Does Minoxidil Work? The answer to this question may seem obvious given that this active ingredient is one of the growth stimulators in hair follicles and is today one of the pillars for the treatment of androgenetic alopecia and, together with finasteride , is approved by Food & Drugs Administration (FDA) as official therapy.
However, among those suffering from baldness “Does Minoxidil Work?” seems to be a very recurring question. Therefore, a guide with the main characteristics of this drug could not be missing.
The active ingredient Minoxidil was born in the late 70’s thanks to the US pharmaceutical company Upjohn Company . In 1999, through a merger, it was incorporated into the Pharmacia Merger group which, in 2003, was in turn acquired by the pharmaceutical giant Pfizer .
Initially, its use was as an anti-hypertensive drug because due to its powerful vasodilatory abilities it was able to reduce blood pressure and was administered orally under the name of Loniten . However, among the users there were several cases of hyper trichosis and hair regrowth and it was therefore thought of a use for the treatment of alopecia.
The oral intake of the drug in subjects who did not suffer from hypertension, however, caused heavy side effects and therefore the route of topical application directly on the scalp was attempted in order to avoid excessive systemic absorption.
Several studies 1) 2) , starting from the early 1980s, demonstrated the effectiveness of topical Minoxidil for hair regrowth .
Subsequently, the use of the oral formulation as a hypotensive took a back seat as more effective drugs came on the market for this purpose and certainly today it is much more famous as a drug for hair regrowth than for its original use.
How Does Minoxidil Work?
Initially, the positive effects on hair and hair were attributed solely to its vasodilator properties . This action of minoxidil is due to the ability to activate, by opening them, the intracellular potassium channels present in the smooth muscle cells of the peripheral arterial system.
This is a feature of several blood pressure lowering drugs that make them very potent, but often characterized by notable side effects. We saw at the beginning of the article that this drug was born as a hypotensive.
The vasodilator effect and the consequent greater blood circulation explains why even oral intake caused hypertrichosis and hirsutism effects in users .
A 1992 study 3) shows that minoxidil, also applied topically via lotion or foam, opens the potassium channels by relaxing the vascular smooth muscle and allowing a greater flow of blood to the hair bulbs present in the area of application. This directly stimulates the dermal papilla and the matrix helping to keep the entire bulb healthy.
However, its effectiveness in stimulating the activity of the hair follicles is NOT due exclusively to the increase in local blood circulation as other more modern and powerful vasodilators have no properties regarding hair regrowth.
So… how come does minoxidil work?
Its mode of action involves the regulation of the biological cycles of the hair, prolonging the Anagen growth phase and minimizing the passive ones of Telogen and Catagen as explained by the study 4) published in the Journal of Dermatological Science of June 2011.
Thanks to this property of stimulating the production of Beta-Catenin in the follicular dermal papilla, the drug tends to synchronize the hair cycle by forcing the Anagen phase in which the hair is active, grows in length and enlarges the diameter.
Then certainly the vasodilating action amplifies the result by providing more nourishment to the follicle forcibly held in Anagen, but as explained, it is not the main factor .
What is Induced Fall?
Precisely this cycle synchronization effect causes what experts call a fall induced by minoxidil to appear at the beginning of the therapy, which generally occurs after about a month of taking and can last up to the third month. During the induced fall the hair falls out in the dormant phases Telogen and Catagen which will be replaced by new Anagen hair .
So do not be scared if the first months of treatment you see yourself getting worse , it is normal because it happens to everyone, some more, some less. Instead, avoid panicking and suspending applications because, as I will explain shortly, abrupt interruptions can be harmful.
Suspension of treatment
Sometimes you may come across desperate requests for help from people who in a very reckless way have made the “insane gesture” and find themselves fighting against an uncontrolled fall .
If you want to suspend or abandon Minoxidil it is certainly a doable thing, but it is advisable that you stick to certain methods in order to avoid running into unpleasant surprises .
To better understand the topic, I refer you to the article where I explain how to stop minoxidil WITHOUT having a maxy effluvium
Minoxidil 2 or 5%
On the market there are formulations with concentrations at both 2% and 5% and many wonder what is the most effective percentage in male pattern baldness.
A clear answer in this sense is given by the study 5) published in the Journal American Academy Dermatology in 1984.
This study examined a sample of 393 people affected by androgenetic alopecia and for a period of 48 weeks they were divided into the following groups:
- 157 people took 5% minoxidil in 2 daily applications
- 158 people took 2% minoxidil in 2 daily applications
- 78 people took a placebo in 2 daily applications
Effectiveness was assessed by examining a specific area of the scalp and periodically assessing its progress in terms of hair count and rapid response. At the end of 48 weeks, the 5% minoxidil group had 45% greater regrowth than the 2% group and response times to therapy were much faster. It must be said, however, that the 5% group had a higher incidence of irritation and itching probably due to the greater amount of glycol necessary to keep the 5% solution stable.
In any case, it was however well tolerated and almost zero systemic absorption effects.
Today, therefore, minoxidil 2% is recommended to women or even men in the case of androgenetic alopecia in the initial stages, while it is well-established practice to recommend minoxidil 5% in the most overt cases.
However, there are also preparations with higher percentages that reach up to 15% . However, in addition to not being approved by the FDA for the treatment of androgenetic alopecia, they have not shown significantly better results than the 5% with greater occurrence of side effects.
As mentioned above, if you still have a good amount of hair it is preferable to use lotions since the pipette allows you to put the product directly in contact with the skin, avoiding excessive waste of product on the hair itself. The foam is instead indicated in case of very short or shaved hair.
The quantity also depends on the extent of the area to be treated, so don’t fossilize yourself on the classic milliliter … for example, to put it all over the head, especially now that I have a considerable amount of hair, I need to put about 3 ml to cover everything well area.
The standard therapy includes 2 daily applications one in the morning and one in the evening as the half-life of minoxidil is about 6 hours and therefore you would have a more uniform coverage during the day. Furthermore, the various studies were all carried out taking into account the 2 applications.
However, many SiTri trichologists, including Dr. Paolo Gigli, whom I follow, are convinced that even a single daily application may be sufficient . In fact, the therapy that I have been following since July 2014 provides for the application of 5% minoxidil lotion only in the evening and the results are there without a shadow of a doubt.
Some factors to consider when applying minoxidil:
- it should be applied to dry skin as moist skin can cause greater systemic absorption and consequently an increased probability of side effects .
- the application must be carried out exclusively in areas prone to baldness because due to its properties as a stimulator of hair growth, if applied in healthy areas it could lead to the appearance of unwanted hair .
- to avoid product waste it is good to put it on the scalp… as much as possible. The dropper pipettes usually provided are very useful for this purpose. Obviously if you wet your hair nothing much will happen , but you will have simply wasted some of this expensive lotion
Does Minoxidil Work? When the first results?
As with finasteride, even in a minoxidil therapy the basic things you need are consistency in application and patience in waiting for results . Unlike Propecia where the treatment is limited to taking a tablet every morning, I can confirm that applying the lotion every day in the long run involves a certain stress . But here the constancy in the treatment is really essential to avoid the problems due to the suspension.
Furthermore, you absolutely must not get anxious when, after the first 3-4 weeks, the period of the induced fall arrives as explained above and for the following 2 months you can even get worse.
Wait at least 6 months to evaluate the first results , then within a couple of years the maximum peak will be reached which will be maintained by continuing the treatment. For evaluations it is always good to rely on a competent doctor who will be able to monitor your progress in a scientific way.
Can it be used to thicken the Beard?
Although it is still an experimental approach and supported by very few scientific studies , it seems that in certain circumstances the use of this active ingredient may prove to be valid in order to make even beard hair thicker.
To learn more, I refer you to the article dedicated to minoxidil for the beard
Contraindications are substantially related to the characteristics of the antihypertensive drug or to the composition of the topical preparation:
- hypersensitivity to the components: in general an intolerance or real allergy to the active ingredient is rare, while it is much more frequent to encounter problems of irritation due to the propylene glycol present in industrial preparations in order to convey the active ingredient in the first layers under the skin. If hypersensitivity to glycol is found, it is advisable to suspend the treatment and resort to galenic preparations that use other carriers (transcutol)
- subject to heart disease, hypertension, arrhythmias: since minoxidil is able to cause lowering of blood pressure , its use in subjects with these problems must be evaluated by a doctor.
- pregnancy and breastfeeding: given that the 2% formulation can also be prescribed to women for other types of alopecia, it should be avoided during these periods
Minoxidil Side Effects
Generally, the use in topical form at the officially approved percentages for androgenetic alopecia does not cause systemic absorption problems and therefore side effects in this sense are extremely rare and could be traced back to the occurrence of what is listed in the contraindications section.
It is advisable to suspend the treatment when:
- chest pain, irregular heartbeat, weakness or dizziness
- sudden water retention or swelling in the hands and / or feet
- redness and irritation of the scalp with the appearance of dermatitis.
- unwanted hair growth if you are not precise with the application
Minoxidil Recipe: Need or Not?
Until the year 2015 in Italy Minoxidil was considered cosmetic for concentration percentages lower than 5% and as such did not require a medical prescription, while for the 5% formulation which as seen above proved to be more effective for androgenetic alopecia, it was the prescription issued by the doctor is required.
To date, however, even industrial preparations of 5% minoxidil, despite being considered Class C drugs (fully paid by the citizen), are without prescription .
On the other hand, the obligation to prescribe on a white prescription remains if it is necessary to obtain a galenic preparation from the pharmacy with different dosages or excipients.
To the initial question of this article, or if minoxidil works in the treatment of androgenetic baldness, we can certainly answer that after finasteride it is the most important weapon currently available to us and undoubtedly gives a boost in the growth of miniaturized hair recovered from the anti-dht action. of propecia and the like, allowing you to attack baldness on several fronts .
Obviously, I always recommend that you follow the instructions of a doctor who specializes in trichology who will be able to better assess your case and prescribe the right therapies.
Do-it-yourself should therefore be avoided .
If you have any doubts to clarify or want to tell your experience with the use of Minoxidil, feel free to leave a comment in the space provided at the bottom of the page