What dosing range of oral minoxidil do you prescribe for patients with hair loss?

I have really enjoyed adding this to our AGA treatment algorithm. I like to start at half of the 2.5 mg tab for women daily and the full tab for men. I then increase at each follow-up based on the patient's tolerance for AEs (increased hair elsewhere, BP, edema, lightheadedness). I max out at 5 in women and 10 in men but rarely do I go that high. I usually keep men at 5 and women at 2.5 that’s my sweet spot in terms of benefits to AEs ratio.

I have been prescribing 1/2 of the 2.5mg tab for both men and women. I counsel on the risks of hypertrichosis, edema (haven't had anyone develop), tachycardia (discontinued in one patient who developed this, subsequently resolved). However, I am getting more concerned with the case reports of anasarca and pleural effusion that do not appear to be dose-dependent. Though very rare, these appear to be real risks and I am considering having patients sign a consent form understanding these risks prior to starting a medication like this (given they would be on it for a lifetime).

Gbadamosi et al., PMID 34249570

Dlova et al., PMID 36117778

I do 2.5 mg bid as the max dose for men, half that for women. I split the dose as it's my understanding that minoxidil has a fairly short half-life.

I tend to use ranging from .625mg - 1.25mg presentation depending, and titrate to effect every 3 months - I see that others are a bit more aggressive. This has generally worked well but I may push the higher doses as others are doing a little bit earlier. I explain risk and benefit… And while I am concerned about some of the reports of side effects as discussed by others, they are uncommon and I do believe, given the limited tx armamentarium for hair loss, the benefits far outweigh the risks.

I just wanted to add on other non-systemic options that can be used for andro alopecia.

Topical dutasteride is available, and can be compounded with latanoprost, minoxidil, and retinoic acids.

Latanaprost and Minoxidil are growth promoters.

Retinoic acid helps to unplug follicles by regulating skin shedding.

Caffeine shampoo alternating with Ketoconazole shampoo can be added to the overall regimen.

Low level light therapy, PRP injections, and supplements can be added as well.