Minoxidil (Rogaine)

Minoxidil for Hair Loss: Effective Treatment for Hair Regrowth

Minoxidil is a widely recognized and FDA approved hair loss treatment for those experiencing thinning hair or balding. Initially developed as a medication for high blood pressure, it was found to have the benefit of stimulating hair regrowth. It works by increasing blood flow to the hair follicles and extending the anagen phase of the hair growth cycle. It is a topical treatment and is available in liquid and foam formulas. Whether you’re experiencing early signs of hair loss, or more advanced thinning, minoxidil is a reliable, non-invasive treatment option.

What is Minoxidil

Minoxidil is a topical medication that is FDA approved to treat hair loss. It’s available over the counter without a prescription and comes in a liquid or foam to apply directly to the scalp. It’s believed to work by increasing blood flow to the hair follicles, promoting new hair growth. It can also help to extend the growth phase of the hair cycle and increase the hair follicle size. Minoxidil can be an effective treatment for hair loss, but the results may vary.

History of Minoxidil

Minoxidil was originally synthesized in the 1960’s as an oral medication to treat high blood pressure, a condition known as hypertension. It was first marketed under the brand name Loniten as an antihypertensive drug. It was primarily used to help lower blood pressure in individuals with hypertension.

In the 1970’s, during the clinical trials and testing of minoxidil as an antihypertensive medication, it was noticed that hair growth was an unexpected side effect. Researchers found that the trials showed an increase in hair growth and follicle size in the participants. The results of the trials showed that minoxidil not only lowered blood pressure, but also showed significant improvement in hair growth. This discovery prompted additional studies into the potential of minoxidil as a hair loss treatment.

The pivotal moment for minoxidil came in 1988 when it was approved by the U.S. Food and Drug Administration (FDA) as a treatment for hair loss. This made minoxidil the first FDA approved treatment for male pattern baldness. After receiving FDA approval, topical minoxidil was sold under the brand name Rogaine. Despite not fully understanding how minoxidil worked, researchers believed that it improved the blood flow to the hair follicles. The improved blood flow helped prolong the growth phase cycle and increased the hair follicle size.

As minoxidil’s popularity increased for treating hair loss, it transitioned from prescription only to being available over the counter. This opened the accessibility of the drug to a larger audience. There are now different forms of minoxidil, including topical solutions and foam, being sold under various brand names.

How Minoxidil Treats Hair Loss

Although the exact process by which minoxidil treats hair loss is not fully understood, it’s believed to increase blood flow to the follicles. This results in new hair growth, extended anagen phase, and thicker hair follicles.

Increases Blood Flow to Hair Follicles

Minoxidil works by widening blood vessels in the scalp, which improves blood circulation to hair follicles. This increased blood flow delivers more oxygen, nutrients, and essential growth factors to the follicles, encouraging them to become more active. Healthier, well-nourished hair follicles are more likely to enter the growth phase, leading to thicker and stronger hair growth.

Prolongs the Anagen (Growth) Phase

Hair growth occurs in four main phases: anagen (growth phase), catagen (transitional phase), telogen (resting phase), and exogen (shedding phase). Minoxidil has been shown to prolong the anagen phase, which is when hair actively grows. By extending this phase, minoxidil gives the hair a longer life, leading to fuller and thicker hair.

Stimulates Dormant Hair Follicles

Many individuals experiencing hair loss have dormant or miniaturized hair follicles that no longer produce visible hair. Minoxidil helps to revitalize these dormant follicles, stimulating them to regrow hair again. This regrowth will initially be fine, thin hair, with a peach fuzz like appearance. Over time, this hair can become thicker, darker, and more noticeable.

Reduces Hair Shedding

Minoxidil helps to reduce shedding by preventing follicles form entering the exogen phase prematurely. Hair loss typically accelerates the exogen phase, and by reducing premature shedding, minoxidil slows the progression of hair loss.

Encourages New Hair Growth

New growth can be stimulated by minoxidil in areas where hair has already been lost. This can be especially beneficial to treat hair loss at the initial symptoms, as it promotes new hair growth.

Biochemical Mechanism of Minoxidil

Minoxidil works to promote hair regrowth and slow the progression of male pattern baldness through several mechanisms.

Vasodilation and Potassium Channels

Minoxidil functions as an adenosine triphosphate (ATP)-sensitive potassium channel opener. When it interacts with these channels, it causes hyperpolarization of the cell membranes in the blood vessels. This process leads to vasodilation, or the widening of blood vessels. As a result, blood flow to the scalp improves, allowing a better supply of oxygen, essential nutrients, and growth factors to the hair follicles. This enhanced circulation helps nourish the follicles, supporting their health and stimulating hair regrowth.

Prostaglandin E2 Production

Minoxidil has been shown to increase the production of Prostaglandin E2 (PGE2) in hair follicles. PGE2 plays a significant role in promoting hair growth by stimulating hair follicle activity. It encourages the transition of hair follicles into the anagen (growth) phase. It may also aid in the proliferation of hair follicle cells, contributing to healthier, thicker hair. The increase in PGE2 levels aids the overall hair regrowth process.

Anagen Phase Augmentation

One of the most important actions of minoxidil is its ability to prolong the anagen (growth) phase of the hair cycle. Normally, hair follicles will cycle through the anagen, catagen, telogen, and exogen phases. By extending the anagen phase, it allows hair follicles to remain in the growth stage for a longer period. This not only results in longer hair, but also increases the hair follicle size.

Dermal Papilla Function

Minoxidil stimulates the dermal papilla cells located at the base of hair follicles. These cells are crucial for regulating hair growth as they control the signals that trigger the hair growth cycle. By enhancing the dermal papilla cell activity, it boosts the signaling that stimulates hair follicle regrowth. This increased cell activity helps support regrowth, especially in thinning or balding areas.

Empirical Evidence

Numerous minoxidil trials have been conducted to secure its FDA approval and validate its efficacy.

The Multicenter Study of Minoxidil (1980)

STUDY OVERVIEW
This was one of the earliest and most comprehensive studies of minoxidil’s effects on hair loss. It involved multiple centers and included a large sample of participants with androgenetic alopecia (male and female pattern baldness). This study helped establish minoxidil as an effective treatment for hair loss.
FINDINGS
The study found that minoxidil led to significant hair regrowth for the majority of users, although results varied based on the severity and extent of hair loss. The results were most noticeable in the vertex (top) of the scalp. These findings led to the FDA approval of minoxidil as a topical solution for hair loss.

The 5% vs. 2% Minoxidil Study (1998)

STUDY OVERVIEW
This clinical trial compared the efficacy of 2% and 5% minoxidil solutions in treating androgenetic alopecia in men. This study was crucial in determining the optimal minoxidil concentration for hair regrowth.
FINDINGS
The study showed that the 5% minoxidil solution was significantly more effective than the 2% solution. Participants using the 5% formulation experienced more hair growth and a higher rate of improvement in hair density. This confirmed that higher concentrations of minoxidil could produce better results in promoting hair regrowth. As a result, this led to the use of 5% minoxidil as the standard concentration for treating male pattern baldness.

Minoxidil in Female Pattern Hair Loss (2004)

STUDY OVERVIEW
This study focused on the use of minoxidil in women suffering from female pattern hair loss. The trial aimed to evaluate the safety and effectiveness of 2% and 5% topical minoxidil solutions for women.
FINDINGS
The study demonstrated that both 2% and 5% minoxidil solutions were effective in promoting hair regrowth in women. The 5% solution showed more promising results in terms of hair thickness and density. The findings of this study helped solidify minoxidil as the only FDA-approved treatment for female pattern hair loss.

Minoxidil and Hair Growth in Alopecia Areata (2013)

STUDY OVERVIEW
This study examined the use of minoxidil in patients with alopecia areata, an autoimmune disorder that causes patchy hair loss. The aim was to assess whether minoxidil could help stimulate hair regrowth with this specific type of hair loss.
FINDINGS
The results were mixed, but some participants showed positive responses, with improved hair growth in affected areas after using minoxidil. The study showed that while minoxidil may not be as effective for alopecia aerate as it is for androgenetic alopecia, it still showed regrowth in some patients. This trial contributed to understanding the broader applications of minoxidil beyond androgenetic alopecia.

Safety and Efficacy of Minoxidil Foam (2007)

STUDY OVERVIEW
This study focused assessing the use of foam as a delivery system, compared to the liquid solution.
FINDINGS
The study concluded that minoxidil foam was equally effective as the liquid form in promoting hair regrowth. The foam also had the added benefit of being less messy and easier to apply. It was found to be well-tolerated, with fewer issues related to skin irritation compared to the liquid form. These results led to the popularity of minoxidil foam as a more convenient option for treating hair loss.

Long-Term Efficacy of Minoxidil (2005)

STUDY OVERVIEW
This trial assessed the long-term effectiveness of minoxidil for maintaining hair regrowth over extended periods of use. It went beyond the 6-month period recommended for evaluating results.
FINDINGS
The study found that while the majority of users experienced continued hair regrowth or stabilization of hair loss with long-term use of minoxidil, results varied. Some participants maintained or improved hair thickness over a long period, while others experienced a plateau in results. This highlighted the importance of ongoing treatment and monitoring to maintain the benefits of minoxidil.

Results

The results of using minoxidil to treat hair loss can vary between individuals. It’s essential to ensure that realistic expectations are set when using minoxidil to treat hair loss.

Hair Regrowth

One of the most significant results of using minoxidil is hair regrowth. The treatment stimulates hair follicles that are dormant or shrinking, encouraging them to begin growing hair again. This is particularly effective in the early stages of hair loss, when hair follicles are still active but not producing visible hair. It helps revitalize these follicles, leading to the growth of fine, soft hairs initially. These hairs will eventually become thicker and darker with continued use.

Slower Hair Loss

Minoxidil works by prolonging the anagen (growth) phase of the hair cycle. This prevents hair from prematurely entering the resting (telogen) phase and eventually the exogen (shedding) phase. By stabilizing the hair cycle, it can significantly slow the rate of hair loss. This helps to maintain existing hair, while also encouraging new hair growth.

Improved Scalp Coverage

Minoxidil can help improve overall scalp coverage, especially in areas of thinning or early baldness. It encourages the growth of new hair in these regions, helping to fill in areas that were previously balding. Studies have shown that the results are typically better in the crown or vertex of the scalp, which is most responsive to minoxidil. The improvement in coverage can help reduce the visible effects of hair loss.

Gradual Results

The results of using minoxidil are not immediate. Most users begin to notice some improvement after about 2 to 4 months of consistent use. The most noticeable changes usually appear after 6 months or a year of use. During initial use, hair shedding may temporarily increase before new hair growth begins. This initial shed can cause some discouragement; however, continued use typically leads to positive results over time.

Shedding

A shedding phase may be experienced during the first few weeks or months of use. This is generally viewed as an indication that the hair is responding positively to the treatment. This happens as the thin, weak hairs are being pushed out by the new, stronger hairs.

Minoxidil Shedding

Minoxidil shedding is usually a temporary phase that may be experienced after starting treatment. This can be alarming as it involves noticeable hair loss within the first few weeks or months of treatment. This is typically a good sign that your hair’s natural cycle is responding positively to the treatment. Understanding why shedding occurs can help manage expectations and reduce the associated anxiety.

When minoxidil is applied, it stimulates the hair follicles by extending the anagen phase and shorting the telogen and exogen phases. During the initial stages, the hair follicles that were previously in the resting phase are pushed into a new growth cycle. As a result, the old, weak hairs will fall out, making room for healthier, thicker hairs. This shedding is temporary at the start of treatment and generally subsides within 2 to 8 weeks. With consistent usage of minoxidil, improved density and growth is often noticed within 3 to 6 months.

It’s important to remain patient during the shedding phase, as discontinuing use too early can prevent new hair growth from fully developing. The shedding phase is not experienced by everyone, and the extent of shedding can vary depending on individual factors. If the shedding continues beyond 8 weeks, or becomes severe, it may be best to consult with a healthcare professional. This can help rule out if there are other underlying conditions and ensure that minoxidil is the right treatment.

Pros and Cons of Minoxidil

Pros	Cons
FDA-Approved Treatment Minoxidil is an FDA-approved treatment for androgenetic alopecia, ensuring it meets rigorous safety and efficacy standards. Its approval makes it a trusted option for addressing hair loss in both men and women.	Potential Side Effects Some users experience mild side effects, such as scalp irritation, redness, or flaking, due to the solution or its alcohol content. While these side effects are typically minor, they can make Minoxidil unsuitable for individuals with sensitive skin.
Promotes Hair Regrowth Minoxidil stimulates dormant hair follicles and enhances blood flow to the scalp, encouraging new hair growth. Many users notice thicker hair and improved density in thinning areas after consistent use, particularly in the crown region.	Requires Continuous Use The effects of Minoxidil are not permanent. Hair regrowth or retention diminishes if the treatment is stopped, meaning users must commit to ongoing daily application to maintain results.
Slows Hair Loss Progression By prolonging the growth phase of the hair cycle, Minoxidil helps stabilize hair loss. This makes it effective in preserving existing hair, even if complete regrowth isn’t achieved.	Initial Shedding Phase During the first few weeks of use, some users may experience increased hair shedding. This temporary shedding occurs as weaker hairs are replaced by stronger ones, but it can be discouraging for new users.
Non-Invasive and Easy to Use As a topical treatment, Minoxidil avoids the need for oral medications or surgical interventions. It is applied directly to the scalp, making it a straightforward addition to daily routines.	Delayed Results Minoxidil takes time to work, with noticeable improvements often appearing after 3–6 months of consistent use. This delayed response requires patience and commitment, which may deter some individuals.
Widely Accessible and Affordable Minoxidil is available over the counter and is generally more affordable than advanced treatments like hair transplants or PRP therapy. Its cost-effectiveness and accessibility make it a popular choice for individuals seeking hair loss solutions.	Limited Effectiveness in Severe Hair Loss Minoxidil works best in cases of mild to moderate hair loss and is less effective for advanced balding or conditions like alopecia universalis. It relies on the presence of active hair follicles, which may be absent in severe cases.

Frequently Asked Questions (FAQ)

How does minoxidil work?

Minoxidil works by stimulating hair follicles and improving blood flow to the scalp. This helps to promote new hair growth and slow down hair loss. Although the exact mechanisms are not fully understood, it is believed to prolong the anagen phase of the hair cycle. Minoxidil is a vasodilator, meaning it widens blood vessels, which increases the supply of oxygen, nutrients, and hormones to hair follicles. This enhanced nourishment supports healthier hair growth and helps revive follicles that have begun to shrink. It is most effective when used consistently over time and on areas where hair is thinning rather than completely bald.

How long does it take to see results?

It typically takes 3 to 6 months of consistent use to show visible results with minoxidil. Some users may notice early signs of improvement, like reduced shedding, within the first few weeks. During the initial stages, it’s common to experience increased shedding as older, weaker hairs make way for new hairs. This is a normal part of the process, and often a positive indicator that the treatment is working. For best results, apply minoxidil twice daily, or as directed, and maintain long term use. Full results can take up to a year to become visible.

Are there any side effects?

Minoxidil is generally well tolerated, but as with any medication, it can cause side effects in some users. The most common side effects include scalp irritation, dryness, redness, or itchiness on the scalp. Some may experience an initial increase in hair shedding during the first few weeks of use. This is generally temporary and a positive sign that the treatment is working. In some rare cases, users may notice unwanted facial or body hair growth due to the accidental spread of the minoxidil. More sever side effects, such as dizziness, chest pain, or swelling are extremely rare but require medical attention. To minimize the risk of side effects, follow the recommended dosage and application instructions.

What areas of the scalp does minoxidil work best on?

A previous study on minoxidil showed that the best results were achieved on the crown or vertex of the scalp. This led to the incorrect belief that it will not work on areas where the temple has receded. Minoxidil will work anywhere there is miniaturized hair, including the frontal and temple regions of the scalp.

Do I have to use minoxidil forever?

For sustained results, it is to be used continuously. Stopping treatment can lead to the loss of any of the new growth hairs gained from minoxidil. It will also lead to hair loss resuming at its previous rate.

How to Use

Proper usage of minoxidil is crucial to maximize the results and effectiveness. As with any medication, it’s important to follow the product directions. Although the instructions may vary between brands, the general application procedure is the same.

Choose the Right Formulation

Minoxidil is available in both liquid and foam formulations. The liquid is applied with a dropper, while the foam is applied directly with your fingers. Both forms are equally effective, but the choice depends on your personal preference. Some find the foam less messy and easier to apply, while others prefer the liquid for more precision.

Clean and Dry Your Scalp

Before applying minoxidil, make sure your scalp is clean and dry. Wash your hair gently with shampoo and pat it dry with a towel. Avoid applying minoxidil to a wet or damp scalp, as this can dilute the solution and reduce its effectiveness. Applying it to a dry scalp ensures optimal absorption and better results.

Apply the Correct Dose

Use the recommended amount of minoxidil for your specific treatment, usually 1 milliliter (mL) for the liquid or half a capful for the foam. Applying more than the recommended dose won’t necessarily improve results but may increase the risk of side effects. Follow the product instructions to ensure safety and maximum efficacy.
- - Liquid: Use the dropper to measure out 1 mL and apply it directly to the affected areas of your scalp, usually the crown or hairline.
  - Foam: Dispense half a capful of foam into your palm and gently massage it into the thinning or balding areas.

Massage Minoxidil into Your Scalp

Once applied, gently massage the minoxidil into your scalp with your fingertips to ensure even coverage. This helps the solution to penetrate the scalp and reach the hair follicles. A light massage is sufficient to distribute the solution. Massaging the scalp will also stimulate blood flow, which can further help with hair regrowth.

Allow Minoxidil to Dry

After application, allow the minoxidil to dry on your scalp for about 2 to 4 hours before touching your hair or scalp. This ensures that the solution has time to be absorbed and prevents it from rubbing off on your clothes or bedding. Avoid wetting your scalp during this drying period to ensure proper absorption.

Apply Twice Daily

Minoxidil should be applied twice a day, ideally once in the morning and once in the evening. Consistent application is key for effectiveness, as it needs to be used regularly for several months for results. Missing an application can delay hair regrowth and slow down the process. Including minoxidil application into your daily routine can help to ensure it’s applied consistently.

Wash Your Hands After Application

After applying minoxidil, wash your hands thoroughly with soap and water to remove any residue. This prevents accidental transfer of the solution to areas where you don’t want it, such as your face or other body parts.

Be Patient and Consistent

Results from minoxidil take time to become noticeable. It may take 2 to 4 months before visible improvement, with full results taking up to a year. During the first few weeks or months, an increase in shedding might be experienced. This is a normal part of the process and is a positive sign that it’s working.

Monitor Your Progress

Keep track of any changes in your hair growth, and document any side effects experienced. This helps to understand the effectiveness of the treatment and ensure no adverse reactions. If you have concerns or serious side effects, consult with a healthcare professional to determine the best path forward.

Safety and Side Effects

While minoxidil is generally safe for most people, it can cause side effects in some users. These side effects are usually mild and often go away as the body adjusts to the medication.

Scalp Irritation

Scalp irritation is one of the most common side effects of minoxidil. This can include itching, redness, dryness, or flaking of the scalp. It occurs because the alcohol or propylene glycol in the liquid form can sometimes cause irritation when applied. If you experience irritation, switching to the foam version may help reduce the discomfort due to it containing fewer irritants. In most cases, irritation is temporary and will subside after a few weeks of continued use.

Excessive Shedding (Initial Hair Loss)

There may be an increase in shedding during the first few weeks of use. This can be alarming but is a normal part of the process. Minoxidil works by stimulating hair follicles to enter the anagen (growth) phase. This can cause the old, weak hairs to shed as the new, healthier hair begins to grow. The shedding phase is temporary and typically lasts for 2 to 6 weeks. After the shedding phase, the new hair typically becomes visible.

Unwanted Facial Hair Growth

Minoxidil can sometimes cause hair growth in areas where it is not intended, especially on the forehead or face. This can happen if the solution accidentally spreads to these areas during application. To avoid unwanted contact, wash your hands thoroughly after applying minoxidil, and be careful not to let the solution drip on unwanted areas.

Dizziness or Lightheadedness

In some cases, users may experience dizziness or lightheadedness, especially when standing up quickly. This is assumed to be due to minoxidil’s vasodilatory effects, which can sometimes lead to a drop in blood pressure. If you experience this, avoid standing up quickly and stay hydrated. If the symptoms persist, consult with your healthcare provider to assess if minoxidil is suitable for you.

Chest Pain or Palpitations

Although rare, some users may experience chest pain or palpitations (an irregular or fast heartbeat). These symptoms can occur because of minoxidil’s effect on blood vessels and circulation. If you experience chest pain, rapid heartbeats, or any other unusual heart symptoms, consult with your healthcare provider. These symptoms could indicate a more serious side effect, and your doctor will be able to provide guidance.

Swelling of the Hands or Feet (Edema)

Swelling of the hands, feet, or ankles can occur due to fluid retention, a known side effect of minoxidil. This happens because minoxidil affects blood vessels, and in some cases, the changes can cause fluid buildup in the lower extremities. If you notice swelling, particularly if it is persistent or accompanied by pain, consult with your doctor. This could be an indication that the dosage needs to be adjusted or discontinued.

Contact Dermatitis

Contact dermatitis is a type of skin rash or allergic reaction. It can occur in some people when they contact minoxidil. Symptoms of this can include redness, swelling, and the formation of blisters. This is typically more common in the liquid formula due to the alcohol content. If contact dermatitis develops, it’s important to stop using minoxidil and consult with a healthcare provider. They can assist with determining if an alternative treatment is necessary.

Conclusion

Minoxidil is an FDA approved, reliable, and effective treatment for those dealing with hair loss. It’s ability to stimulate hair growth, prolong the anagen phase, and improve scalp health has made it a popular choice for those looking to combat hair loss. While results can vary, many users see noticeable improvement in hair density and growth after consistent use. Minoxidil is backed by years of research and has proven to be a safe and accessible treatment option. If you’re struggling with hair loss, minoxidil provides you with the option to regain a fuller, healthier head of hair.

References

“Multicenter Study of Minoxidil for Male and Female Pattern Hair Loss,” Journal of the American Academy of Dermatology, 1980s.
“Comparison of 5% and 2% Minoxidil in the Treatment of Male Pattern Baldness,” Journal of the American Academy of Dermatology, 1998.
“Efficacy and Safety of Minoxidil in the Treatment of Female Pattern Hair Loss,” Dermatology, 2004.
“Minoxidil for the Treatment of Alopecia Areata,” International Journal of Dermatology, 2013.
“Efficacy and Safety of Minoxidil Foam for Hair Regrowth in Men and Women,” Journal of the American Academy of Dermatology, 2007.
“Long-Term Efficacy of Minoxidil for Male and Female Pattern Baldness,” Archives of Dermatology, 2005.

Note: Always seek professional medical advice before starting any treatment.