Rogaine, Regaine, Growell. 

Suppose these brands of anti-hair loss remedies ring a bell, then you might be familiar with their key active ingredient – minoxidil.

Minoxidil is an old drug, FDA-approved for hair loss since the 1980s. (The only other FDA-approved drug for hair growth is finasteride, also known as Propecia.)

Traditionally, it has been available in the topical form and, more recently, as a foam. And now, the low-dose oral version is gaining traction for hair growth.
 

How Does Minoxidil Work?

Minoxidil was initially used to treat hypertension in the 1970s – patients on oral minoxidil unexpectedly had good hair growth, leading to the development of topical minoxidil. Subsequently, the drug was approved for androgenetic alopecia (the most common form of balding due to ageing and hormones) in both men and women.

Minoxidil boosts the scalp’s blood flow, which means more nutrients and oxygen get to the hair follicles. It also releases growth factors around the hair follicles to promote the growth phase of hairs.

The nett effect is the thickening of existing hairs + growth of new hairs, leading to improved scalp coverage (i.e., see less white of the scalp).

Is Minoxidil Really That Effective?

Minoxidil is not magic. As with most hair-loss remedies, you need consistency and patience.

Hair grows an average of 1 cm a month, so you will need 3 to 6 months of diligent use to see some results.

Generally, a higher strength of 5% minoxidil works better than 2%, and the foam version is better tolerated (less risk of redness and itch) than the solution.

Balding cannot be cured, and minoxidil is one way to control it. Treat minoxidil like an essential routine, like brushing your teeth. Use it daily, and do it long-term. A sudden disruption of minoxidil can trigger hair fall in the subsequent months.

At IYAC, we recommend minoxidil 5% foam, used once daily for ladies and twice daily for men.

A small percentage of people do not respond to topical minoxidil, even if it’s the 5% foam – their scalps lack an enzyme to convert the applied minoxidil into its active form.

Tip: Always buy topical minoxidil from a clinic or pharmacy to ensure authenticity. 

And there’s ORAL minoxidil for those who do not respond to topical minoxidil or find it challenging to fit it into their daily lifestyle. Oral minoxidil gets activated in the liver and blood, so this route supplies more useful minoxidil to the hair follicles. There has been growing momentum in prescribing low-dose minoxidil (< 5mg daily) since data regarding oral minoxidil for female pattern hair loss was presented in 2017, including a recent soar of oral minoxidil prescriptions in the United States after a 2022 New York Times article highlighted oral minoxidil for hair loss. The consensus is that low-dose oral minoxidil is inexpensive, safe and effective for many individuals.

What About Side Effects?

Side effects from minoxidil are generally limited and happen in a small percentage of people.

The foam version is better tolerated for the topicals than the solutions.

Those who use the solutions may experience scalp irritation like redness and itching, transient hair shedding (the typical response of the hair follicles preparing to enter the growth phase), and facial hair growth (due to the physical transfer).

Oral minoxidil’s main side effect is growing too much hair! About ¼ of people may experience increased facial hair, affecting sideburns and temples. This can be managed by adjusting the dose or hair removal. The other reported side effects of postural hypotension (feeling transiently faint during sit-to-stand) and swelling in the legs are rare and related to higher doses used.

Pregnant or breastfeeding women should avoid both forms of minoxidil.

Conclusions

• Good old minoxidil can grow new hair.
• Consider the 5% foam – buy from reputable clinics and pharmacies.
• Minoxidil, though effective, is not magic. You need to be consistent and use it habitually.
• Genetic variations do affect the efficacy of topical minoxidil. If the topical version is not for you, consider the oral version after consulting your doctor.
• Get your scalp checked at the doctor’s if you are concerned about hair thinning or shedding. The answer may not be just minoxidil.

At IYAC, our doctors provide a medical diagnosis with our AI-powered trichoscopy analysis and have curated a broad range of scientifically-backed hair treatments and products to improve your scalp health and hair quality. 

If you are experiencing any hair woes, ask us for help and experience the IYAC difference. 

References:

1. Sinclair RD. Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol. 2018 Jan;57(1):104-109. doi: 10.1111/ijd.13838. Epub 2017 Dec 12. PMID: 29231239.
2. Goodwin Cartwright BM, Wang M, Rodriguez P, Stewart S, Worsham CM, Stucky N, Jena AB. Changes in Minoxidil Prescribing After Media Attention About Oral Use for Hair Loss. JAMA Netw Open. 2023 May 1;6(5):e2312477. doi: 10.1001/jamanetworkopen.2023.12477. PMID: 37159202; PMCID: PMC10170338.
3. Heymann WR. Coming full circle (almost): Low dose oral minoxidil for alopecia. J Am Acad Dermatol. 2021 Mar;84(3):613-614. doi: 10.1016/j.jaad.2020.12.053. Epub 2021 Jan 6. PMID: 33421481.