People’s Pharmacy: Hair loss could be treated with low-dose oral minoxidil

Q. Do you have any suggestions about how to handle hair loss for women? I have always had baby-fine, thin hair all my life. Now it is even thinner. What can I do to remedy this problem?

A. Hair loss is a common problem as people grow older, and women can be affected as well as men. For decades, dermatologists have recommended topical minoxidil (Rogaine), which can be moderately effective but must be applied conscientiously without pause.

For the past several years, dermatologists have been experimenting with low-dose oral minoxidil. A systematic review of 10 studies (in which men greatly outnumbered women) concluded that this treatment is often safe and successful (International Journal of Dermatology, August 2020). A consensus statement of dermatologists agreed that this could be a viable treatment option for adults (JAMA Dermatology, Jan. 1).

We were relieved to learn that, at this dose, minoxidil does not appear to affect blood pressure significantly (Journal of the American Academy of Dermatology, Nov. 7). Nevertheless, this treatment requires medical supervision and blood pressure monitoring.

Q. I had been on simvastatin for about 18 years when I suddenly became very ill. I was completely fatigued and the right side of my body felt tingly and numb. At the hospital, they thought at first it was a ministroke but ruled that out and sent me home.

I continued to feel quite unwell with peripheral neuropathy in my right leg. On the third trip to the hospital, one doctor asked how long I had been on statins and remarked that they sometimes cause side effects. That inspired me to discontinue the drug, although my GP wasn’t enthusiastic.

About three months later, I began to feel almost normal. Over the past year, I have controlled my cholesterol through diet. To my surprise, my severe joint pain has also disappeared, and my digestive problems are fading. Have you heard from others who didn’t suspect the statins were causing chronic symptoms?

A. There is an underdiagnosed condition called statin-induced autoimmune myopathy (Southern Medical Journal, April 2022). It can take years to show up and can be hard to treat. Even after stopping statins, some people continue to suffer symptoms such as fatigue, pain and muscle weakness that may interfere with getting out of a chair or climbing stairs.

To learn more about the side effects of statins and myositis, you may wish to read our “eGuide to Cholesterol Control & Heart Health.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. I am afraid you may have frightened a reader by mentioning tuberculosis as the problem treated by a combination of drugs that cleared their breathing difficulties. As a pulmonary care specialist, I know this combination would not be used for tuberculosis. Rather, it is the most common regimen for treating other infections, such as Mycobacterium avium complex.

A. Thank you for sharing your expertise. The drugs in question were azithromycin, rifabutin and ethambutol, along with an antifungal agent. These medicines are sometimes used to treat TB, but we hadn’t taken the lung infection you mention into account. Our mistake.

The reader was pleased that this treatment cleared a long-lasting condition that resembled asthma. Whatever the underlying pathogen, the drug combination appears to have worked.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla. 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”