How to Reduce the Side Effects of Topical Minoxidil

Many people start on topical Minoxidil only to find out six months later that it doesn't work for them. 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 to see your doctor asap).

• Dizziness, hypotension and ankle swelling

• Irritation and dryness of the scalp from topical formulation

Please note, the side effects for oral minoxidil listed above are serious but they are also extremely rare. In practice, dizziness and headaches are more commonly reported.

 

What are the side effects of 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 reduce the side effects of topical Minoxidil 

There are several options and each of these options can be provided by a compounding pharmacy:

Removing alcohol from the formulation to reduce itching and irritation - these also known as non-alcoholic formulations

Reduce the amount of alcohol used - these are known as hydroalcoholic formulations 

Removing alcohol and PG altogether 

 

The last option would be to reduce the concentration of minoxidil from 5% to 2% but most people do not respond favourably to the 2% strength. 

 

 Tips for making Minoxidil more effective

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 improve hair density. 

Combining Minoxidil and Finasteride. Finasteride is a potent prescription drug that inhibits 5-alpha reductase, the enzyme that converts testosterone to DHT. Topical Finasteride have shown be equally as effective as oral dosing with significantly less systemic adverse effects.

 

 

 

 

Author: Dan Atkinson B Pharm

 

References:

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.