Case Report: Managing Longstanding Male Hair Loss with Oral Minoxidil in a 48-Year-Old Patient
At our dermatology practice in Houston and Katy, Texas, we frequently see men who have been struggling with hair loss for decades. A recent case of a 48-year-old male patient illustrates how androgenetic alopecia (male pattern baldness) can be managed with modern therapies such as oral minoxidil and adjunctive scalp treatments.
Patient Presentation
The patient reported diffuse, gradual hair loss over the past 20 years. His hair thinning was moderate in severity and located across the scalp. He had previously tried:
Oral finasteride, which was discontinued due to potential side effects.
Compounded topical minoxidil and finasteride, which he stopped 4–6 months ago.
He presented seeking new treatment options after noticing continued thinning.
Clinical Examination
On exam, the patient had diffuse non-scarring hair loss, most consistent with androgenetic alopecia (AGA). Dermoscopy confirmed the diagnosis.
Treatment Counseling
We provided a comprehensive discussion of the pathophysiology of male pattern baldness and reviewed the range of treatment options, including:
Topical Minoxidil (Rogaine foam): A conservative, over-the-counter therapy to slow progression.
Oral Minoxidil: Effective for stimulating hair regrowth in men.
Finasteride: An oral option, though the patient had discontinued previously due to side effect concerns.
Nutritional supplements (Nutrafol, Viviscal, Votesse).
Low-level laser therapy (LLLT) devices such as Theradome.
Platelet-rich plasma (PRP) therapy.
ALMA TED non-invasive ultrasound-based treatment.
Hair transplant surgery for advanced cases.
Patient’s Choice
After an extensive discussion, the patient elected to start oral minoxidil. He was counseled that results typically take 6 months or longer to become noticeable, and that shedding may occur in the first 8–10 weeks as part of the hair growth cycle reset.
He was prescribed:
Oral Minoxidil 2.5 mg daily, with a gradual dose escalation plan if tolerated.
Ketoconazole 2% shampoo, to be used 2–3 times per week, left on the scalp for 5–10 minutes before rinsing.
We also provided detailed counseling on the potential side effects of oral minoxidil, including swelling, dizziness, low blood pressure, rapid heartbeat, or unwanted hair growth, with instructions to discontinue use and call the office if symptoms occur.
Takeaway for Patients in Houston & Katy
This case highlights the importance of individualized treatment for male hair loss. For men who cannot tolerate finasteride, oral minoxidil offers a safe and effective alternative, often in combination with supportive therapies like ketoconazole shampoo, PRP, or supplements.
At our Houston and Katy clinics, we provide comprehensive care for androgenetic alopecia, tailoring treatment plans to each patient’s medical history, comfort level, and long-term goals.
