Minoxidil

Over 60 percent of men and 50 percent of women will experience hair loss at some point in their lives [1]. 

There are many different causes of hair loss, but aging and genetics are considered key factors. 

Losing your hair can be a major source of stress, and there are few effective treatment options available. Hair transplants are expensive, and herbal supplements and vitamins rarely work. 

But some medications can help. 

One of the most popular (and effective) hair loss medications is minoxidil — commonly sold under the brand name Rogaine. 

In this article, we’ll cover everything you need to know about minoxidil. We’ll cover how it works, how to use it safely, and where you can find the brand name and more affordable generic versions of the drug. 

What is Minoxidil?

Minoxidil is the active ingredient in Rogaine®. It’s an antihypertensive and hair-growth stimulator used to restore hair loss in both men and women. 

Despite being on the market for nearly three decades, researchers struggle to understand exactly how minoxidil actually works.

But the results speak for themselves. 

Roughly 40% of men using minoxidil experienced hair regrowth within 3 – 6 months [2]. 

While a success rate of just under half isn’t ideal, hair loss is notoriously difficult to treat. A 40% success rate for minoxidil places it higher than just about any other form of hair loss treatment on the market — including hair transplants. 

Millions of men worldwide are using Minoxidil to help regain their confidence with a full head of hair without having to undergo surgery or other invasive treatments. 

The downside? Minoxidil must be used indefinitely. Once you stop the treatment, your hair will gradually regress back to where it was prior to treatment. 

What’s the Dose of Minoxidil?

The dose of Minoxidil can vary substantially from one manufacturer to the next, so always read the label before you begin. 

In general, the dose of Minoxidil is about 1 mL of minoxidil solution, or half a capful of Minoxidil foam, applied twice per day. 

If you miss a dose of Minoxidil, take your next dose as soon as possible. This medication works best when used consistently over several weeks or months.

How Long Does it Take for Minoxidil to Work? 

Minoxidil only works in roughly 40% of men and women. Most people report improvements in their hair growth after three months. Some people report the benefits to take even longer — close to 6 months after first starting the treatment.

Be patient and persistent. Don’t give up on the medication until you’ve gone at least six months without experiencing any benefit. 

How Long Does Minoxidil Last?

Unfortunately, the changes caused by Minoxidil are not permanent. You’ll need to continue using the drug to maintain the new hair growth. 

After stopping treatment, hair loss will return within 12 to 24 weeks [4]. On very rare occasions, the hair regrowth will remain after stopping treatment. 

Why Doesn’t Minoxidil Work For Everyone?

The success rate for Minoxidil is only around 40%. The exact reasons for this are unknown, but it’s been found that people with lower activity of a specific enzyme in hair follicles called sulfotransferase experience weaker effects from the drug. This enzyme is needed to convert Minoxidil into its active form — minoxidil sulfate. 

There are a few other reasons why Minoxidil may not work.

For example, Aspirin and other salicylates inhibit the sulfotransferase enzyme. Low-dose aspirin (ASA) is a common preventative medicine prescribed to patients with underlying heart disease. Patients using ASA often report minoxidil didn’t work for them because of this interaction between the two drugs. 

What Does Minoxidil Do to Healthy Hair? 

Minoxidil is thought to improve the growth phase of healthy hair — preventing or slowing the natural loss of hair. 

Most people who use Minoxidil still have some healthy hair, which remains unaffected by the medication. 

In rare cases, Minoxidil can lead to the loss of healthy hair. The reason for this remains unknown and is very uncommon.  

How Much Does Minoxidil Cost? 

When Rogaine was first released, the manufacturer — The Upjohn Company — sold a month’s supply for around $60. In 1996 the FDA approved the drug to generic manufacturers — which dramatically increased the competition for the drug. The Upjohn Company cut the cost per bottle in half in response so they could compete with the new generic brands. 

Today, Rogaine costs around $30 for the standard topical solutions and foam. 

However, there are now several different versions of Rogaine, each with a proprietary formula of carriers, nutritional additives, and botanical extracts. The cost of these products will vary. 

The generic market for minoxidil is extensive. You can order products at costs as low as $10 for a month’s supply, up to $160 per month, depending on the brand and other ingredients. 

How to Use Minoxidil for Hair-Loss

Minoxidil comes in a few different topical forms, most commonly a foam. 

Apply the foam or other topical directly to the affected area. This can include regions of thinning hair, bald spots, eyebrows, or facial hair. 

Always follow the directions on the label — some formulas require specific steps to follow due to additional ingredients in the formula.

Here are some steps to follow when applying topical minoxidil for hair loss:

1. Make sure the area is completely dry before applying
2. Starting in the center of the target area, work your way outward, spreading the minoxidil over the entire region
3. Leave the minoxidil on the area for at least 4 hours before using any soaps or shampoos and allow the solution to dry before going to bed or wearing a hat (minoxidil can stain your clothes and sheets while wet)
4. Wash your hands immediately after the application
5. Repeat once or twice per day or as recommended by your doctor

The History of Minoxidil — The Journey From an Ulcer Medication to a Hair Regrowth Wonder Drug

Minoxidil was first invented in the 1950s by the Upjohn Company, which was later bought by Pfizer. The compound was first developed as a way to treat ulcers. 

Minoxidil didn’t offer any benefit towards ulcers but was eventually approved by the FDA for the treatment of high blood pressure in 1979. At the time, this drug was named Loniten. 

A dermatologist named Guinter Kahn was the first to notice that Loniten had a strange side effect that caused lost hair to regrow. The Upjohn Company was unaware of this effect until after losing a patent war with Khan, earning him royalties on the sale of minoxidil for hair-regrowth applications.

The Upjohn company spent nearly ten years developing a topical form of the drug for use in treating hair loss, which was approved by the FDA in 1988. 

The first name the company put forward was Regain — but the FDA deemed this name too misleading, so the company had to change the name to Rogaine.

The first iteration of the drug was a prescription-only 2% topical application for men, followed by a separate 2% solution for hair loss in women in 1991. 

Later, in 1996, the drug was removed from the prescription-only status and can now be purchased over the counter. 

That same year, the FDA approved several manufacturers to produce generic drug versions.

The 5% solution is the most common form of minoxidil today and has a nearly 40% success rate.

Rogaine is still the leading brand name version of minoxidil, but there are dozens of other trade names on the market today as well. All of these products have the same active ingredient but use different base ingredients and formulations with other active ingredients. 

Who Should Use Minoxidil?

Minoxidil is used by men and women experiencing stunted hair growth or total hair loss. The most common reason for using the drug is to stimulate hair growth on the scalp.

Some men are also using it to stimulate growth on the face and beard. 

This medication is available over the counter (no prescription needed). The FDA has only approved the drug for androgen-excess hair loss — but there are several off-label uses for the drug as well. 

FDA-Approved Applications of Minoxidil

• Androgenic alopecia
• Female-pattern hair loss

Off-Label Applications of Minoxidil

• Alopecia areata
• Beard hair growth enhancement
• Central centrifugal cicatricial alopecia
• Chemotherapy-induced alopecia
• Eyebrow enhancement
• Frontal fibrosing alopecia
• Monilethrix
• Loose anagen hair syndrome
• Telogen effluvium

Is Minoxidil Dangerous?

Minoxidil comes in two forms — a tablet designed for internal use (antihypertensive medication) and a topical version for stimulating hair growth. 

Oral minoxidil poses separate risks from the topical form. The most significant risk is to the cardiovascular system. The drug can potentially cause pericardial effusion and exacerbate angina pectoris — both serious health conditions. 

Topical versions of the drug are much safer — only 1% of the drug is absorbed into the bloodstream. 99% of topical Minoxidil remains in the skin and poses little risk to the cardiovascular system.

Side Effects of Minoxidil (Topical)

• Burning sensation in the skin
• Dandruff
• Dryness and eczema
• Increased heart rate (Tachycardia)
• Increased skin sensitivity to sunlight

In rare cases, higher doses of minoxidil are absorbed into the bloodstream, which can result in side effects such as dizziness, fatigue, headache, fast or irregular heartbeat, or weight gain. 

Side Effects of Minoxidil (Oral)

• Chest pain
• Dizziness
• Edema
• Fatigue
• Fluid buildup in the lungs
• Nausea/Vomiting
• Rapid weight gain
• Severe skin reactions
• Swelling in the hands or feet

Does Minoxidil Cause Erectile Dysfunction?

There are some reports that Minoxidil products such as Rogaine cause erectile dysfunction — but this has already been disproven. 

If you’re experiencing erectile dysfunction while taking minoxidil, it’s worth considering what other factors may be at play. 

This rumor likely came from the negative side effects of a related hair-loss drug — Finasteride. 

Finasteride (Propecia or Proscar) has been shown to cause erectile dysfunction in nearly 92 percent of men in a study published in 2011 [5]. This drug is completely unrelated to minoxidil and works through separate mechanisms. 

Minoxidil & Negative Drug Interactions

Fortunately, the risk of adverse drug interactions with minoxidil hair-loss medications is low. Topical minoxidil is barely absorbed into the bloodstream and is, therefore, unlikely to interact with other oral medications.

With that said, there are still some medications that can interfere with minoxidil:

1. Aspirin and Salicylates

Aspirin (including low-dose ASA) inhibits a key enzyme required for Rogaine and other Minoxidil formulas to work. Taking Aspirin may deactivate the Rogaine and render it useless. 

2. Retinoids & Other Photosensitizing Compounds

One of the most common side effects of minoxidil is an increased sensitivity to UV light. People using Rogaine often experience more frequent and severe sunburns. 

Combining minoxidil with other photosensitizing drugs like retinoids (used for acne treatment), certain antibiotics (such as Bactrim), tricyclic antidepressants, or antihistamines (such as Benadryl and Dramamine) may further increase the rate and severity of sunburns. 

Who Should Avoid Using Minoxidil?

Topical minoxidil poses little risk to the user — however, there are a few people that should consult a medical professional before using minoxidil to avoid negative side effects. 

1. Patients with diagnosed heart disease
2. Patients taking high-blood pressure medications
3. People with skin conditions or frequent sunburns

How Does Minoxidil Work?

Despite being on the market for several decades now, and dozens of high-level research papers published that explore the effects of the drug — little is known about how minoxidil actually works. 

Here’s what we do know:

Minoxidil isn’t directly responsible for promoting hair growth. Once absorbed, the drug is converted into a compound called minoxidil sulfate in the hair follicles. 

In order for this conversion to take place, an enzyme known as sulfotransferase is needed to catalyze the reaction. Minoxidil sulfate is the culprit believed to stimulate the production of hair follicles in the skin. 

The concentration of this enzyme varies significantly from one person to another — which is thought to be the primary reason why minoxidil doesn’t work for everybody. Patients with higher enzyme activity respond better to minoxidil than those with lower enzyme activity.

Minoxidil works as a potent arteriolar vasodilator — which means it causes the tiny blood vessels in the surface of the skin to dilate and allow more blood to flow through them. It’s believed that this effect can stimulate hair growth by improving blood flow to the hair follicles. 

The drug has also been shown to play a vital role in the early stages of cell division [3]. This is important because cell division is a critical element in the growth of hair follicles.

Minoxidil & The Hair Growth Cycle

Human hair is produced in cycles. There are four stages of hair growth, starting from the growing phase to the shedding phase over a lifecycle lasting from 2 to 7 years. 

Minoxidil is thought to work by altering the growth cycle of our hair to optimize and promote growth periods over resting or shedding stages. 

Here, we’ll cover the four stages of hair growth and how Minoxidil impacts each stage of hair growth. 

A) Anagen (Growing Phase)

The growth phase of a hair follicle lasts 2 to 7 years. This is the phase that determines how long our hair can grow. People with a longer anagen phase grow longer hair if left uncut than those with a shorter anagen phase.  

The drug has been shown to promote continual hair growth during this phase by stimulating a compound called prostaglandin E2 [7]. 

B) Catagen (Transition) Phase

During the catagen phase, the follicle shrinks and detaches. The hair is no longer growing but remains in the skin. This period lasts about ten days. 

C) Telogen (Resting) Phase

For about three months, the hair remains in the skin but is no longer growing. Below the old hair begins the growth of new hair. 

Minoxidil shortens the telogen phase in rats to about one day, instead of twenty, and stimulates the production of anagen bulbs underneath old hairs [6].

D) Exogen (Shedding) Phase

During the exogen phase, the new hair begins to push out the old hair, causing it to shed. On average, we lose about 50 to 150 hairs per day. This is completely natural and part of the lifecycle of a hair follicle. 

From here, the process repeats itself. 

Minoxitine Alternatives

The hair regrowth industry is massive. There are hundreds of different products on the market made from minoxidil and other compounds. 

Minoxidil itself is sold under dozens of different brand names, including: 

Other hair regrowth compounds are also available: 

1. Diazoxide (Proglycem)
2. Finasteride (Proscar, and Propecia)
3. Dutasteride (Avodart)

Where to Buy Minoxidil in 2020

Minoxidil is listed as a non-prescription drug in most countries around the world. You can buy topical minoxidil products at your local drugstore or online on marketplaces like Amazon. 

The most common form of minoxidil in both Europe and North America is Rogaine. This was the original brand name topical version of the drug for hair loss and remains the most well-respected brand today. 

There are dozens, if not hundreds of other manufacturers selling their own version of minoxidil online too. Each one with its own proprietary formula. You can also buy minoxidil step treatments that are designed to be used at different times of the day.

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References

1. Ors, S. (2017). Hair Transplantation in Migraine Headache Patients. Plastic and Reconstructive Surgery Global Open, 5(9).
2. Goren, A., Shapiro, J., Roberts, J., McCoy, J., Desai, N., Zarrab, Z., … & Lotti, T. (2015). Clinical utility and validity of minoxidil response testing in androgenetic alopecia. Dermatologic therapy, 28(1), 13-16.
3. Malhi, H., Irani, A. N., Rajvanshi, P., Suadicani, S. O., Spray, D. C., McDonald, T. V., & Gupta, S. (2000). KATP Channels Regulate Mitogenically Induced Proliferation in Primary Rat Hepatocytes and Human Liver Cell Lines Implications for Liver Growth Control and Potential Therapeutic Targeting. Journal of Biological Chemistry, 275(34), 26050-26057.
4. Rossi, A., Cantisani, C., Melis, L., Iorio, A., Scali, E., & Calvieri, S. (2012). Minoxidil use in dermatology, side effects and recent patents. Recent patents on inflammation & allergy drug discovery, 6(2), 130-136.
5. Irwig, M. S., & Kolukula, S. (2011). Persistent sexual side effects of finasteride for male pattern hair loss. The journal of sexual medicine, 8(6), 1747-1753.
6. Suchonwanit, P., Thammarucha, S., & Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy, 13, 2777.
7. Suchonwanit, P., Thammarucha, S., & Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy, 13, 2777.