Longstanding Male Hair Loss Managed with Oral Minoxidil: A 51-Year-Old Patient Case

Case Overview

A 51-year-old male presented to Reena Jogi MD Dermatology in Houston, Texas, for evaluation and management of chronic hair loss and multiple skin tags on the neck.
The patient reported diffuse scalp thinning over the past 20 years, describing gradual progression despite consistent use of topical minoxidil (Rogaine) and Nutrafol supplements. He denied scalp pain, itching, or irritation.

A strong family history of male pattern hair loss was noted on the paternal side.

Clinical Findings

Examination revealed diffuse, non-scarring thinning across the vertex and frontotemporal scalp, consistent with androgenetic alopecia (AGA).
A positive hair pull test confirmed active shedding, suggesting ongoing follicular miniaturization.

Additionally, the patient exhibited multiple pedunculated, skin-colored papules on the anterior and lateral neck, clinically consistent with acrochordons (skin tags).

Diagnosis

• Androgenetic Alopecia (L64.8) — diffuse, moderate, longstanding

• Skin Tags (Acrochordons, L91.8) — benign pedunculated lesions of the neck

Treatment Plan

1. Oral Minoxidil 2.5 mg Daily

Given minimal improvement with topical treatments, the patient elected to transition to oral minoxidil, an off-label but well-studied systemic therapy for hair restoration.

Counseling provided:

• Mechanism: Enhances scalp blood flow and prolongs the anagen (growth) phase of hair follicles.

• Expected timeline: Initial shedding may occur in the first 8–10 weeks; improvement visible after 3–6 months of consistent use.

• Potential side effects: Dizziness, ankle swelling, unwanted hair growth, rapid heartbeat, and rarely, pericardial effusion.

• Advised to discontinue and contact clinic immediately if any of the above symptoms occur.

Prescription:

• Minoxidil 2.5 mg tablet PO daily

• Dispensed 90 tablets with 3 refills

2. Discussion of Adjunctive and Procedural Options

Comprehensive counseling covered the following treatment alternatives and adjuncts:

• Oral finasteride – DHT-blocking medication for male pattern baldness

• Low-Level Laser Therapy (LLLT) – Red light phototherapy to stimulate follicle activity

• Platelet-Rich Plasma (PRP) injections – Autologous growth factor treatment for scalp stimulation

• Alma TED – Non-invasive, ultrasound-based transdermal delivery of growth serums

• Hair transplantation – Considered for advanced or refractory cases

After discussion, the patient chose to begin oral minoxidil monotherapy and reassess response in six months.

3. Skin Tag Removal (Cosmetic Procedure)

The patient elected to have 10 symptomatic skin tags removed from the neck region during the same visit.

• Local anesthesia: 1% lidocaine with epinephrine (1 cc)

• Removal method: Gradle excision technique

• Post-procedure care: Advised gentle cleansing, topical petrolatum for healing, and monitoring for infection

Risks reviewed: mild bleeding, pigment changes, scarring, or infection.
Outcome: All lesions were successfully removed with minimal discomfort.

Counseling and Expectations

• Androgenetic alopecia is a genetically driven and progressive condition.
  While full reversal may not be achievable, combination therapy can slow progression and stimulate regrowth.

• Early consistency with oral minoxidil is essential for visible results.

• Skin tag removal is considered a cosmetic procedure and generally heals within 1–2 weeks.

• The patient will return in 6 months for follow-up hair density evaluation and possible consideration of PRP or Alma TED if response is suboptimal.

Discussion

This case demonstrates an evidence-based, systemic approach to long-term androgenetic alopecia management using oral minoxidil in a patient with decades of diffuse thinning.
Oral minoxidil is increasingly favored in men with poor tolerance or limited success using topical treatments, offering enhanced efficacy and convenience.

Concurrent management of skin tags through in-office excision provided immediate cosmetic benefit and improved comfort.
At Reena Jogi MD Dermatology, individualized treatment plans combine medical, procedural, and aesthetic therapies to restore confidence and optimize results for each patient.

Key Takeaways

• Oral minoxidil is an effective, convenient option for men with longstanding hair loss.

• Adjunct therapies like PRP or Alma TED can enhance regrowth and scalp health.

• Skin tag removal is a quick, safe, and cosmetic procedure with minimal downtime.

• Regular follow-up ensures safe use of oral medications and sustained hair improvement.

About Our Clinic

At Reena Jogi MD Dermatology, we specialize in comprehensive hair loss management and cosmetic dermatology for patients in Houston and Katy, Texas.
We offer advanced treatments for androgenetic alopecia, alopecia areata, and other scalp conditions, as well as PRP, Alma TED, and laser-based therapies.
Our clinic also provides safe, in-office removal of benign lesions such as skin tags, seborrheic keratoses, and moles.