division, although some remnants of it are apparently meant to be folded into a new federal health department, along with a maintained $220 million in EHE funding. Much of the CDC's HIV-prevention and -surveillance budget is distributed in grants to state and local health departments and nonprofit organizations. Severe federal budget cuts would most likely hobble those entities' efforts to educate at-risk populations and doctors about lenacapavir and provide services to facilitate its use. Another hurdle for prescribers is whether they can ensure that people at risk of HIV return for lenacapavir shots twice yearly. Two recent studies, one published in May and another presented at a conference in March, found that fewer than half of oral PrEP users stay on it for six months or longer. Historically, the National Institutes of Health has funded research to help implement new forms of PrEP, examining weak spots and devising interventions. But the Trump administration's campaign to slash NIH spending has had a severe impact on HIV research, including PrEP, according to a dossier of canceled grants compiled by a Harvard researcher. A federal judge ruled Monday that some such NIH grant terminations were 'arbitrary and capricious' and 'void and illegal.' But the temporary win for researchers doesn't mean the NIH under Trump will necessarily become newly hospitable to grant proposals concerning PrEP implementation. Johanna Mercier, Gilead's chief commercial officer, said in an interview this month that the company has been pushing insurers to cover lenacapavir. She expressed optimism for ultimately widespread coverage of the drug. Gilead will cover up to $7,200 annually in out-of-pocket costs for insured people receiving lenacapavir. And its patient assistance program will provide it free to low-income uninsured people. There is otherwise a patchwork system nationally that can often aid the uninsured in covering the required clinic visits and lab tests. Tristan Schukraft, CEO of the popular PrEP-focused telehealth company Mistr, said it intends to begin offering lenacapavir immediately through its storefronts in seven major urban gay neighborhoods. The company has also formed partnerships with a nationwide network of community-based clinics that can provide the shots, including to people without insurance. 'We're ready,' Schukraft said.
