Minoxidil

Written By Janine Yorio

The History

Minoxidil, initially developed in the late 1950s by the Upjohn Company (now part of Pfizer) as an oral medication for severe hypertension, was approved by the U.S. Food and Drug Administration (FDA) in 1979 under the brand name Loniten. During clinical trials, patients experienced unexpected hair growth, leading to its development as a topical treatment for hair loss. In 1988, the FDA approved topical minoxidil for male pattern baldness, followed by approval for female pattern hair loss in 1991.

The Good

Topical minoxidil is widely used to promote hair growth in individuals with androgenetic alopecia. Studies indicate that approximately 39% of men experience moderate to dense hair regrowth on the crown of the head with minoxidil use. Low-dose oral minoxidil has also shown effectiveness in treating hair loss, with studies reporting significant increases in hair count and density.

The Bad

Common side effects of topical minoxidil include scalp irritation, itching, and dryness, often due to alcohol and propylene glycol in the formulation. Unwanted facial hair growth may occur if the medication inadvertently contacts other areas. Oral minoxidil can cause systemic effects such as fluid retention, tachycardia, and, in rare cases, pericardial effusion. Hypertrichosis, or excessive hair growth, is a common side effect of oral minoxidil, occurring in approximately 80% of patients.

The Ugly

You may have to take it forever.

You generally have to keep taking minoxidil indefinitely if you want to maintain the hair you’ve regrown. Minoxidil works by stimulating hair follicles to stay in the growth phase (anagen phase) longer, but it doesn’t address the root cause of hair loss, such as androgenetic alopecia or other underlying conditions.

If you stop using minoxidil:

  • The hair you regrew while on the treatment will likely shed over the course of a few months.

  • You may return to the same level of hair loss you had before starting treatment.

Minoxidil is not a cure for hair loss, but it can be an effective long-term management tool if used consistently. This is why it’s important for anyone starting minoxidil to understand that it’s a commitment. 

It can cause weird side effects.

While minoxidil is a widely used treatment for hair loss, there have been instances where its use has led to legal actions. In 2021, a class-action lawsuit was filed against Hairitage concerning their Minoxidil 5% Hair Regrowth Topical Solution. The allegations included scalp irritation, hair loss, and misleading labeling about side effects. This case is ongoing, and the court has yet to determine if Hairitage misled consumers and is liable for damages. 

How to get it

Minoxidil is available in both topical and oral formulations for treating hair loss, each with distinct efficacy profiles and considerations.

Topical Minoxidil

Topical minoxidil, commonly known by the brand name Rogaine, is FDA-approved for treating androgenetic alopecia in both men and women. Applied directly to the scalp, it stimulates hair follicles and prolongs the anagen (growth) phase of the hair cycle. Clinical studies have demonstrated that topical minoxidil can increase hair count and density, with noticeable improvements typically observed after several months of consistent use.

Oral Minoxidil

Originally developed as an oral medication for hypertension, low-dose oral minoxidil has been used off-label to treat various hair loss conditions. Recent studies suggest that low-dose oral minoxidil is effective in promoting hair growth, with some patients experiencing significant increases in hair density. For instance, a study comparing 1 mg daily oral minoxidil to 5% topical minoxidil solution found that both treatments resulted in clinical improvements, such as increased hair density and reduced shedding.

Which works better?

Direct comparisons between oral and topical minoxidil indicate that both formulations can be effective in promoting hair growth. Some studies suggest that low-dose oral minoxidil may offer similar or even superior efficacy compared to topical applications. For example, a study involving female patients with pattern hair loss reported that 1 mg of oral minoxidil was significantly more effective than 1 ml of 5% topical minoxidil applied daily.

The percentage of minoxidil you should use depends on your gender, the severity of hair loss, and your healthcare provider’s recommendations. Here’s a breakdown:

For Men

  • 5% Minoxidil: The standard and most commonly recommended concentration for men with androgenetic alopecia (male pattern baldness). Studies show that 5% minoxidil is more effective than lower concentrations, providing faster and greater hair regrowth.

  • 2% Minoxidil: Less commonly used for men but can be an option for those experiencing sensitivity or irritation with the 5% solution.

For Women

  • 2% Minoxidil: Traditionally recommended for women with androgenetic alopecia (female pattern baldness). It is FDA-approved and generally well-tolerated.

  • 5% Minoxidil Foam: Approved for use in women as well, offering a stronger option for those who don’t see results with 2%. The foam formulation is often less irritating than the liquid.

Other Considerations

  • Low-Dose Oral Minoxidil: For both men and women, low-dose oral minoxidil (typically 1-5 mg per day) has shown promise for treating hair loss. This is an off-label use and should be prescribed by a healthcare provider.

  • Higher Percentages (10% or 15%): Occasionally used off-label for more severe hair loss, but these are not FDA-approved and may come with a higher risk of side effects like scalp irritation.

Janine Yorio
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