ADVERTISEMENT INFO: SOME PRODUCTS MENTIONED IN THIS POST ARE PR (GIFTED) AND LINKS USED ARE AFFILIATE LINKS. I RECEIVED NO MONEY TO WRITE THE BLOGPOST. PLEASE READ DISCLAIMER

 

Thinking about using Minoxidil for hair loss? Here’s what no one tells you: It only works for some—and how you apply it makes all the difference. In this blog post, I’ll break down who it’s right for, how to use it correctly, what kind of results you can realistically expect, and why as a pet owner, you might need some extra precautions.

 

 

And yes—I’ve been using it myself for the past six months, so I’ll show you exactly what it did for my hair.

 

 

What Is Topical Minoxidil and Where Did It Come From?

I bet you have heard of Minoxidil or its best known brand name Rogaine as hair loss medication. Well, when developed back in the 1970s, it was actually designed to lower blood pressure. So why do we use it on the scalp now?

Minoxidil lowers blood pressure by dilating the blood vessels in the body through opening potassium channels in the cell membrane. This dilation means the heart has it easier to pump out the blood and it also means that blood flow in the periphery is increased. Despite being known as a hair loss medication now, you can still find it as part of the treatment of elevated blood pressure, used in combination with other blood pressure medication in those that don’t respond well to basic treatment.

After being used for blood pressure for around a decade, people noticed that among expected side effects like increased heart rate for example, those using it reported increased hair growth on head, face and body.

And then clever people decided: That isn’t a bug – it’s a feature! and started capitalzing on that effect. After all we have many different drugs targeting blood pressure, but basically none that help you keep your hair.

So it was changed from being used as a pill to being used as a topical medication – we have a liquid version and a foam as well as both a 2% and a 5% concentration. The 2% liquid was approved in 1986, the 5% one in the 1990s, and the foam came even later than that.

 

 

How does topical minoxidil work?

So with topical minoxidil being approved for male pattern hair loss 40 years ago, you’d suspect we would have a very good understanding of its mechanism of action right now. Let’s look at a few things it does when applied to the scalp:

1. It increases blood flow to the follicle. Just like it dilates the blood vessels in the body when taken by mouth, topical application will dilate the blood vessels on the scalp, and wider blood vessels mean more blood, which in turn transports more oxygen and nutrients to the follicle, giving it the ideal circumstances for growth.
2. It activates potassium channels—tiny gateways in cell membranes that regulate how potassium moves in and out of the cell. In hair follicles, this activation may encourage the follicle to transition from the resting (telogen) phase to the active growing (anagen) phase, contributing to new hair growth. It also stays in the growing phase for longer. You can see an uptick in growth factors responsible for stimulating the hair follicle with topical minoxidil use, which supports that theory.
3. Topical Minoxidil reduces collagen synthesis around the follicles. But wait, don’t we all want more collagen? On your scalp, in certain types of hair loss, increased collagen deposition around the follicle could lead to the hair follicle miniaturising, the follicle basically gets strangulated, and here a reduction in collagen is a good thing.

Three mechanisms of action, all with findings in studies to support them – but none of them a full explanation of why topical minoxidil actually works.

 

 

Does topical minoxidil work for everyone?

Or, put better, topical minoxidil actually works on some. So why are the results people get with topical minoxidil so different? There are two main reasons (if you exclude using it wrong, that would be the third), and the second one is actually quite interesting:

1. There are different types of hair loss! I have a separate post dedicated to them already, but in short: there is androgenetic alopecia or male and female pattern hair loss, but also stress related temporary hair loss called telogen effluvium or autoimmune conditions when the body attacks and destroys the follicle. Minoxidil has shown good results for androgenetic alopecia, but the others need treatment of the underlying cause first and won’t respond to Minoxidil only in the same way.
2. Minoxidil is actually a pro-drug, meaning that to work it needs to be transformed into Minoxidil Sulfate first. That happens through enzymes called Sulfotransferase Enzyme that are located in your scalp. Now everyone has different levels of activity of those enzymes, and interestingly, testing for Sulfotransferase Enzyme Activity is available in some specialized clinics, which may help identify whether you’re likely to respond to treatment.
   Those with a high enzyme activity will get better results than those with a low enzyme activity – they could be what we call non-responders.

 

 

Is Topical Minoxidil Effective? The data we have

So what are the effects you can expect with topical minoxidil? What do the studies show and do we have good data?

Given that it has been around for so long, we have a ton of data, and while the first studies were almost exclusively funded by the companies selling Minoxidil, the patent on it has long run out and countless people have used it for long periods of time, reducing any bias we might have had in the past.

Whenever tested against placebo, both 5% and 2% solutions showed either reasonable hair growth with new hair growing and the hair being thicker or at least a halt in further hair loss.

Roughly 40% of people had their hair grow back fuller and another 40% at least didn’t lose any more hair, leaving 20% where there was no change at all and the hair loss proceeded at the same speed as it did before.

Increasing the concentration above 5%, to 10% for example, didn’t give better results, but increased the risk for side effects.

In all studies done 5% twice daily performed better than 2% twice daily, but especially with people born female, using 5% twice daily had more side effects. Using the foam also led to a reduction in scalp irritation, but that most likely not because of the concentration, but because of the lack of Propylene Glycol in the carrier.

Studies could also show that Minoxidil showed better results, the earlier in the hair loss journey it was started – probably because it can reactivate the follicle if it has gone in resting phase, but won’t be able to reverse the process of miniaturising a follicle that has been dormant for long. That is also the explanation as to why it seems to work better in younger people.

The hair growing back will have the same color as the hair that was previously growing out of the follicle – if your hair is black, it will be black, if you had gone grey already, it will be grey. And as the process of going grey is not affected by Minoxidil, the hair growing back might go grey over time. (More info: Why we go grey and why it matters)

In summary:

Studies show Minoxidil works if you manage your expectations – only 40% get noticeable hair growth with an additional 40% where hair loss is at least stopped. It works best at concentrations of 5%, but 2% is also better than placebo and you get the best results if you start early.

 

 

The Shedding Phase: What to Expect and Why It Happens

Quite a few people start their Minoxidil treatment and instead of seeing their hair regrow, it starts to fall out in increasingly large numbers – the internet is full of that alarming story. Will that happen to you and is there a way to prevent it?

To understand why that happens, we need to look at the hair growth cycle: The hair grows in the anagen phase, then enters the telogen phase where it rests in the follicle without growing any further and as last step in the cycle it sheds. The shedding is necessary for the new hair growth cycle to start. Now we already established that Minoxidil works by shortening the telogen or resting phase, which means that the hair doesn’t rest as long, but gets shed quicker to make room for the new hair, which then will spend a longer time growing than the previous one.

That is exactly what we want, we want the follicle to stop resting and start growing, but that means that all the hair we would have lost anyway over the course of the next months now falls out in a much shorter period of time, usually within the first 6-12 weeks – the dreaded shed. If you have born children you know that phenomenon, it is the same mechanism as postpartum hair loss. (More info: Postpartum hair loss – why it happens and what you can do about it)

So yes, it is likely to happen to you—it’s a common and expected part of the process. Your scalp declutters all the old stuff it was going to get rid of anyway to make way for the new. But as the new hair is small and needs to grow, it might look as if things are getting worse at first.

Now don’t stop now, that would be the worst thing to do, you’d loose the hair without the benefit of quicker regrowth, but push through. Most people will see results starting at the 3 month mark, with the maximum benefit reached within 6 to 12 months. After that, you’ll usually not see further improvement, but keep what you gained for as long as you keep using Minoxidil. If after 4 months you are still losing more hair than expected, consult with your doctor. There might be another underlying reason for your hair loss.

 

 

How to Use Minoxidil Correctly (And What Not to Do)

So what is the best way to use Minoxidil? That depends.

The way best studied is applying a 5% liquid solution to balding patches twice a day. Always on a dry scalp and with enough time for the product to absorb before wetting your hair or applying heat. Why? Because a wet scalp or intense heat change absorption and could lead to more irritation.

Minoxidil has in people born male been studied mostly for the crown—also known as the vertex area—rather than for receding hairline treatment, so technically using it on a receding hair line isn’t backed by the data we have, but as a hair follicle is a hair follicle, it will work just as well.

People born female can use 5% minoxidil twice a day as well – this is what I did for the last few months – but are more prone to scalp irritation. To prevent that, you could either use a 2% liquid solution twice a day, which will give slightly worse results, or a 5% foam once daily. The foam is measured in “cups”, the liquid solution is measured in ml, with 1 ml being the amount you should use with each application. In the product I had that was defined by amount of pumps, so stick to manufacturer instructions. More is certainly not more here.

Concentrate in on the place where you want it to work – that is either bald patches or, for female pattern heat loss, around the parting where the hair gets thinner.

I found the application to be quite tricky as my hair wasn’t really thin yet, so I would pump the recommended amount into an empty bottle of scalp treatment and part my hair in three different places, administering the product along the parting and then rubbing it in with my fingers.

No matter which vehicle in which concentration you use, you need to use it consistently. If you keep forgetting half of the time, you won’t see results, and if you stop, things will go back to baseline within a few weeks.

Oh, and don’t let it drip down your face, your neck or use your fingers for distribution without washing them afterwards. Wherever you have hair follicles, Minoxidil will work, so unless you want to grow some extra hair on your back, it shouldn’t really go there.

 

 

The Most Common Concerns and Side Effects

Now we already talked about the dreaded shed, the initial phase of hair loss most people experience. What else is there to expect as potential side effect? The first and the last one are usually what makes people stop.

I already touched on it when we talked about how to apply Minoxidil, and it really is the most common thing: Scalp irritation and scalp dryness. If you never experienced it, lucky you, but for me, blessed with a happy and healthy scalp for all my life, regular application of 5% twice a day led to intense itching over time. That isn’t caused by the Minoxidil itself, but by the Propylene Glycol used in the liquid form, so it can often be avoided by either using the foam or applying it only once a day with only minimal reduction in effects. You could of course also be allergic to the medication, which is why patch testing is recommended, but the irritation isn’t an allergic reaction. It is a very common side effect.

Another thing you need to be prepared for is the change in texture. I usually wash my hair every third day, depending on my workouts and my schedule, but I had to increase washing to every second day while using Minoxidil. It gives the hair a lot of body, like hair spray would, and also a certain greasiness that I happen to hate, so I couldn’t go any longer between washes without feeling dreadful.

Minoxidil applied topically is absorbed in very low amounts, so it shouldn’t have any systemic effects – when used to lower blood pressure, you would take about 20 times the dosage orally you apply to your scalp. But if used in too high doses, on broken skin, too frequently, whatever leads to increased systemic absorption, you could show reactions like increased heart rate, dizziness, low blood pressure or oedema. If that happens, stop using it and talk to your health care provider.

If you have pets, you need to know that Minoxidil is toxic to cats and dogs. If they ingest the product, they could die. Now I have two cats and was never worried they might come in contact with the medication: I keep it in my bathroom, in a drawer, I wash my hands after application and before handling anything else and I wear a silk night cap to bed, meaning it won’t transfer to my pillow in the unlikely case any of the cats would sleep on that – something I don’t let them do anyway. But there is a story online about a woman whose cat died. She ingested Minoxidil because she had the habit of licking her owners hair and the woman hadn’t been warned about that. So if you have pets, keep them away of your hair as long as you are using the product. And maybe don’t let them lick your hair or face anyway – they lick their butthole all day.

The last one, actually more proof of it working than a side effect, is hypertrichosis or increased hair growth in places you don’t want that. Not on the head, but on other body parts that either come in contact with product transferring during application, through unwashed hands or through your pillow during sleep or that react to minimal systemic absorption. Wherever you have hair follicles, you might experience increased hair growth, most commonly on your forehead, your cheeks and jaw line or down your neck and back. I had some more hair growth on my temples, where the previously unnoticeable baby hairs became visible, but overall that wasn’t a big issue as my facial hair is blonde and fine anyway – apart from the occasional stiff one growing out of my chin at random times – but if you already have facial hair that is more noticeable than you like, you need to be prepared that extra shaving, tweezing or waxing might be needed.

 

 

Is Minoxidil safe to use during pregnancy and breastfeeding?

No.

Minoxidil might pose a risk to the foetus and might be absorbed into breast milk, meaning you should stop application if you are trying to conceive, pregnant or breastfeeding. No need to panic if you used it before realising you were pregnant, as systemic absorption is supposed to be low, but not recommended during that time in your life.

 

 

Is Topical Minoxidil Enough? What Can I Combine It With?

With only 40% of people seeing hair regrowth, the question arises if pairing topical minoxidil with other hair loss treatments is possible and will yield better results, so let’s look at the possibilities there are.

For people assigned male at birth, the combination with Finasteride is often recommended. Both together seem to show better results than each one used individually. Finasteride is taken orally and works by inhibiting 5-Alpha-Reductase, an enzyme metabolising testosterone. Potential side effects are reduction of sex drive, difficulties maintaining an erection and depression, so it should always be taken under a doctor guidance. It is not recommended for people assigned female at birth in their reproductive years.

People assigned female at birth can combine Minoxidil with Spironolactone taken orally, another medication used to treat high blood pressure. As that will affect potassium levels in the blood, it is again only advised to do so under your doctors guidance.

Another option is to combine topical Minoxidil with scalp microneedling, as the treatment itself is supposed to increase hair growth – there is some data, but way less than on Minoxidil – and the combination seems to work even better than microneedling alone. The reason is probably the increased absorption through the micro channels created, which in turn also increases the risk for systemic absorption. Micro needling will work best on bald patches, as diffuse hair loss when the hair is thinning, but not completely gone in one area bears the risk of damaging the existing hair through the needling process. (More info: Microneedling – is it safe to do at home?)

Instead or combined with micro needling, there is Platelet-Rich Plasma (PRP) therapy, where you either inject or micro needle processed components of your own blood into the scalp, typically in a clinical setting, and combine that with Minoxidil.

Then there is Low Level Laser Therapy or LLLT where you wear a helmet or cap for a defined amount of time per day. Again, there is some data that this paired with Minoxidil works better than the helmet alone, although I assume the Minoxidil is doing the heavy lifting here. If you wait for it to dry down after application and before donning the helmet, you should not experience side effects. (More info: Low Level Laser Therapy for hair growth)

And the last thing, not really a combination, but a change in approach, is taking your Minoxidil orally. I mentioned before that Minoxidil is a pro drug that needs one conversion and that the converting enzyme is present in the scalp at different levels, so taking it orally might turn non-responders into responders, simply because the amount of enzyme in your scalp isn’t the limiting factor anymore. It will also minimise the risk of scalp irritation, another limiting factor in regular application. But, and that is a trade-off you need to be aware of, it will increase the systemic effects and the risk for unwanted hair growth on other body parts, as now it isn’t topical anymore, but will go everywhere via the blood stream. In Germany it is prescription, so you need to see a doctor to get it.

 

 

How Long Do I Need To Use Minoxidil?

If you decide to use Minoxidil to treat hair loss, you will need to keep using it forever, or at least until you don’t care about your hair loss anymore.

Minoxidil treats a symptom, not the underlying condition, similar to other medications used for chronic diseases. If you have high blood pressure (assuming you have already implemented the lifestyle changes that might better your condition), you take medication to keep it in the normal range and prevent long term effects. If you stop taking your medication, your blood pressure will go up again.

As long as you keep using Minoxidil, you will keep the results you gained. But if you stop using it, you will gradually lose the hair you kept and return to the baseline you would be at if you hadn’t taken it all this time. So it won’t make you go bald quicker, as some people claim online, but if you pushed your balding for two years and then stop the medication, you will catch up on those two years quickly.

 

 

My six months results

When I took pictures of my hair line and parting for the review of the Currentbody LLLT Helmet (read my review here), I was shocked about the thinning I hadn’t noticed yet in my day to day life. So I went backwards through my pictures and realised that for the last years, my hair had gradually become thinner. Not that I had thick hair to begin with, but my pony tail was now at least reduced in size by 1/3. Other conditions like nutrient deficiencies, problems with the thyroid gland or autoimmune conditions could be ruled out, so I decided to start topical Minoxidil, 5% applied twice a day, six months ago.

I touched on my general experience before: My scalp got irritated and itchy and I hated the way it made my hair feel, but did it deliver results?

My hair line and my middle part, on your left the before and on your right the after.

What really impressed me though was that around 4 months, I noticed a change in thickness, which at least right now isn’t overly attractive. The regrowth I was lucky enough to get poufs up around my crown and has a tendency to stick out everywhere, making me look as if I failed at cutting a decent fringe. That was to be expected as those hairs need to grow out now to match the rest in length – at the speed my hair grows I am probably in for at least a year of weird looking hair styles now.

Still, I am very happy with the results—there is visible regrowth around my crown and parting—and will continue using Minoxidil to maintain these gains.

 

TL;DR

Minoxidil for male and female pattern hair loss – is it a good idea? That depends. First of all you need to figure out why you are losing your hair. There are many different reasons and Minoxidil won’t work for all of them. Then you need to be aware of the side effects and the need to use it for as long as you want to keep your hair. It is not a temporary treatment in most cases. And third you need to see which concentration, vehicle and frequency is best for you.

If you are pregnant, trying to get pregnant or breastfeeding, it is not for you and if you suffer from an underlying heart condition, you should discuss using it with your doctor first.

Be aware that only 40% of people see noticeable regrowth, another 40% are able to stop hair loss with using it and 20% are non-responders, so there is no guarantee it will work and give you back a full head of hair.

 

 

Don’t forget to check out the Discount Code Page on top if you want to save some money on your next skincare purchase, or click here to let me build a personalized skincare routine for you.
If you want to get more involved and pick my next topics or see exclusive behind the scenes content, don’t forget you can head over here and become a YouTube Channel Member!