Topical Minoxidil: What You Need to Know

Minoxidil is, simply put, notorious.  There are few medications or active ingredients that are the subject of more misconceptions, rumors and misinformation.  Anybody who follows me on social media knows I love this stuff!  It’s the only over-the-counter medication we have that can provide substantial results for people suffering with hair loss.  While countless interactions with my patients have clued me in to the fact that many people are scared to try minoxidil, this pales in comparison to some of the comments I’ve seen on my social media posts.  “It’ll make you hair fall out!”  “It’s addictive!” “It doesn’t work!”  Research done by my colleague Dr. Julia Schwartz showed that up to 40% of people with hair loss might have some of these same misconceptions, which is truly a shame since few treatments are as accessible, well-studied and, most importantly, safe.

Let’s set the record straight!  Here’s what you need to know about topical minoxidil.

What is it?

Originally developed as a blood pressure medication, minoxidil was adapted for use in hair loss after the observation that some patients taking the oral form developed hypertrichosis – basically excessive hair growth.  Topical forms of either a 2% or 5% solution or foam have been used for hair loss with different concentrations and dosing schedules marketed toward women and men.  They have been off-patent for decades and are available over-the-counter at affordable prices from many retailers.

How does it work?

While the exact mechanism isn’t fully elucidated, we know that minoxidil prevents and treats hair loss by its action on the hair growth cycle.  To summarize: hair growth has 3 phases called anagen (the growth phase), catagen (a transitional phase) and telogen (the “resting phase” where hair can fall out).  In androgenic alopecia (male or female-pattern hair loss) there is a higher ratio of telogen to anagen hairs (so more hair can fall out at any given time) as well as a progressive miniaturization of the individual hair shafts.  Topical minoxidil addresses both of these problems by causing more hair units to enter the anagen phase and by increasing average hair diameter.  The end result is more hair growth, less hair fall and thicker, fuller hair.

How do I use it?

Both the foam and the solution can be applied to affected areas on the scalp once or twice daily.  In my own experience, the 5% concentration provides better results, so I do recommend it to both men and women.  In my opinion, if you’re going to do the work of using minoxidil, you may as well see the maximum benefit.  The 2% concentration solution is marketed toward women out of a concern for hypertrichosis in unwanted areas such as the forehead and eyebrows – I’ve personally never seen this happen.  While the foam formulation has been shown to be less irritating, I’ve found that the solution is easier to use if you have a lot of hair.  If you can, try both and see which works better for you and your specific hair type.

What else should I know?

There are some potential side effects including skin irritation and itching (less often seen with the foam version).  Minoxidil’s action on hair may cause an increase in hair shedding in the first few weeks – these are all telogen hairs that were going to fall out over the next few weeks anyway that will now loop back to the anagen/growth phase.  Additionally, it may take a long time to see a result due to the nature of the hair growth cycle.  I tell my patients to give it at least 4 to 6 months of consistent use before making a call on whether minoxidil works for them.

If you do see a benefit from using minoxidil (less hair loss, more hair growth), you will have to continue using it in order to maintain that benefit.  If you discontinue use, your hair growth will likely regress to where you started.  It will not make more hair fall out.  The way I like to explain it to my patients is this: you have to brush your teeth every day to keep them healthy, and it’s the same for your hair — daily treatment is important.  Lastly, consult with your doctor before starting minoxidil or any other medication.

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