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Article: How to Reduce the Side Effects of Minoxidil

minoxidil 5 side effects

How to Reduce the Side Effects of Minoxidil

Many people start on topical Minoxidil only to find out six months later that it doesn't work for them. So they are waking up at 2am searching on reddit how to regrow their hair and why they have not been successful despite dedicating six months and hundreds of dollars - yet they are afraid to tell their doctor it didn't work.

We take a deep dive into topical Minoxidil for the treatment of hair loss for men and address:

  • What are the side effects of oral minoxidil and topical minoxidil,
  • Why Minoxidil doesn't work for many people and 
  • How to minimise the side effects for topical Minoxidil


The History of Minoxidil

Minoxidil was originally approved by the FDA as an anti-hypertensive. Its discovery for the treatment of hair loss was accidental due to reported unwanted hair growth.

How does Minoxidil work?

The exact mechanism of Minoxidil for the treatment of hair loss is still uncertain. It is thought that minoxidil works by stimulating blood flow and improving circulation by opening potassium ion channels.

What are the side effects of Oral Minoxidil?

Some of the reported adverse effects from oral Minoxidil include:

• Mood changes and reduce zest for life - Minoxidil is found to increase the hormone prolactin. Prolactin has the opposite effect of dopamine.

• Gynacomastia - Although rare, Gynacomastia (man boobs) can also be associated with oral Minoxidil if serum levels are high enough. Gynacomastia is a result of high levels of Prolactin. In very rare cases, milk let down can occur (now this is serious stuff and you need a second opinion if this happens for a guy).

• Dizziness, hypotension and ankle swelling

• Irritation and dryness of the scalp from topical formulation

Please note, the side effects for oral minoxidil listed above appear serious but they are extremely rare.

minoxidil 5

What are the side effects for topical Minoxidil?

Localised irritation and scalp dryness account for up to 80% of cases. This is attributed by the high content of alcohol and propylene glycol required to solubilise and deliver Minoxidil into the scalp tissue.  

Contact dermatitis can also occur with prolong exposure to alcohol and high propylene glycol.


How to minimise the side effects of topical Minoxidil and improve it's effectiveness

  • Removing alcohol from the formulation to reduce itching and irritation. Opt for a non-alcoholic formula and ingredients that work in synergy with Minoxidil.
  • Combine Minoxidil and micro-needling once a week. Ensure you are using medical grade needles that are approximately 1mm-2.25mm in length. This helps improve the penetration of Minoxidil. Micro-needling has also shown to hair density. 
  • Combining Minoxidil and Finasteride. Finasteride is a potent prescription drug that inhibits 5-alpha reductase, the enzyme that converts testosterone to DHT. Finasteride and Minoxidil topical solution have shown be equally as effective as oral dosing with significantly less systemic adverse effects.
  • Choosing the 5% strength over the 2% strength.



    Author: Dan Atkinson B Pharm



    1. American Academy of Dermatology. “What is Male Pattern Hair Loss and can it be Treated?” News release Updated December 13, 2022. Last accessed June 5, 2023.

    2. Olsen, E et al. (2002). "A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men." Journal of the American Academy of Dermatology, 47(3), 377 385.

    3. American Academy of Dermatology. “What is Male Pattern Hair Loss and can it be Treated?” News release Updated December 13, 2022.

    4.Udare, S et al (2023) "Low-Alcohol and Alcohol-Free Minoxidil Formulation for the Management of Androgenic Alopecia." International Journal of Trichology, Jan-Feb 15(1): 13–17.

    5. Gupta, A et al (2022). "Minoxidil: A Comprehensive Review." Journal of Dermatological Treatments. 2022 Jun;33(4):1896-1906.

    6. Barbareschi, M (2018). "The Use of Minoxidil in Males and Females for Androgenic Alopecia, a Story of more than 30 years." Italian Journal of Dermatology and Venereology.2018 Feb;153(1):102-106.


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