Comparing Adherence, Side Effects, and Satisfaction in Oral and Topical Minoxidil: A Cross-Sectional Study

Hair loss disorders negatively impact quality of life. Topical and oral minoxidil are hair loss therapeutics that require daily use to achieve sustained benefits. Patients on topical minoxidil often report aesthetic and discomfort concerns (eg, greasy hair), which may limit adherence. Oral minoxidil is not FDA-approved for alopecia and carries a higher risk of systemic side effects. Efficacy between the 2 is similar. However, the impact of the route of administration on patient adherence and satisfaction remains unclear. Our study investigates whether topical or oral minoxidil yields greater adherence and satisfaction while comparing side effects. A survey was distributed to patients on minoxidil (n=50, response rate 98.0%) to assess ease of treatment, adherence, satisfaction, and side effects. Patients on oral minoxidil reported greater ease of treatment (P=0.0004) and styling their hair on treatment (P=0.0112). Fewer patients on oral minoxidil stopped treatment due to difficulty of use (0% vs 18.8%, P=0.0076). Oral patients missed less treatment days (x=0.15 vs x=1.2, P=0.0022) and reported greater satisfaction in hair volume (P=0.0098) and change of hair (P=0.0159). Side effects were similar, except for a higher incidence of hypertrichosis among patients on oral minoxidil (48.5% vs 6.25%, P=0.0015). These findings suggest that oral minoxidil is superior to topical in terms of ease of use, adherence, and satisfaction without increasing systemic side effects. By circumventing scalp application, oral minoxidil reduces the treatment burden and avoids the aesthetic and discomfort complaints that limit adherence. When establishing treatment plans, physicians should consider patient experience and its impact on adherence. J Drugs Dermatol. 2025;24(2):131-133. doi:10.36849/JDD.8424.