What Is Minoxidil and How Does It Work?

Highlights 

• Minoxidil is the only FDA-approved topical hair loss solution.
• Doctors still don’t understand exactly how minoxidil stimulates hair regrowth.
• Minoxidil can be very effective, but it only works in 40% of users.
• We now have a test that can tell hair loss sufferers whether they will respond to minoxidil.
• People who don’t respond to minoxidil may benefit from alternative hair loss medications like Propecia and its generic, finasteride.
• For the best hair regrowth results, use FDA-approved medications only. 

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What is minoxidil? Minoxidil is a hair loss drug that works for female and male pattern hair loss. It is FDA approved and may be your best bet if you’re looking for a topical solution to stop the thinning of your mane. Interestingly, we still don’t understand how and why minoxidil achieves its hair-growing effects. 

What is Minoxidil?

Minoxidil, also called 2,4-Diamino-6-piperidinopyrimidine 3-oxide, is a potassium channel opener. It causes blood vessels to dilate, increasing blood flow to the hair follicles. 

Since more blood can deliver more nutrients to the follicles, this may be its mechanism of action. Doctors suspect, however, that other biochemical processes may cause minoxidil’s hair-growing effects. 

Here’s what we know about minoxidil’s effects on the body and hair. 

• It is a vasodilator. Doctors also use it for the treatment of high blood pressure.
• It works for both men and women. Minoxidil may not act on the hormonal level as it works equally well in men and women.
• It only treats the crown area. The drug cannot restore a receding hairline.
• Minoxidil is old. Invented in the 1950s, minoxidil failed as an ulcer drug but proved to positively impact blood pressure and hair growth.
• It works best against recent hair loss. The best responders to topical minoxidil are people under 40 with recent hair loss. 

Because it was originally a blood pressure medication, minoxidil used to only be available as an oral drug. Now, it’s the only FDA-approved topical treatment for hair loss. It’s sold under the brand names Rogaine, Keeps, Loniten, Regaine, and others. 

How Does Minoxidil Work?

Unlike other FDA-approved drugs like finasteride, minoxidil does not affect the hormones. It is not a DHT blocker. Its ability to dilate the blood vessels may be its only mechanism of action, but researchers aren’t sure yet. 

Based on our current understanding, here’s how doctors think minoxidil may work to promote hair growth. 

By opening the potassium channels and widening the blood vessels, minoxidil helps the body deliver more oxygen, nutrients, and blood to miniaturized hair follicles. By doing so, it prompts the hairs in the telogen phase of growth to shed. That would explain the initial shedding many users report. The follicle replaces the dropped hairs with new, thicker strands in the anagen phase. 

In some users, minoxidil may cause telogen effluvium, a condition that can cause severe shedding in a short amount of time. 

The anagen phase of growth is the active growth phase, during which hair is less likely to shed. 

In addition to its vasodilating effects, minoxidil may promote hair growth through other means. 

• Anti-inflammatory effect. Minoxidil inhibits a compound that promotes inflammation. Inflammation inhibits hair growth. Thus, minoxidil removes a hurdle from the path of healthy hair growth.
• Wnt signaling. Minoxidil may stimulate the Wnt/beta-catenin signaling pathway, promoting hair growth.
• Androgen inhibition. Despite what doctors currently believe, minoxidil may interfere with the action of 5-alpha reductase, a compound responsible for the formation of DHT.
• Prostaglandin E2 stimulation. Minoxidil stimulates prostaglandin E2, which stimulates hair growth.

Once users discontinue their minoxidil treatments, hair loss returns. After they stop using the drug, patients can expect to lose all of their recently regained hair within a few months. 

Minoxidil’s Effectiveness

Does minoxidil work? Minoxidil is a complicated drug, and it’s not particularly effective. It triggers hair growth in around 40% of users. The remaining 60% of users are non-responders. 

To discover whether you are a lucky responder or not, you must complete a months-long treatment and assume all the side effects that occur. Fortunately, we now have minoxidil tests that can tell you whether the treatment is likely to work for you. 

Doctors use colorimetric assays to measure the presence and quantity of a compound in your follicles. Only people with plenty of this compound in their scalps respond to minoxidil treatment. 

How To Use Minoxidil

For alopecia, doctors recommend topical minoxidil. This type of minoxidil comes as foam or liquid you slather on your scalp twice a day. Stick to your doctor’s recommendations regarding the quantity you use. Using more minoxidil than recommended won’t accelerate hair regrowth or regrow more hair. 

Though oral minoxidil is generally used to treat high blood pressure, in small doses, it may be a more efficient hair-loss drug than the topical version. However, oral minoxidil can cause more severe side effects than topical variants. To mitigate these effects, doctors may prescribe it with loop diuretics or beta blockers. 

If you take oral minoxidil for hair loss, never exceed the prescribed dosage. Higher doses may lead to sodium or potassium retention and may cause an abnormally high resting heart rate. 

Minoxidil Contraindications

Is minoxidil safe? Most people tolerate minoxidil well, but there are some exceptions. Do not use minoxidil if you suffer from any of these conditions: 

• Chronic congestive heart failure
• Pulmonary hypertension
• Kidney disease 

Pregnant women should avoid minoxidil as well. The compound damages animal embryos, though there are no human studies to date.

Those allergic to the compound should never use it in oral or topical form. If you notice allergic symptoms after taking minoxidil, seek medical attention immediately. 

Minoxidil’s Side Effects

Users tolerate topical minoxidil better than the oral version, but even the topical solution can cause side effects.

Some of the common side effects of topical minoxidil are: 

• Irritation of the scalp
• Redness of the skin in the treated area
• Itching, including of the eye
• Increased hair growth elsewhere on the body
• Changes in hair texture
• Dry skin 

Minoxidil may even amplify hair loss in some users instead of fighting it. 

More severe — but less common — side effects of the drug include: 

• Headaches
• Lightheadedness
• Fainting
• Swelling of the face
• Chest pain
• Rapid weight gain
• Dizziness
• Heartbeat irregularities
• Low blood pressure 

Some rare side effects of topical minoxidil are: 

• Increased facial hair growth
• Acne at the site of the treatment
• Painful and inflamed hair roots 

All of minoxidil’s side effects are rare. It is an FDA-approved hair loss drug, which means that it has undergone extensive testing and safety assessments. Sticking to FDA-approved medication is your best bet when dealing with hair loss. 

Minoxidil Alternatives

Minoxidil is one of several medications that are approved by the FDA to treat hair loss. Propecia and its generic finasteride are proven to be highly effective for hair regrowth. These medications are safe choices for both men and women and even work for those who are minoxidil non-responders.

Minoxidil and topical finasteride can also be used together following effective treatment with oral finasteride, for those who want to discontinue the oral medication. 

Take advantage of our free consultation to find out if one of these hair-loss solutions is right for you. 

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